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Nov 08 10 01:04p BIG DADDY'S M.H. SET -UP (863)875 -0703 p.3 <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID JFi DATE (NWDD/YYYY) PETER -1 11/05/10 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> GIS Insurance Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> "GIS Insurance Inc" HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 1500 6th Street NW ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. <br /> "Winter Haven FL 33881 <br /> Phone:863- 294 -4241 Fax:863- 294 -4243 INSURERS AFFORDING COVERAGE NAIC <br /> INSURED 1 INSURER A: The Burlington Ins Co EX <br /> Big Daddy's Mobile Home Set Up INSURER e: Fla Citrus Business <br /> -- -. s <br /> Service, LLC Jackie Peterson INSURER G: <br /> Eagle 33839 INSURER D: <br /> I INSURER E: <br /> COVERAGES <br /> TEE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REOUI REMENT. TERM OR CONDITION OF ANY CONTRACT CR OTHER DOCUMENT MATH RESPECT TO WHICH THIS CERPFICATE MAY BE ISSUED OR <br /> MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUELIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAZ CLAIMS. <br /> LTR IN ,- •• TYPE OF INSURANCE POLICY NUMBER D POLICY LIMITS <br /> GENERAL LABILITY EACH OCCURRENCE S 1,000,000 <br /> A El COMMERCIAL GENERAL uABILfTY 26473004009 07 /21 /10 07/21/11 I ES jea" ° noel $ 50,000 <br /> ■ CLAIMS MADE L X . I OCCUR MED EXP (Any one pommy S 5,000 <br /> PERSONAL d ADV INJURY 1 1,000,000 <br /> GENERAL AGGREGATE 11,000,000 <br /> GENL AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS - COMP/OP AGG 5 INCLUDED <br /> PRO- <br /> POLICY Jjecy El LOC <br /> AUTOMOBILE UABIUTY <br /> CONFINED SINGLE LMT!T <br /> ANY AUTO (Ea accident) <br /> AL_ OWNED AUTOS _ - - � BODILY INJURY I b <br /> SCHEDULED AUTOS (Per X 601) <br /> HIRED AUTOS ( BODILY INJURY i S <br /> NON-OWNED AUTOS (Per accident) <br /> _T PROPERTY DAMAGE 5 <br /> (Per accident) <br /> GARAGE UABIUTY AUTO ONLY - EA ACCIDENT 5 <br /> I ANY AUTO OTHER THAN EA ACC 5 <br /> AUTO ONLY: AGG 5 <br /> N]CCESSIUIIBNTELLA tJABILITY I ; EACH OCCURRENCE 5 <br /> I OCCUR I 1 CLAIMS MADE ! AGGREGATE S <br /> $ <br /> I DEDUCTIBLE • _ s _.._._ <br /> I l <br /> RETENTION $ g <br /> WORKERS COMPENSATION AND 1 TORY I. IM 5 1 I ER <br /> $ EMPLOYERS'LIAALTDY 106 -45771 09/03/10 ' 09/03/11 EL EACHACCIDENT 1100000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE • <br /> OFFCCERMEMBER EXCLUDED? <br /> E.L. DISEASE - EA t3NPL0 S 100000 . describe under( II <br /> S.ECIAL PROVI ONS below EL DISEASE - POLICY LIMIT 15500000 <br /> `^ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES l EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Jackie Peterson Installer License # IH0000537 <br /> Aggregate Limits shown may have been reduced by paid claims in reference to <br /> General Liability... <br /> CERTIFICATE HOLDER CANCELLATION <br /> C=SC ,z SHOULD ANY OP THE ABOVE UESICDOBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF. THE ISSUING INSURER WIU. ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> City of Zephyrhills <br /> 5335 8th St. IMPOSE NO OBLIGATION OR LABILITY OF ANY HIND UPON TIE INSURER, ITS AGENTS OR <br /> Zephyrhills FL 33542 _ REPRESENTATIVES. <br /> ACORD 25 (2001/08) ACORD CORPORATION 1988 <br />