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05/23/2011 08:37 9545775412 RAY PALHEGYI INSURAN PAGE 02 <br />FN)Iicy number: 033787095 <br />ASA DRAINAGE AND VAC <br />Page 2 at 4 <br />Outline of coverage <br />JAMES5CRIMA <br />0#4x" on <br />... I .. ...... ................... ............. . - ............................. <br />Lir"t, ......................... ..... D.B010111k <br />f1i "M <br />........... <br />$7 734 <br />Liability To Others <br />2. <br />Bodily Injury and Properly Damage Liability <br />&I,000,000 combined single limit ......... ................... <br />1.11 ................ <br />...... I ....... - <br />... -- ... ....... ............ ............................................ <br />Hired Auto Liability To Others <br />189 <br />Bodily�iabil� r <br />$ 1,000,0W combined single limit <br />............ ................ I ....... ................. I ......... I ........................ <br />. <br />167 <br />Employer Non -Owned Auto Liability To Others <br />7 <br />Wily injury and Property Damage Liability <br />$1,000,000 combined single limit .......................................................... <br />O'n, i , ns , u , In , d , Motorist , , , Non - Stacked ...................... <br />S1 1 000,00 0 combined sin le limit I .......... I ..................................... <br />1,998 <br />Basic 0�r's'o-n-al,fn'Ju-ri, *P,,r'o',1te,-c,ii'0"n* ....... ....... * ........... <br />........ .., ................... <br />199 <br />Without Wotk Cbrnp-Nanied Insured Only <br />$10,000 each person $0 <br />.1, .......... I ................. ...... ....................... <br />— ............. <br />Medical . ........... ** ------ <br />..................... <br />$5,000 each person ......................... .............................................. <br />46 <br />Fire And Theft With Combined Additional ... ................ <br />Coverage <br />I ................ .......... <br />1,582 <br />See Auto Coverage <br />Limit of liability less deductible .......................... <br />! ............... <br />.................... <br />�.: .... — ....... ...................... I ...................... <br />Collision <br />52.996 ........ 3666 <br />1,380 <br />See Auto Coverage Schedule <br />Limit of liability less deductible <br />Subtotal palky li.m.. i.u..m .... ............................................... <br />......................... ......... ........................... <br />SIM95.8.0 <br />.................. — ... ....... .......... <br />Florida Hurrianc Catastmphc FwW Aawsmant <br />............................. . ................................ <br />163.73 <br />.... - ...... ................... ..... ...................... <br />fees ................................................ <br />Tota112�mon1� polity <br />........ .......................... <br />.............. ...................... <br />100.00 <br />.... ...... <br />Total 72 month peliq am and fen <br />...... <br />$500 <br />$5 94 <br />Number of Employees: (0 - 10) <br />Cost of Hire: 55,000 or less (if any) <br />Rated drivers <br />1. <br />JAMES5CRIMA <br />...................................................... <br />2. <br />Auto coverage <br />schedule <br />1. <br />1999 Ford L9T <br />Stated Amount: <br />160,1300 <br />VIN- 1F[)Z596KIWVA41470 <br />Garaging Zip Code: <br />3307.8 <br />Radius: 50 <br />Liability <br />L40111ty UwJM M ..... <br />PIP <br />Med Poy <br />.............................................. <br />.................... <br />Premium <br />52.996 ........ 3666 <br />b46 <br />323 <br />Physical-Damage <br />FT/W FrOC <br />DedtKvW IRMO= <br />w(w <br />Dedmj* <br />(UN51W <br />... ... <br />AU10 TOM <br />Premium <br />$500 <br />...... <br />$500 <br />$5 94 <br />11 11 0 <br />2. <br />1997 Ford NSF <br />Stated Amount: <br />$45,000 <br />VIN: IFOYR82EIVVA21025 <br />Garaging Zip Code: <br />33028 <br />Radius- 50 <br />Liability <br />Uatiffty ummmul <br />*146 ............. <br />PIP <br />" <br />mep!! ............................................................................... <br />­iij <br />.............. <br />Premium <br />i249-9-6 ........ <br />W <br />.FTXAC I•TOC C6111511M •NSW Auto Tote <br />Physical Damage Ded . 0 . a . Oe ......... PM14 . M ... ....... . De d I KO le ......... PMMIUM ..................................................... ........................ ........ <br />Premium $50D $571 $ Soo 3476 <br />Form fial; FL OSPO <br />