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AGORAE' CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDIYYYY) 9/21/2010 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 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 pollcy(les) must be endorsed. If SUBROGATION 1S 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 Linda Fetherolf NAME: S.S. Nesbitt & Co /Bham r AJC ON ra .. k (205)262 -2700 j ( F Ar °X C, No, (205)269 -2701 3500 Blue Lake Drive, Ste. 120 L ss . ifs thero1fBssnesbitt.com PRODUCER 00031548 CUST ID #. Birmingham AL 35243 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A :CSU Producers Resources, Inc . /B INSURER'S :FOCI Insurance Capsco Industries, Inc. INSURERc National Union Fire Ins Co 155 Main Street INSURER D : INSURER E : Summiton AL 35148 INSURERF: COVERAGES CERTIFICATE NUMBER:2010 -11 All 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 POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMJDOIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 A CLAIMS -MADE ( X 1 OCCUR C=0013545 9/14/2010 9/14/2011 MEDEXP Orly One WSW) $ Excluded PERSONAL &AOV INJURY $ 1, 000, 000 GENERAL AGGREGATE _ $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG_ 5 2,000,000 POLICY ' f F LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT' 5 1,000,000 X ANY AUTO (Ea accident) B ALL OWNED AUTOS CA001186501 9/10/2010 9/10/2011 BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) 5 X HIRED AUTOS Ded. comp/Doll $1, 000 PROPERTY DAMAGE $ Mediclay X NON -OWNED AUTOS Hired Phy Ded. $1,000 c apay ) — Medical 5 5 ,000 s X UMBRELLA LIAB OCCUR EACH OCCURRENCE _ S 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DEDUCTIBLE $ C X RETENTION $ 0 DB060357317 9/14/2010 9/14/2011 $ – WORKERS COMPENSATION II WC STATU- OTH- AND EMPLOYERS' LIABILITY l TORY LIMITS I ER ANY PROPRIETORJPARTNER/EXECUTNE Y J N OFFICER/MEMBER EXCLUDED? ( I N /q E.L. EACH ACCIDENT $ (Mandatory in NH) 11/ es, describe under E.!. DISEASE - EA EMPLOYEE s ESCR IPTION OF OPERATIONS below E.t. DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace is required) License Holder: Martin B Hoglievina #14044500012009 Covers all employees in the State of Florida CERTIFICATE HOLDER CANCELLATION City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE Dee Mazingo /DEEMAZ A" — ---t5 ACORD 25 (2009109) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD