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CERTIFICATE OF LIABILITY INSURANCE (161)A�� ° CERTIFICATE OF LIABILITY INSURANCE DATE 3") THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lassiter -Ware Insurance of Leesburg 1317 Citizens Blvd. Leesburg FL 34748 CONTACT Connie Russell PHONE No. Ertl: (800)845 -8437 I ac.Nol: (888) 883 680 E-MAIL cornier @ lassiter- ware.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC it INSURERA:Bridgefield Employers Ins Co 10701 INSURED Dee's Roofing, LLC 5480 Johnson Avenue Haines City FL 33844 INSURER B: Z:s INSURERC: INSURERD: $ INSURER E : $ INSURERF: CLAIMS -MADE OCCUR COVERAGES CERTIFICATE NUMBER:13 /14 Master • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR wvn POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP IMM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY Z:s / ,- EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PFR9 LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS a ` p .' ` 3 .. _.... COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ — UMBRELLA UAB EXCESS LIAB _ OCCUR CLAIMS -MADE '"" �) ' C �, �, i EACH OCCURRENCE $ AGGREGATE $ DED I I RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 0830 -45328 6/11/2013 6/11/2014 x I TORY LIMITS I IOER E.L. EACH ACCIDENT $ 100, 000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION (727)562 -4576 City of Clearwater 100 S Myrtle Avenue Clearwater, FL 33758 -5520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Doug Childers /VIVR ACORD 25 (2010/05) 1NS025 (201005).01 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD