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CERTIFICATE OF LIABILITY INSURANCE (170)ACCPRE, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/74/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF CERTIFICATE DOES NOT AFFIRMATIVELY OR BELOW. THIS CERTIFICATE OF INSURANCE DOES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE IMPORTANT: If the certificate holder is an ADDITIONAL the terms and conditions of the policy, certain policies certificate holder in lieu of such endorsement(s). INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED HOLDER. INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER Aubrey Rogers Insurance Agency Inc. 2400 N.W. 6th Street Gainesville, FL 32609 Phone (352) 373 -2003 Fax (352) 376 -2235 CONTACT Ashley NAME: PHONE FAX ac. No Ext >: (352) 373 -2003 (NC, No): (352) 376 -2235 -MAIL ADDRESS: Ashley @aubreyrogers.com INSURER(S) AFFORDING COVERAGE Insurance Company NAIC # INSURER A : Canal Indemnity INSURED Paul Schaper Construction, Inc. 8949 Gall Blvd Zephyrhills, FL 33541 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS ILTR A IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDLSUBR SUYD 4 POLICY NUMBER (MM /DDY/YEYYYI 06/08/2013 L. :7-7Th ' ✓ i :- .- ' " ° , J (MM/DD/YYYY) 06!08/2014 LIMITS EACH OCCURRENCE $ 1,000,000.00 GENERAL LIABILITY Y GL103182 7-- r-r-Ch DAMAGE TO RENTED PREMISES (Ea occurrence) ' 50000.00 $ , $ 5,000.00 V COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) ❑ ❑ CLAIMS -MADE V OCCUR ❑ PERSONAL &ADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ ;EC ❑ LOC PRODUCTS - COMP /OP AGG $ 1,000,000.00 COMBINED SINGLE LIMIT (Ea accident) $ $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL ❑ AUTOS OWNED ❑ SCHEDULED NON-OWNED ❑ HIRED AUTOS ❑ AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ ■ _ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE N / A y EACH OCCURRENCE AGGREGATE $ $ DED ❑_RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? -- (Mandatory in NH) L_i If yes, describe under DESCRIPTION OF OPERATIONS below $ WC STATU- 0TH ❑❑CRY LIMITS ❑ ER - $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) LICENSE #'S: CPC1456713; CCC059134; CBC059817 CERTIFICATE HOLDER City of Clearwater 100 S. Myrtle Ave #C -110 Clearwater, FL 34616 ACORD 25 (2010/05) QF CANCELLATION 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 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD