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CERTIFICATE OF LIABILITY INSURANCE (168)JAGRE -1 OP ID: SW 4 �, - -- CERTIFICATE OF LIABILITY INSURANCE DATE 06/26/13�) 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 352 - 796 -8200 Brown P 0 Box 5Ax 548 Brown of Florida, Inc InC 352 - 799 -1399 273 North Broad Street Brooksville, FL 34605 -0548 Christopher Scavuzzo NAMEACT Susan Wilder FAX (A/C, No): A/C.NNo. Eat):352- 796 -8200 352 799 -1399 E -MAIL ADDRESS: susanwilder @bbbrooksville.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Westfield Insurance Company 24112 INSURED JA Green Plumbing & Mechanical Inc 602 N. Rome Ave. Tampa, FL 33606 INSURER B : INSURER C : EACH OCCURRENCE INSURER D : DAMAGE TO PREMISES {Ea occurrence) RENTED INSURER E : MED EXP (Any one person) INSURER F : • 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 JNSR SUBR WVD POLICY NUMBER POLICY EFF (MM/ D //YYYY) POLICY EXP (MM /DD/YY Y) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CMM3434747 jfl +y' �-7' d I r [I, _t- - 07/01/13 07/01/14 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES {Ea occurrence) RENTED $ 150,000 MED EXP (Any one person) $ 10,000 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 7 POLICY X LIMIT APPLIES JECOT- PER: LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - SCHEDULED AUTOS NON -OWNED AUTOS CM 1343.4747 . "-,--,-.2,. L f = r n, "`- `' w - , v' - L 07/01/13 07/01/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPS accident) $ PIP $ 10,000 A X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE CMM3434747 07/01/13 07/01/14 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED X RETENT ON $ $0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATION., below Y / N N / A WC STATU- TORY LIMITS 0TH - ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Installation Equip CMM3434747 TEMPORARY STORAGE LOC. 07/01/13 07/01/14 Storage 400,000 Less Ded. 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) John A. Green CF CO19132 John A. Green CM CO13422 William D. Green PMG0013 City of Clearwater 100 South Myrtle Ave., #C -110 Clearwater, FL 34616 -5520 CLEARWA 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD