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CERTIFICATE OF LIABILITY INSURANCE (164)AWRO® CERTIFICATE OF LIABILITY INSURANCE GATE (MMIDD/YYYY) 12/19/2012 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 CGB Insurance, LLC 2531 Green Forest Lane #1 0 1 Lutz FL 33558 CONTACT Audra Browder NAME: PHONE ExtJ (813) 749 -7948 (NC, No): (813) 200 -2120 E- MRESS:audra @egbinsurance.corn INSURER(S) AFFORDING COVERAGE NAIC # INSURER A Depositors Insurance Co 42587 INSURED The Dan Wright Corp 5319 Locust Place New Port Richey FL 34652 INSURER B ASSOCiated Industries 23140 INSURERC: EACH OCCURRENCE INSURERD: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) INSURERF: ICATE NUMBER:2013 -2014 Master REVISION NUMBER: 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 WVD POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP (MM/DD /YYYY) LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ACP592453892 .mr � - (, 1 �I: i� .... : -, -. ; _. _ .. 28/2013 6/28/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PF� PER: LOC $ A UTOMOBILE AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON-OWNED ED ,; ACP592p4$3896 /,; ) ,28/2p13 6/28/2014 COMBINED SINGLE LIMIT (Ea accident) 1 000 000 $ r BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (PerracEcident)AMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ACP5924538926 6/28/2013 6/28/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED X RETENTION$ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y / N OFFICER /MEMBER EXCLUDED? Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A AWC1018373 1/1/2013 1/1/2014 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater Occupational License Dept PO Box 4748 Clearwater, FL 33758 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 Kraig Blancher /AMANDA ACORD 25 (2010/05) I N S025 roni nnFi El © 1988-2010 ACORD CORPORATION. All rights reserved. Then Af_f1Rn nmmn and Inn^ wren rnnicfenrnrl mnrlac of AftflRll