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From :Shirley R. Bain FaxID: Page 2 of 2 Date:08 /10/10 10:29 AM Page:2 of 2 1 CERTIFICATE OF LIABILITY INSURANCE OP ID T9 DATE(MMIDD/YYYV) 08/10/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Neu of such endorsement(s). {.V191 A..1 PRODUCER NAME: Brown & Brown of Florida, Inc. PHONE FAX �ac 5900 N. Andrews Ave. #300 air...). I M P.O. Box 5727 ADDRESS` Ft. Lauderdale FL 33310 -5727 CI AWESO Phone:954- 776 -2222 Fax:954- 776 -9996 INSURER(S)AFFORDNGCOVERAGE NAIL# INSURED NSURERA: Amerisure Mutual Ins. Co. 23396 Awesome Construction, Inc. INSURER B: 3766 N.W. 124 Avenue Coral Springs FL 33065 INSURER C : INSURER D: INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH LTR TYPE OF INSURANCE NS11 WVD POLICY NUMBER (MM/D (MM/DO/YYXY) LIMITS LTR - GENERAL UABLITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY GL2046508030010 0 07/01/11 P Dawrence) $ 300,000 CLAIMS -MADE X OCCUR MEDEXP(Anyoneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATELIMITAPPLIESPER: PRODUCTS - COMP/OP AGG $ 2,000,000 — 1 POLICY n PRO- n LOC Emp Ben. $ 1,000,000 JECT I f AUTOMOBILE LIABLITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) A X ZANY AUTO CA20465050302 07/01/10 07/01/11 BODILY INJURY (Per person) $ 1 ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON -OWNED AUTOS $ $ UMBRELLA UAW I OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC204651003 07/01/10 07/01/11 X WGSIAIU- IU A ND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE V / N E.L. EACH ACCIDENT $ 500,000 OFFICE ER EXCLUDED? N / A (Mandatorory y ki E.L. DISEASE - EA EMPLOYEE $ 500, ODD in N NH) II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 1111, Additional Remarks Schedule, i1 more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE ZEPHYRB THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills Building Department AUTHORIZED REPRESENTATIVE 5335 8th Street Zephyrhills FL 33542 n _ .. ice.,' PORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD