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Sep 22 1001:42p MIKE SLOAN INSURANCE 863 *853 *3146 p.1 <br /> D ATE (MWDOrYYY11 <br /> A ° � ' CERTIFICATE OF 'LIABILITY INSURANCE 1 09/22r2010 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pohcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br /> terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in rieu of such endorsement(s). <br /> PRODUCER NACT MIKE SLOAN <br /> MIKE SLOAN INSURANCE PNOne FAX <br /> 863 853 1221 (A/c.„ Net 863 853 3146 <br /> 6737 US HWY 98 N A MIKE.SLOAN.BXKB ®STATEFARM.CDM <br /> LAKELAND,FL 33809 CUSTOMER 591878 <br /> CUSTOMER ID M: <br /> INSURERS) AFFORDING COVERAGE NAIL a <br /> INSURED INSURERA State Farm Fire and Casualty Company 25143 <br /> CAUDILL HEATING & AIR INsueERB State Fans Florida Insurance Company 10739 <br /> CONDITIONING LLC INSURER C: <br /> 4265 US HIGHWAY 98 N STE 575 INSURER D: <br /> LAKELAND FL 33809 -3817 INSURER £' <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR IADOL IOUCY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSR WVDI POLICY NUMBER (MMIDOIYWYI (MWDD/YVYYI LJES <br /> B GENERALUABILm 1 1 98- BG- D532 -9 B 031012010 03/0312011 EACH OCCURRENCE j s 1,000,000 <br /> DAMAGE TO RENTED <br /> X COMMERCIAL GENERAL LIABILITY i PREMISES (Ea occurrence) <br /> ; 5 <br /> CLAIMS-MADE © OCCUR WED EXP (Any one person) S 5,000 <br /> PERSONAL & ADV INJURY 5 <br /> GENERAL AGGREGATE 5 2,000,000 <br /> GENL AGGREGATE MKT APPLIES PER. PRODUCTS - COMPIOP AGG 5 2000,000 <br /> POLICY �- r n LOC - 5 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE OMIT 5 <br /> (Ea aaridenI) <br /> ANY AUTO ❑ ❑I BODILY INJURY (Per person) I 5 <br /> ALL OWNED AUTOS <br /> BODILY INJURY (Per accident!' S <br /> SCHEDULED AUTOS I PROPERTY DAMAGE <br /> HIRED AUTOS 5 <br /> (Per accident) <br /> _ NONOV,NED AUTOS <br /> 5 <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 <br /> EXCESS LIAR CLAIMS -MADE AGGREGATE <br /> 5 <br /> DEDUCTIBLE a 5 <br /> RETENTION 5 ! I 5 <br /> I 07/0 V C STATU- 0TH- i <br /> A WORKERS Pn, 98- BH- D460 -7 F 07106/2010 0710612011 TORY LIMITS ! FR ! AND rI <br /> ANY PROPRIETCRIPARTNERIEXECUTIVE ❑ EL EACH ACCIDENT i a 500,000 <br /> OFFICER/MEMBER EXCLUDED? N 1 A <br /> Mandatory M NM) = j E.L. DISEASE - EA EMPLOYEE 5 500,000 <br /> B C oA riAt PRn Isielrro , I EL DISEASE - POLICY '-IMR i S 500,000 <br /> .CI <br /> DESORPTION OF OPERATIONS: LOCATIONS 1 VEHICLES (Mach ACORD 101, Additional Ramants Sehedele, V more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITY OF ZEPHRYHILLS BUILDING DEPT SHOULD ANY OF TIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br /> 5335 8TH ST POLICY PROVISIONS. <br /> ZEPHRYHILLS, FL 33542 <br /> AUTHORIZED REPRESENTATWE <br /> MIKE SLOAN "'C' ,. = <br /> © 1988- 2009 ACORD CORPORATION. AN rights reserved. <br /> ACORD 25 (2009109) The ACORD name and Togo are registered marks of ACORD 1001486 132849.4 02 - 11 - 2010 <br />