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J� DATE (MMIDDIYYYY) <br /> coir CERTIFICATE OF LIABILITY INSURANCE OP ID CM <br /> PETER -3 07/01/10 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Hillcrest Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> P.O. Box 1364 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br /> Mount Dora FL 32756 <br /> Phone: 352 -383 -8164 Fax: 352- 383 -5899 INSURERS AFFORDING COVERAGE i NAIC # <br /> INSURED INSURER A. Auto- Owners 18988 <br /> INSURER B: Owners Insurance Company 32700 <br /> Petersons Construction & <br /> Mobile Home Setup, Inc. INSURER C: Southern Owners Ins. Co. 10190 <br /> P 0 Box 108 INS S URER D: <br /> Ferndale FL 34729 <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICES. AGGREGATE LMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS, <br /> 1 LT MNSRC R I N POLICY (MMIDDIYYTYY DATE (M Y) <br /> LTR SRC TYPE OF INSURANCE POLICY NUMBER LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1000000 <br /> U At IJ I<= <br /> B X COMMERCIAL GENERAL LIABILITY 72688080 08/24/09 08/24/10/47 MI ence _ s 300000 <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10000 <br /> PERSONAL & ADV INJURY $ 1000000 <br /> X Non - Owned/Hired C GENERAL AGGREGATE s 2000000 <br /> GEL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2000000 <br /> POLICY d LOC <br /> AUTOMOBILE LABILITY <br /> COMBINED <br /> A X ANY AUTO 4101977201 08/24/09 08/24/10 aacderlq NGLELIMIT $ 500,000 <br /> ALL OWNED AUTOS <br /> BODILY INJURY <br /> SCHEDULED AUTOS (Per Perms) <br /> HIRED AUTOS <br /> BODILY INJURY <br /> NON -OWNED AUTOS (Per accident) <br /> -.- -_ ___ -_ -_ -- __ - - - - - - -_ PROPERTY DAMAGE <br /> (Per accident) $ <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> C ANY AUTO 4101977202 08/24/09 08/24/10 OTHER THAN EA ACC $ <br /> X G $100,000 AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA UABILTTY EACH OCCURRENCE $ <br /> OCCUR (. - CLAIMS MADE AGGREGATE $ <br /> $ <br /> __ -- DEDUCTIBLE $ <br /> RETENTION $ / $ <br /> WORKERS COMPENSATION NJ WC S I AI U- O (N <br /> AND EMPLOYERS' LUIBILRY X ITORY LIMBS 1 __ I ER <br /> A o ER IETO ECUBV 72 68 8 081 08/24/09 08/24/10 EL. EACH ACCIDENT $ 100,000 <br /> (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 100,000 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ 500,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS <br /> William Peterson # IH00O0354 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> CITYZEP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> City of Zephyrhills REPRESENTATIVES. <br /> 5335 8th St. AUTHORIZED REPRESENTATIVE <br /> Zephyrhills FL 33542 <br /> ACORD 25 (2009/01) CORD CORPORATION. All <br /> registered rights reserved.. <br /> The ACORD name and logo are Istered marks of ACORD <br />