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Aug 05 10 - 10:44a Lg Edwards Ins 3525676766 p.l co • CERTIFICATE OF LIABILITY INSURANCE OP ID KS DATEIMM/DDIYYYY) 08/05/10 TH C ERTIFICATE 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 ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEENTHE 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 tertificate holder in lieu of such endorsement(s). PRODUCER LUN 141. NAME: PHONE FAX -" M.G. Edwards Insurance Agency ac, No, Est): (A/C, No): T.O. Box 1548 ADDRESS: Dade City FL 33526 -1548 CUSSTOMERID#: GAVIN -1 .Phone:352- 567 -6751 Fax INSURERIS) AFFORDING COVERAGE NAIC 0 INSURED INSURER A : Atlantic Casualty Ins Co Gavin Roofingg INSURER B : Rick Gavin dba: P 0 Box 1363 INSURER C : Dade City FL 33526 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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. INbR TYPE OF INSURANCE AMA ,UUI PULILY ti-t• MUM? txP LTR IINSR WVD POLICY NUMBER (MMIDO/YYYY) (UMIDO/YYYY) UMITS GENERAL LIABILITY EACH OCCURRENCE $ 300 , 000 A X COMMERCIAL GENERAL LIABILITY L0830047241 08/04/10 08 /04/11 PREMSES x _ $50,000 _ CLAIMS -MADE n OCCUR MED EXP (My one person) $ 5, 000 PERSONAL 8 ADV INJURY $ 300 , 000 GENERAL AGGREGATE I s 300, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 300 , 000 A I POLICY n PRO- n LOC $ JECT , I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS ( (Per accidenl) $ NON -OWNED AUTOS i $ $ UMBRELLA LIAB 1 OCCUR EACH OCCURRENCE $ -- EXCESS UAB — 1 CLAIMS -MADE AGGREGATE $ - DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION I TO RY UMR I I T AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVFD N/A E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 11 yes, describe under l i -- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ � I 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. if more space is required) /22 v& �-9 t) , ,, AY -4 /2-0„7 'O - p/ 17 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYOFZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills (813) 780-0021 AUTHORIZED REPR ENTATIVE 5335 8th Street Zephyrhills FL 33541 ©1988- 009 AC RD ORP RA All rights reser ed. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD