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11/14/2011 11:20 3525671159 PETERSON INS PAGE 01/02 <br /> V���� Page 1 55039 (11-8r) <br /> ISSUed 08-29-2011 <br /> INSUF7ANCE COMPANY TAILORED PROT�CTIQN POLICY DECLARAT�NS <br /> 6101 ANACAPRI BLVD., LANSING, MI 48917-3999 <br /> Renewak Effective 11-Q1-2a11 <br /> r PETERSON tRA INSURAIdCE LLC <br /> � 12-0902-00 MKT TERR 052 (352) 567-9771 POLICY NUMB�R 014612-20608899-71 <br /> iHSUREC DOUGLAS F ROGERS <br /> �BA RQG�RS ELECTRIC <br /> Company POLICY TERM <br /> AODitE99 33184 PORTAGE PATH B i f( 12 : 01 a. m. 7 2:01 a. m. <br /> DADE CITY, F� 83523-9114 11-01-2011 11-01-2012 <br /> conslderatlon of payment of the premium sflown Delow, this policy is renewed. Please attacn tllis <br /> �aclarations antl attaChmenis to your pollcy. I f you have any quastivns, plg8se co�ault with your egent. <br /> COMMON POLlCY INFORMATION <br /> S1151NESS DESCRIPTION: E I e c t r I c Work <br /> ENTlTY: Individusl <br /> PROGRAM: Premier Contractors <br /> THlS POLICY CONSISTS OF THE FOLL�WING COVERAGE PART{S). PREMIUM <br /> THIS PREMIUM MAY 8E SUBJEC7 TO ADJUSTMENT. <br /> COMMERCIAL GEN�RAL LIABILITY COVERAGE $227.00 <br /> COMMERCIAL ENLAND MARINE COVERAGE 136.00 <br /> SURTAX �•22 <br /> FLORIDA EMERGENCY TRUST FUND SURCHARGE 4.00 <br /> FLORIDA HURRICANE CATASTROPH� �UWb ASSESSMENT 4. <br /> CITIZENS PROPERYY INSURANCE CORPORATIaN EMERGENCY ASSESSMENT 2.27 <br /> FLORIDA fNSURANCE GUARANTY ASSOCIATION ASSESSMENT (2007) 0.94 <br /> TOTAL $374.43 <br /> PRSMIUM SHOWN ABOVE FOR COMMERCIAL GENERAL LIA�ILI7Y COVERA(3E IS AN ADVANCED PR�MIUM <br /> DEPOSIT AND MAY BE 8UBJECT TO AUDI7. <br /> FORMS THAT APPLY TO ALI. COV�RAGE PART SHOWN ABOVE (EXCEPT GARAG� LIABILITY, DEALEI2'S <br /> BL 5500 � (OM B ) �A`ILOOOMOBILE�S� APPI.ICABLE) <br /> Countersigned B : <br /> (]�:J�� v����� <br />