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11/14/2011 11:20 3525671159 PETERSON INS PAGE 62/02 <br /> Page 2 55040 (11/87) <br /> OWNERS IPIS. CO. Issued 08-29-2011 <br /> nneNCV PET�RSON LRA iNSURANCE LLC ComPany POLICY NUMBER019612•xOb08899-11 <br /> 12-0902-00 MKT TERR 052 B i I I <br /> INSURED DOUGLA5 F ROGERS Term i 1 9 1 t o 1 1-01 012 <br /> COMMERCIAL GEN�RAL LIABILITY COVERAGE <br /> LIMITS Of INSURANC� <br /> General Agg regate �500,000 <br /> P�od�cta Com Ieted t/o s d te ate tions) 500.800 <br /> Pe�sonel Injupy And Advertising jury 500,000 <br /> Each Occurrence 500,000 <br /> Damage to Premises Rented to Yau {Fire Damage) 50,000 Any One Premises <br /> Medical Payments 5,000 A�y One Person <br /> Twice the "General Aggregate Limlt", Shawn above, is provided at no additionsl <br /> charge for each 12 month period in accardance wlth form 55300. <br /> AUDIT TYP�: Annual Audit <br /> FORMS THAT APPL.Y 'r0 rH�S cOVERAGE: 59350 (01-08) 55066 (OS-ss i�oaz� �� � <br /> IL0017 11-85) 55146 (06-04 55188 09-04 55238 (06-04) 55300 (Q7•05) <br /> 55371 �{01-07) 55296 {09-093 55376 �04-11; <br /> LpCATIpN OF PREMI8ES YOU OWN, RENT OR OCCUPY <br /> LOC 002 BLDG 001 33184 Portag e Path <br /> Dade C(ty, FL 33523-9�14 <br /> TERRITQRY: OOS COUNTY: Pasco <br /> Premiunt <br /> Classification Subiine Basis Rates Premium <br /> CODE 21585 Total Costs Each 1U00 <br /> Premier Contractors Class PremlOp j f Any 1.409 <br /> Sub-Cont�aCtsd Work Prod/Comp Op <br /> CObE 22478 P a y r o l l Each 1000 <br /> Premier Contractors Class P�em/Op 15.000 11.738 g176.D0 <br /> Electric Work Within Buildings Prod/Comp Op 15,000 3.241 $49.00 <br /> T�RRORISM - CERTlFIED ACTS SEE FORM 59350 $2.00 <br /> LOCATION 002 PREMIUM $227.Q0 <br />