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Oct 10 11 10:16a ELAINE RIEGLER INSURANCE 8137887133 p,1 <br /> Certificate of Insurance <br /> This certifies that State farm Fire and Casualty Company Bfoomnqton minois <br /> fTwTl H�M State Farrn (ieneral Insura�ece Company 6loomington, ilNnois <br /> State Farrn Fire and Cawalty Company, axwa, or�nrio <br /> IN�YlANC� State Farm Fbrida Insurance Company, v+Fn�er r+aven, Floriaa <br /> S`tate Farm Lbyds, Dallas, Texas <br /> insures the followin0 palicyhotder forthe covera�ges indicated below: <br /> Policyholder JAMES O MORTON ELECTRIC CO INC <br /> Address of policyholder PO BOX 1537 36906 EILAND BLVO ZEPHYRHILLS, FL 33542 <br /> �ocaEian af operations <br /> Description of opera�ons ELECTRICAI. WORK <br /> The policies listed be(ow have bee� issued to the po�cyholder forthe poticy periods shown. The insurance described in these policies is <br /> subject to all the terms, exclusians, and condfians of �ose poiicies. The limils of babilily► shovm may have been redaiced by any paid daims. <br /> Pof�y Perloti Limits oi Uability <br /> Pdicy Number Type of Insurance Eflecttve Date : Expr�on Dabe (at beginntng of polky period) <br /> Comprehensive BODlIY I,VJ�IRY AAD <br /> Busines.s Liability PROPERN DAMAG� <br /> ------- - - -- -- ---------- <br /> ----"-'- ------'...' "" ---��'--- ---"' ------" � --� �- <br /> This insurance includes: Products - Camp3eted Op�ons <br /> Contractual Liability Each Occurrence $ <br /> Personal Injury <br /> Advertising Injury General Aggregate g <br /> Product = Completed $ <br /> Operafions Aggregate <br /> Policy Period BO !LY INJ RY AND PROPERTY DAMAGE <br /> Pollcy Number EXCESS LIABILITY Efiective Date 6 Expiration Date (Combined Singie Limit) <br /> � ���� Each Occurrence � <br /> [] Other A egate $ <br /> Pollcy � erlod <br /> Etf�ective DaGe i Ex aRion Dabe Part 1- Work�s Co ensa�� - Statuto <br /> - Workers' Corr�ensation a3122/11 D3/22N 2 art II - Employers Liability <br /> and Employers Liability Each Acadent $ 100,000.00 <br /> Disease - Each Employee $ 10Q�000.00 <br /> �isease - Policy Limit $ 500,OQ0.00 <br /> Po1kY Penad Umfts of Liability <br /> Pollcy Number T e of Insurance Ef'lective Dabe : Expiration Dabe (at Inning ot licy 'od) <br /> 7HE CERTIFICATE OF INSURANCE iS NOT A CONTRACT OF 1NSURANCE AND NEITHER AFFIRMAIiVELY N10R NEGATNELY <br /> AMENDS, EXTENDS OR ALTERS TNE COVERAGE APPROVED BY ANY POLICY DESCRIBED H�REIN. <br /> Name and Address of Gertification Fidder If any of the described policies are canceled before <br /> their expration date, State Farm� will�y Lo mail a <br /> written notice ta the certificate holder 3 � days <br /> CITY OF ZEPHYRHILLS before cancellation. If we tail to mail such notice, no <br /> 5335 8TH STREET obligation or liability wpl be irnposed on State Farrn or <br /> ZEPHYRHILLS, FL 33542 ii.s agerris or representatives. <br /> Ai�Qc?d <br /> t�9S <br /> Signature of rize eprese�fative <br /> INSRIRANC ACCT REP 10/10111 <br /> Title pape <br /> ELAINE RlEf3LER <br /> Agent Name <br /> Telephone Number �813) 783�5500 <br /> RgenYs Code Stam� <br /> A�nt Ccde 2+66 <br /> �ooizso <br /> A=0 Coce F875 <br /> 'OE399.9 03-16200P <br />