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06/22/2011 22:46 FAX 8137887133 STATE FARM C� p2 <br /> Certificate of Insurance <br /> �,.« ...� This aertifies that State Farm Fire and Casualty Corr�p�ny� eloomrgmn, ��inas <br /> St�e F�nn 6ene�al insurance Comp�nY� e�oominqan, ntinois <br /> � x Staba Fahn Fi�e and Casualty Company� �uora, orrta►io <br /> �■w..»�s State Farm Florida InsuranCe Company, vur�rer Naven, Florida <br /> $bte FRrn� I.IoydB, oaUas, Te�cas <br /> ins�xes fhe foMowing poli��rhdder for the coverages indica6ed betow: <br /> po6qrhnider JAMES O MORTON �LEC7RIC COMPAN1f INC. <br /> Addres� of poi;cj,halder PO BOX 1537, ZEPF�YRHILLS. FL Ss53�36906 EILAND BLVD. ZEPMYRHII.LS�FL <br /> La�atinn ot opersaons <br /> p�� � ap�p� ELECTRIC�Ie11. YVORK <br /> The poliaes Gsted below have been issued to the poli�yholder for the poBcy pe�ods shown. The ins�xance described in Ih�e poliaes is <br /> subject ta ali ihe terms, exdusions, and oondidons of d�qse poliCies. The limits of Nabiliry shown may have been r¢duoed by any paid daims. <br /> PoGq Period I.imits of ' <br /> Policy Number Type of buurance eM!�ctive Da�e ? Expintlon Da6e (at "MUng d poli <br /> Comprehensive 80CILY INJURY AND <br /> Business Uability ; PROPERTY dAMAGE <br /> -- .. ...... ..................... <br /> u�...�.. .�...00w�����������.. ...ow�� �r ......���� ... <br /> Thie Inr�ranoe indudes: Produds - Completed Operations <br /> Co►nrac�:ual Liability Ead� Ooarrenoe g <br /> Personal Injury <br /> Advertising In�ury Gene►al A9� S <br /> Pradurs - Completed $ <br /> � �Paa�o^e A99�� <br /> Pou�y eooi�Y iruuaY a� � <br /> NUmber EKCESS LWBIUTY Ethctire Date 9 Expira0on Da�e (Comlo+ned Sin le Lim' <br /> [] umbrdla � Each oocurrenae $ <br /> Q oU�er , $ <br /> POI�I PerlOd <br /> EfRecbivs pate 9 �an Dabe Pa�t I- Wakers Com nsation - <br /> Worlcers' Compensstidn Part 11- ployers Va ' <br /> a�d Employers Liability Eadi Aaad�t S 10Q�000:00 <br /> 98 �H HS119F 431Z?111 03@?J12 �- Ead� Employee S 900.000.00 <br /> Disease - Pdiq Limit S 500,000.00 <br /> �;�, � u o��a <br /> ' Number T of Insurence EfFective Oabs ; E�i�atjon D�s (at 'nnl d P� <br /> s <br /> 7FIE CERIIFICATE OF tNSURANCE IS NOT A�ONTRACT OF {NSURANC� AND N�ITF�ER A�IRMM7VELY I�R NEC+��'N��Y <br /> AMENDS. E-XTENDS QR ALTERS THE COVERACyE APPROVED BY ANY PO�� �� H�N. <br /> Name and Address of Certificabion Hdder If any aF the described poliaes are canoded be(�of�e <br /> fhElr PXplfddon d�e, S� Farm� Mn6 by to mail s <br /> C17Y CF ZEPHYRNILLS writben notioe b the ce�ficate hokler 30 day� <br /> 5335 8TH ST. betore car�oeNedon. If w�e fail to mail such natice, no <br /> ZEPHYRHlLLS. FL 33542 ob�igstion or fi2bilih► will be imposed on S'FSte Falm or <br /> its age�ts a repr�r�ti�• <br /> .�� � <br /> a �� <br /> 1NS. ACCT. REP. o�s <br /> T1tle <br /> EU►1NE RIEGLER <br /> �� <br /> Teleph� Number (81 S) 783�8500 <br /> 1 � c°°e sm��v ?,�se <br /> i �� <br /> AFQ c�de F811 ���o aea�� <br /> .,N.�m ._ - • . — "'�"" � � <br />