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Date: 9/22/2011 Time: 2:55 PM To: Odioxne Insurance Page: O1 <br /> A �� � I N SU RAN CE BI N DATE (MMADNYYY) <br /> �„�- DER 9�22,20�� <br /> THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON REVERSE 31DE OF THIS FORM <br /> AGENCY Old Dominion IS15. CO. B�NDERf <br /> George H Odiorne Insurance Agency Inc 1192222966 <br /> PO BOX H3O pA � EFFECTiVE 7�ME DATE XPIRATION nME <br /> X o,rn X i2 oi ,Qrn <br /> Brandon FL 33509 9/20/2011 12:01 PM 10/20/2011 NOON <br /> PH C N ert : (813) 685-7731 q/� ryo ; (813) 685-1823 <br /> TH�S BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY <br /> CODE: SUB CODE: PER EXPIRING POLICY #'j'$D <br /> AGEN 00016949 DESCWPTION OF OPERATIONSfVEHICLEBIPROPERTY Includin Locdlon <br /> CUSTOMER ID: ( Q 1 <br /> MISURED <br /> Tampa Bay Pressure Washing, Inc. <br /> 5051 Windingbrook trail <br /> SLEY CHAPEL FL 33544 <br /> COVERAGES LIMITS <br /> TYPE OF INSURANCE COVERAGEIFORMS DEDUCTIBLE COINS % AMOUNT <br /> PROPERTY CAUSES OF LOSS <br /> BASIC � BROAD ❑ SPEC <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $ 1�000�000 <br /> X COMMERCIAL GENERAL LIABILIT �l DAMAGE TO $ 100 � 000 <br /> RENTED PREMISES <br /> CLAIMS MADE a OCCUR MED EXP (My one person) $ 5, 000 <br /> PERSONAL&ADVINJURY $ 1�000�000 <br /> GENERALAGGREGATE $ 2�000�000 <br /> RETRO DATE FOR CLAIMS MADE PRODUCTS - COMP/OP AGG 2� 000 � 000 <br /> VEHICLE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO BODILY INJURY (Per person) <br /> ALL OWNEDAUTOS BODILY INJURY (Peracadent) <br /> SCHEDULEO AUTOS PROPERTY DAMAGE <br /> HIREDAUTOS MEDICAL PAYMENTS <br /> NON-OV�iVED AUTOS PERSONAL INJURY PROT <br /> UNINSURED MOTORIST <br /> VEHICLE PHYSICAL DAMAGE DED ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE <br /> COLLISION STATEDAMOUNT $ <br /> OTHER THAN COL <br /> GARAGE LIABILITY AUTO ONLY - EAACCIDENT <br /> ANY AUTO OTHER THAN AUTO ONLY <br /> EACH ACCIDENT <br /> AGGREGATE <br /> E%CE33 LIABILITY <br /> EACH OCCURRENCE <br /> UMBRELLAFORM AGGREGATE <br /> OTHER THAN UMBREILAFORM RETRO DATE FOR CLAIMS MADE SELF-INSUREDRETENTION <br /> WC STATUTORY L IM ITS <br /> WORKER'S COMPENSATION <br /> AND E.L EACH ACCIDENT <br /> EMPLOYER'3 LIABILITY E L DISEASE-EA EMPLOYEE <br /> EL DISEASE-POLICYLIMIT <br /> SPECIAL FEES <br /> CONDITIONS/ <br /> OTHER TAXES <br /> COVERAGES <br /> ESTIMATED TOTAL PREMIUM <br /> NAME � ADDRESS <br /> MORTGAGEE ADDITIONAL INSURED <br /> LOSS PAYEE <br /> LOAN # <br /> AUTHORIZED REPRESENTATiVE <br /> Steven Roberts (C) /JSH d �...�y� t <br /> ACORD 75 (2007/01) Page 1 of 2 �ACORD CORPORATION 1993-2007. All rights reserved. <br /> INS075 �zoo�o��e <br /> The ACORD name and logo are registered mazks of ACORD <br />