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Jun 21 2010 11:48AM HP LASERJET FAX p•1 P ID ACORD ' CERTIFICATE OF LIABILITY INSURANCE OP DATE (MM /DD/YYYY) 2 06/21/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE CERTIFICATE RC Ewing, Blackwelder 6 Duce HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 100 s . 10th Street ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. Raines City FL 33844 Phone:863- 422 -2345 Fax:863- 422 -8782 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A • Southern ' Owners ' Inaurance 10190 _ INSURER B: ' Owners 'Insurance CO w ' 32700 Statewide Electric of Central Florida, Inc INSURER C: Auto Owners Insurance Co . 4628 Lincoln Street INSURER D: . . Lake Wales FL �59 INSURER E. . COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIIIMMDDI - POLICY EFFECTIVE. POL.LCY EXPIRATION . LTR 'NSRL TYPE OP INSURANCE POLICY NUMBER GATE (M■IDD/YY) DATE INMIDDIYY) LIMITS GENERAL UABIJTY EACH OCCURRENCE $1,000,000 AT�Mt I�NI A X COMMERCIAL GE NERALL1ABLITY 72726197 -09 12/14/09. • .12/14/10 V PREMLS i E S V (Esoaur ence) $300,000 CLAIMS MADE X I OCCUR • MED EXP (Any one person) $ •10 , 000 PERSONAL S ADV INJURY $ 1 , 000,000 GENERAL AGGREGATE S Z , 000 , 000 GEL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2 , 000 , 00 7 POLICY I spi LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO (Ea aoc SenlI $1,000,000 • ALL OWNED AUTOS BODILY INJURY • B X SCHEDULED AUTOS 4824649900 01/12/10 01/12/11 (Perpers0n) $ X HIRED AUTOS BODILY INJURY 5 X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ - (Per accident) - GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ • ANY AUTO OTHER THAN • EA•ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1 , 000, 000 C X OCCUR CLAIMS MADE 4824649901 01/12/10 12/14/10 AGGREGATE S 1, 000, 000 $ • DEDUCTIBLE $ • X RETENTION $10,000 $ WORKERS COMPENSATION AND • X TORY LIMITS E EMPLOYERS'LIABILRI' C 72727568 01/12/10 12/14/10 E. L. EACH ACCIDENT 5 500,000 ANY PROPRETORPARTNEIVEXECUTIVE OFFICERIMEMBER EXCLUDED? . • E.L. DISEASE- EA EMPLOYEE S 500,000 describe PROVISIONS below • SPECIAL E.L. DISEASE- POLICY LIMIT $ 500 000 CL PROIIO � OTHER DESCRIPTION OF OPERATIONSI LOCATIONS / VEHICLE8 / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Fax: 813- 780 -0021 CERTIFICATE HOLDER CANCELLATION C ITYOFZ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 30 DAYS WRITTEN City of Zephyrhil is . NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Building Department !IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5325 8th Street Zephryhills FL 33542 , IIIIIIIINSIPFATIVES. AUTM REPRESEN >— . --' P o d8 4 IPA • ACORD 25 (2001!08) ( //� ` ® ACORD CORPORATION 1988