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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DDNYYY) 07/19/2010 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 AFFORDEDBY THE POUCIES 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 Neu of such endorsement(s). PRODUCER CONTACT Pat Di Pi etro Blackadar Insurance Agency PHONE Eat): 407.831 407.830.4681 No, 1436 N. Ronald Reagan Blvd. EMAIL Longwood, FL 32750 CUSTOMER ID S- Pat DiPietro INSURER(S) AFFORDING COVERAGE NAIC INSURED INSURER A: Southern- Owners Insurance Co 10190 US Heating & Air Conditioning Inc INSURER 6: American Economy Insurance Coe 624 Douglas Ave INSURERC: Scottsdale Insurance Company Ste 1402 INSURER D: FFVA Mutual Insurance Company 10385 Altamonte Springs, FL 32714 MISURERE INSURER F : COVERAGES CERTIFICATE NUMBER: 10 /11 incr LIMB limits 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM OF INSURANCE AD SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MWDD►Yyyy) (MMipp1YYYYl - GENERAL LABILITY 0646827267762710 0110/12010 0110•'12011 I EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY 1 DAMAGE TO RENTED $ 300 000 I PREMISES (Ea occurrence) . CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 A X Inds Contractual PERSONAL 6ADVINJURY $ 1,000 r 0 X Liability GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:' PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY ITC' JECT I X LOc — - -- - - $ AUTOMOBILE LABIUTY 02CE21522110 02/09/2010 02/09 /2011 COMBINED StNGLE UNIT $ 1,000,000 1 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ B SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON -OWNED AUTOS $ UMBRELLA LAB X OCCUR XL50064109 01/01 /2010 01/01/2011 EACH OCCURRENCE $ 5,000,000 C EXCESS UAB CLAIMS -MADE AGGREGATE $ 5,000,000 DEDUCTIBLE _ —. -_ RETENTION $ $ WORKERS COMPENSATION WC8 40001 7 5 5 3 20 10A 02/25/2010 02/2512011' X j TORY AIM S ER AND EMPLOYERS' LIABILITY y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory in NH) . E.L. DISEASE - EA EMPLOYEE $ 1,000,000 Il yes desc ribe under DESCRIPTION OF OPERATIONS below. E.L. DISEASE - POLICY LIMB $ 1, 000, 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills Building Department AUTHORIZED REPRESENTATIVE 5335 8th Street Zephyrhills, FL 33542 Lorrie Partridge /RPM © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD