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'`� °� CERTIFICATE OF LIABILITY fNSURANCE D 07/15/2 M 0�11� <br /> THIS CERTiFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATiON IS WAIVED, subject to the <br /> terms and conditions of the policy, certain policies may require an endorsement A statemerrt on this certificate does not coMer rights to the <br /> certficate holder in lieu of sueh endorsemerrt(s). <br /> PRODUCER David M. Shrader - State Farm Insurance �E �ud roler <br /> 273 W. Jefferson St. �� o : 352 � Na : 352 <br /> Brooksville, FI 34601 <br /> no�o�ss: �ud .toler.� h statefarm.com <br /> � INSURER�S) AFFORqNG COVERAfaE NAIC iF <br /> iNSURErt a. State Farm Fire and Casual Com n z51a3 <br /> INSURED Jack Schimelfining dba Jack Schimelfining Electric �NSURERB: <br /> PO Box 7299 INSURER C: <br /> Wesley Chapel, FL 33545-0104 INSURERD. <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NONNTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MTH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOVIM MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> l 5U POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE POLICY NUMBER M MID LIMfiS <br /> GENERAL LIABILITY ❑❑ EACH OCCURRENCE 5 <br /> COMMERCIAL GENERAL LIABILITY A <br /> PREMISES Ea occurrence E <br /> CLAIMS-MADE � OCCUR MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GENERALAGGREGATE S <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG b <br /> POUCY PRO- �� $ <br /> AUTOMOBILE IJABILl7Y ❑ ❑ EOM LIMIT $ <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY (Per accident) b <br /> HIRED AUTOS N���ED PROPERTY DAMAGE <br /> AUTOS Per accideM 5 <br /> S <br /> UMBRELLA LIAB pCCUR ❑❑ EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE <br /> AGGREGATE y <br /> DED RETENTION $ <br /> a <br /> A WORKERS COMPENSATION 1MC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y/ N x T�RY LIMIT ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 500,000 <br /> OFFICFJMEMBER EXCLUDED? N❑ N � A 98-BH-G649-2F 01/15/2011 01H5/2012 <br /> (MandaMry in NH) E.L. �SEASE - EA EMPLOYE $ 500,000 <br /> tf yes, desaibe under <br /> E.L. DISEASE - POLICY LIMIT $ 500,000 <br /> � � . <br /> DESCWPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 701, Addltional Remarks SchedWe, M more space is required� <br /> Jadc Schimetfining - Contractor licence #EC13001508 <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITI( OF ZEPHYRHILLS BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> E EXPIRATION DATE THEREOF, NOTICE WILt BE DELNERED IN <br /> 5335 8TH ST . CC ANCE WITH THE POLICY PROVISIONS. <br /> ZEPHYRHILLS, FL 33542 <br /> 813-780-0021 AU ED REPRESENT TNE <br /> 0198&2010 ACORD CORPORATION. All rig e d. <br /> ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849 1-15-2010 <br />