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1 ® DATE (MMIDDIYYYY) AW D CERTIFICATE OF LIABILITY INSURANC,o 12/1/2010 PRODUCER Lockton Insurance Brokers, LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 725 Figueroa Street 35th Fl. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AL HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR C ice C cnse roa Str et es OF 9 7 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. (213) 689 - 0065 INSURERS AFFORDING COVERAGE NAIC # INSURED PetersenDean Roofmg and Solar Systems, Inc. INSURER A: Arch Insurance Company, 11150 1311496 1011 Fairfield Drive INSURER B: Insurance Company of the State of PA 19429 West Palm Beach FL 33407 INSURER c: Lexington Insurance Company 19437 INSURER 0: 1 INSURER E: MAI COVERAGES PETDE02 Q2 I �ER(S , AUTHORIZED REPREBENTATNE OCONSTITUTE RA R AND THE CERTFICATE HOLDER. ISSUING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD I. POLICY EFFECTIVE POLICY EXPIRATION LTR NSRL TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIVYYY) DATE (MMIDD/YYYY) UNITS X GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 C X COMMERCIAL GENERAL LIABILITY 023462649 4/30/2010 4/30/2011 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 C - 1 CLAIMS MADE © OCCUR (RESIDENTIAL) MED EXP (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY n 28-- n LOC X AUTOMOBILE UABIUTY A X ANY AUTO 71PKG2297502 4/30/2010 4/30/2011 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ XXXXXXX _ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY 1 $ XXXXXXX — NON -OWNED AUTOS (Per accident) — PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE UABIUTY AUTO ONLY - EA ACCIDENT $ XXXXXXX R ANY AUTO NOT APPLICABLE OTHER THAN AUTO ONLY: EA ACC $ XXXXXXX AGG $ XXXXXXX EXCESS / UMBRELLA UABIUTY EACH OCCURRENCE $ 5,000,000 B OCCUR CLAIMS MADE 7520696 4/30/2010 4/30/2011 AGGREGATE $ 5,000,000 $ XXXXXXX DEDUCTIBLE UMBRELLA FORM XXXXXXX xxxxxX RETENTION $ $ XX3>7Q(XX WORKERS COMPENSATION X I TORY L MRS I 10TH- ER A AND EMPLOYERS' LIABILITY Y / N 71 WCl2297302 - Sales /Clerical 4/30/2010 4/30/2011 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? A n (Mandatory In NH) 71W Cl2297402 - Field 4/30/2010 4/30/2011 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT [SPECIAL PROVISIONS THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED. Certificate Holder is an Additional Insured(s) to the extent provided by the policy language or attached endorsement issued or approved by the insurance carrier. General Liability coverage provided is primary and noncontributory per attached endorsment. Waiver of Subrogation applies per attached endorsement(s). Policy is subject to attached wrap exclusion. CER IFIC TE HO DER CANCELLATION [M449001] [M4476881 [M4479811 [M447680] [M447689] [M449266) [M447684] 3536929 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills - Building Department DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Zephyrhills FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AU SENTAT ACORD 25 (2009101) © 8 -20Q9 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD For questions regardIng this certificate, contact the number fisted in the Producer' section above and specify the cIerd code PETDE02'.