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FROM : LGE INS FAX N0. : 3525679359 Jul. 11 2011 08:41AM P1 <br /> �� � QP ID: MC <br /> ' CERT�FICATE OF LIA�ILITY INSURANCE �'TE(MMIDD/YYYY) <br /> o7r��l�+ <br /> THIS CER'�I�ICATE iS ISSUEO AS A MATTER 0� INFORMA710N ONLY AND CONFEl25 NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICA7E DOES NOT AFFIRMATIVELY O�t NEGATIV�LY AMEND, EXTENO OR ALT�R THE COVERAGE AFFORDED BY THE POLICtES <br /> SELOW. THIS CERTIFICATE OF INSUItANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZ�D <br /> REPRESENTATIVE OR PRO�UCER, AND THE C�RTIFICATE HOLDER. <br /> (MPORTAMT: If the CeltiflCate ho{def is an ADDITIONAL INSURED, the policy(ies) must be endorLed. If SUBROGATION iS WAIV�D, Subject to <br /> the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not co�fer rights to the <br /> certificate holder in fieu of such endorsemer�s . <br /> pRODUCER 352-567-6751 CO A� Kat�en Surratt <br /> L.G. Edwe►ds Insur�nce Age�cy 352-567-6766 �" �,�,: 35Z-567-6759 we►: 352-567-6766 , <br /> P.O. BoX 1548 ' � <br /> Dade City, FL 33526-i548 k ar9nSU1Ti 1 mpa .y rr.COr� . <br /> � � *, dAV21�1 _ . , <br /> INSU 8) AFFQRONI6 C OVERAGE , , � � <br /> iNSUxeo .1av 2 Inc �ys a: N ation$1 Gro (ns C o . <br /> Double M Electric dba MSURER B ; . _ <br /> Jim Mace INSU .. . � <br /> �0410 River Rd �NSURER D: . <br /> pade City, FL 33525 „�uRea E� .,_. . <br /> I SU RF: <br /> COVERAGES CERTIFICATE NUMSER: REVI810N NUMRER: <br /> TH�S 1S 70 CERTIFY THAT THE POL[CIES OF INSURANCE LISTEO BELOW HAVE BEEN ESSUEO TO TNE 1NSURED PIAAMED ASOVE FOR 7HE POLICY PERfOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIRENIENT, T�R�ut OR COND�TION OF ANY CONTRACT OR dTHER OOCUMENT WITH RE3PECT TO WHICH TMIS <br /> CERTIF(CA7E MAY SE ISSUED �R MAY P6RTAIN, THE 1NSURANCE AF�ORDED BY THE POLICIES DESCRIBED NEREIN IS SUBJECT TO ALL THE 7ERMS, <br /> �XCLUSIONS ANfl C OND(TIONS OF SUCH POLICIES. LIMlTS 8 HOWN MAY HAVE B EEN REDUCED BY PAID CI�UMS. . <br /> , r�r,�,�sr—• �p�€' ucYEX uenrs <br /> R SYpH OF 1NSURANCE ��� t �� POLICY NUMBER MWDDIYY <br /> QEN�RAL WI1BIUn, EACH pCCURRENCF, 5 'I �OOO�OO <br /> v7►o���� 07l01/12 � � ��� �oo,o <br /> A co�nurRCUOt GeN�Rn� �weiur 08L000001604 p �$ES (Ca occu . S <br /> CW�.+"-1�IAOE �X,� OCCUR MED EXP (Ar�y on a rson) i, b,OO <br /> PERS ONAL R AD INJURY a 1,OU0,00 <br /> — G6W ERALAGCR E GA7E S 2•OQO�O <br /> GEN'L AGGREGATE LIfA1T APPLIES �: PROOUCTS - COI�/OP AGG S ��OOO�OO <br /> X LICY � LpC <br /> AUTOMOBIIE LUB�UT1' COMBINED SINGIE I,IMIT s <br /> (Ee acci <br /> ANY AUTO BOOIIY I WU RY (PYr peroan) S <br /> ALl OWNE� ��1'�OS BOO� INJURY (Par aa�tleM) t <br /> $CHEDULEO AUTOS PROP�TY DAI�MGH : <br /> (Pot SoCiAlM} <br /> riIREG AUTOS <br /> S <br /> NON-OWNEQ AU70S <br /> f <br /> ���� �� �� E ACN OCCU , S <br /> �� �� CuIMS-MApE A G6REG�T E L „ <br /> • a <br /> oeoucne�e - <br /> : <br /> R anoN s wc srATU- on+- <br /> WORK6RS COM?�NSATION <br /> AND SMP[AYERS' W►s1UT1' E,I.. pqCH ACClDE1J�? S <br /> ANY PROpRIETORlPARTNERIE7CECIfiVE Y � � 1 A - <br /> OrfICERlIAEMBER EXCLUDED'! E.L. DISEAS� • EA tMPlO�'E 5 <br /> (M■nenory Io NX) <br /> Mya6, dltp5b6 UIId6� �L. O15EA$E • POLICY LIMIT E <br /> D�SCRIPTION OF OPERATtONS Dalow <br /> DESCRIPTION OF OPERATWN� J LOCA710N5 I VEMICLES (Atlteh ACORD 101, AdA160n71 R�onfKi Sd�eAYl0. (f inere epicc fs �9a4hcd) <br /> Eleatrical within buildings <br /> CERTIFlCATH FIOLDER CANCELUITION <br /> CITY Z� <br /> SliOULC ANN CF THE ABOVE DESCWBEO POUCIES BE CANCELLEQ BEPOR£ <br /> TNE EXP�ItAT10N DA7E 7HEREOF, NO'i10E YVILL 9E DPLNERED IN <br /> CITY OF ZEPNYRH (LLS ACCO1tDl►Nt:� wIT'►t TNE POtdCY PROV1310NS. <br /> BUILDING pEPARTMEtVT <br /> 5335 STH STREET aun�o o neartESSNrarnr� <br /> ZEPHYRHILLS, FL 33540 J�� <br /> � <br /> � 1988-2009 ACORD CORPORATI ts res�rved• <br /> aeo�tD 25 t2oo9JO9) Thp ACORD neme and logo are registered marks of ACORD <br />