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ACORD . TM. 01/11 CERTIFICATE OF LIABILITY INSURANCE DATE 01/11/2010 <br /> /2010 <br /> PRODUCER Phone: (813) 988 - 1234 Fax: 813 988 - 0989 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ASSOCIATES AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> PO BOX 16190 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 11470 N. 53RD ST. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> TEMPLE TERRACE FL 33687 <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> Agency Lic#: R001766 <br /> INSURED INSURER A: SOUTHERN OWNERS INSURANCE CO. 10190 <br /> Gator Transport and Setup,Inc. INSURER B: AUTO OWNERS INSURANCE CO. 18988 <br /> James and /or Jeffrey Wagner INSURER C: AMCOMP INSURANCE CO. <br /> 9113 Wire Road <br /> Zephyrhills, FI 33540 INSURER ID: <br /> 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR INSRC DATE (MM/DD/YYI DATE (MMIDD/YY) <br /> • <br /> GENERAL LIABILITY 20704177 01/28/10 01/28/11 EACH OCCURRENCE _ $ 1,000,000 <br /> DAMAGE TO X COMMERCIAL GENERAL LIABILITY <br /> PREMISES (Ea N T E ence) $ 300,000 <br /> CLAIMS MADE X OCCUR MED. EXP (Any one person) $ 10,000 <br /> A PERSONAL & ADV INJURY $ 1,000,000_ <br /> GENERAL AGGREGATE $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMP /OP AGG. $ <br /> 1 PRO <br /> 7 POLICY F 1,000,000 <br /> JECT LOC <br /> AUTOMOBILE LIABILITY 4752425000 01/28/10 01/28/11 COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $ 300,000 <br /> X ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> B <br /> — <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 OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> - . <br /> $ <br /> DEDUCTIBLE $ <br /> RETENTION $ — — <br /> $ <br /> WORKERS COMPENSATION AND WCV 7072870 05/31/09 05/31/10 X ORY TS OTHER <br /> EMPLOYERS' LIABILITY <br /> `` ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100 <br /> OFFICER/MEMBER EXCLUDED? <br /> tr yes, describe under <br /> E.L. DISEASE -EA EMPLOYEE $ 100,000 <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br /> License #'s IH- 000467 & CRC - 058513 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS <br /> WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE <br /> City of Zephyrhills TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, <br /> 29421 South Avenue ITS AGENTS OR REPRESENTATIVES. <br /> Zephyrhills, FI 33542 <br /> AUTHORIZED REPRESENTATIVE <br /> Attention: Jason Farquhar <br /> ACORD 26 (2001/08) Certificate # 191639 © ACORD CORPORATION 1988 <br />