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Nov 18 10 01 :44p Lg Edwards Ins 3525676766 p.1 --.. OP ID: KS A I,. )' • CERTIFICATE OF LIABILITY INSURANCE DATE 11 / 11h8/10 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 POLICIES 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 352- 567 -6751 NAM E AcT Karen Surratt L.G. Edwards Insurance Agency 352 -567 -6766 PHONE 352 -567 -6751 FAX 352 567 -6766 INC. No. Eel: -- .____ -- -- (A/C, No): P.O. Box 1548 s ADDRESS: karensurrattgtampabay.rr.com Dade City, FL 33526 -1548 PRODUCER cu olyieR ;pi AMERI -1 INSURER'S) AFFORDING COVERAGE _NAIL b _ INSURED American Solar Energy, LLC INSURER A : American Vehicle Ins Co Labron E Taylor, Jr INSURER e : Guarantee Ins Company Inc 5109 Meadows End Lakeland, FL 33810 INSURER c : Old Republic Surety Company INSURER 0 : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM1D11PYYYY) (MM/DDIYYYY) OMITS GENERAL LIA8ILFTY EACH OCCURRENCE i $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY GL0521016551 04/25/10 04/25/11 PREMI E 1 O RENTED ■ S 100 PREMISES (Ea mnvrence) _________ — CLAIMS -MADE [ X 1 OCCUR MED EXP (Any one person) S 5,000 PERSONAL A ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 _ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 1,000,000 XI POLICY 1 1 PRO 1 1 LOC $ — AUTOMOBILE UABN.ITY COMBINED SINGLE LIMIT $ -- (Ea accident) ANY AUTO �_....___. �.._... - -_. BODILY INJURY (Per person) $ ALL OWNEO AUTOS �� BODILY INJURY (Per accident) S r SCHEDULED AUTOS PROPERTY DAMAGE $ +' HIRED AUTOS (Per accident) NON -OWNED AUTOS $ J iUMBRELLA UAB OCCUR 1EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE 3 DEDUCTIBLE $ ----- RETENTION $ $ WORKERS COMPENSATION WC STAT I - OTH AND EMPLOYERS' LIABILITY X�TORY LIM _11$ L. EB . Y! N B ANY PRKWRIETORIPARTNER/EXEC J1IVE GWG0334000313 -110 09/23/10 09/23/11 E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? I Y I N/A - -'— - -' (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 100,000 If yea, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 500,000 C 'Hillsborough Co OFL0584009 06(13/10 ! 06/13/11 Surety 5,000 iL&P Bond 1 ( Bond DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more apace Is required) Solar energy contractors - Labron E Taylor, Jr.- License #CVCO56667, is exempt from workers compensation coverage. 30 day cancellation for workers compensation CERTIFICATE HOLDER CANCELLATION CITYOFZ SHOULD ANY OF THE ABOVE DESCRIBED POLIC )ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ZEPHYRHILLS ACCORDANCE WITH THE POLICY PROVISIONS. 813 - 780 -0021 5335 8TH STREET AUTHORIZED REPRESENTATIVE ZEPHYRHILLS, FL 33541 C__-- y ©1988 009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The AGORD name and logo are registered marks of AGORD