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CERTIFICATE OF LIABILITY INSURANCE (227)------, ® �`� ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 8/27/2013 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 Tampa Bay 4401 West Kennedy Blvd Suite 200 Tampa FL 33609 CONTACT BJ Small NAME: rAin Et, (800)845 -8437 FAX Not: (888)883 -8680 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Amerisure Mutual Insurance Co. 23396 INSURED H &H Mechanical, Inc. P. O. Box 1196 Brandon FL 33509 INSURERB:Amerisure Insurance Company 19488 INSURER C : 9/1/2014 INSURERD: $ 1,000,000 INSURER E : $ 300,000 INSURER F: $ 10,000 COVERAGE CERTIFICATE 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 TYPE OF INSURANCE ADDL INSR SUBR W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP M/ (MDD/YYYYI LIMITS A GENERALUABIUTY X COMMERCIAL GENERAL LIABILITY CPP2048099 -, "_- " " -''. ' - -- :.. 9/1/2013 9/1/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 X Contractual GENERAL AGGREGATE $ 2,000,000 X XCU Included PRODUCTS - COMP /OP AGG $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: POLICY I •n l PRO- POLICY I I LOC IF $ A AUTOMOBILE X _ X LIABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X NON SCHEDULED AUTOS -OWNED AUTOS t¢ -. CA2048008 " - 9'/112013 9/1/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Uninsured motorist combined $ 100,000 A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE CU2048101 9/1/2013 9/1/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED I X I RETENTION$ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE �YIN OFFICER/MEMBER EXCLUDED? I ' I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A NC2025973 9/1/2013 9/1/2014 WC STATU- X I TORY I IMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E 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) Re. Blanket / All Projects CERTIFICATE HOLD CANCELLATION City of Clearwater P. O. Box 4748 Clearwater, FL 34618 -4748 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 Kirk Bramlett /BJSMAL TA - `—iEw.— _ ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD