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SEP -20 -2010 21:12 P.02 A GORD ° DATE (MMroDmYr) CERTIFICATE OF LIABILITY INSURANCE 9/14/2010 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 POUCIES 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 lieu of such endorsement(s). PRODUCER CONTACT N►ME: Hazy R ots Alan Williams & Assoc Ins Agency Inc � "I t (239) 418 -1100 Nol (239)419•1164 T 13700 -1 Ben C. Pratt/ trAlis5: mretz8 alanwilliame . net Six Mile Cypress Pkwy PRCIDU Io ,00007688 Ft . Myers FL 33 912 INSURERI ) AFFORDING COVERAGE _ NAIC p INSURED INSURER A Ohio Casualty Insurance 27074 INSURER a Bridgefield ESI 10701 Tri -Area Electrical Construction, Inc. INSURER CI 1 1 1 1 ( V\ 1'1g. 1 o l s rei N o" NE , uYSURER o ■ Unit 38 INSURER E : • Cape Coral FL 33909 I_... INSURER F I I . COVERAGES • CERTIFICATE NUMBER :10 -11 cL /AU /wc /t M5 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMICM THIS CERTIFICATE MAY 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. VW TRR TYPE OF INSURANCE O MR VNO POLICYNUMBER (M DINYYYY) ( UNITS GENERAL UABIUTV — EACH OCCURRENCE $ 1, 000, 000 • X COMMERCIAL GENERAL UA9ILITY DAMAGE TO RENTED 2BEMISES,(Eeocanence)_ $ 100, 000 il A , CLAIMS -MADE OCCUR • . B[CO59669654 9/7/2010 9/7/2011 MED EXP./Any one pehsn) S 10,000 X PO Dad 8300 PERSONAL a ADV INJURY s 1 , 000,000 X XCU i Contractual GENERAL AGGREGATE _ S 2 , 000 , 000 GErn. AGGREGATE UMIT APPLIES PER: . • PRODUCTS - COMP/OP AGG S 2,000,000 7 POUCY F 1; j LOC S AUTOMOaILE LIABILITY COMBINED SINGLE UNIT S 1,000,000 000 • X ANY AUTO (Ea ecGOeIIU , , A ALL GAMED AUTOS 53053669854 9/7/2010 9/7/2011 BODILY INJURY (Per Deleon) S _ SCHEDULED AUTOS BODILY INJURY (Per accidere s ` . X HIRED AUTOS PROPERTY DAMAGE' S . (Pe raaideM) X NONOWNEDAUTOS . MecscelpeymeMs S 5,000 unlnsureo molonacomsned $ 100 , 000 . - UMBRELLA LIAB OCCUR . • EACH OCCURRENCE S - .� EXCESS MAR • CLAIMS -MADE AGGREGATE — S DEDUCTIBLE S — • A X RETENTION S 0 US053669854 9/7/2010 9/7/2011 — $ B WORKERS COMPENSATION I WC STATU 10TH- AND EMPLOYERS UAEIUTY Y X TORY ISMS FR • ANY PROPRIETORIPARTNERIEXECUTIVE E 500,000 OFFICER urseeR E7CCWOED9 N/A E.L. EACH ACCIDENT S (Mamdahxy to NN) 0830 -39137 4/8/2010 4/8/2011 E.L. DISEASE - EA EMPLOYEE S 500,000 If yga, desaioe unoer DESCRIPTION OF OPERATIONS below • E L, DISEASE - POLICY UMIT I•S - SOO , 000 - • • DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES Bleach ACORD 107, Adedieml Remarks Schedule, if more apace M required) Re: William T. Leone CERTIFICATE HOLDER CANCELLATION (813)780 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Zephyr Hills Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8th Street Zephyr Hills, FL 33542 AUTHORIZEDREPR5SENTATNE Esther Maddox /CL11 r ACORD 25 (2009/09) 01988 -2009 ACORD CORPORATION. All rights reserved. INSO2S (zoo$Q9) The ACORD name and logo are registered marks of ACORD