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Sep. 24. 2010 11:49A N o 999 P. 1/2,00,, AGurcu =KTIFICATE OF 'LIABILITY INSURANCE 09/24/2010 <br /> PRODUCER <br /> 813.933.6691 FAX 813.932.6287 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Adcock & Ad Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 315 W. Fletcher Ave. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Tampa, FL 33612 -3414 <br /> Li sa Wal lace INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED Lee Electric , Inc . INSURER A: Old Dominion 40231 <br /> DBA : Luis Espel INSURER B: <br /> P.O. Box 17222 INSURER C. <br /> Tampa , FL 33612 INSURER D. <br /> 1 INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADM. POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY(Y) DATE (MMIDOTYYYY) LIMITS <br /> GENERAL LIABILITY MPG72873 08/08/2010 08/08/2011 EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY <br /> PREMISES SES (Ea occurrence) $ 500, 000 <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 <br /> A PERSONAL & ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 <br /> 1 POLICY PRO- I�I — <br /> JECT I f LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br /> BODILY INJURY <br /> NON -OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO — — <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE — <br /> RETENTION $ — $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. ACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? $ <br /> (Mandatory in NH) E.L DISEASE - EA EMPLOYEE $ <br /> If yes. describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS !VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT l SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> Ci ty of Zephyrhi 11 s NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Building Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 5335 8th St REPRESENTATIVES. <br /> Zephyrhills, FL 33542 AUTHORREDREPRESENTATIVE <br /> John Alexander Green /LPW # <br /> ACORD 25 (2009/01) FAX: 813.780.0021 ©1988 -2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />