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CERTIFICATE OF LIABILITY INSURANCE (244)AWR °J CERTIFICATE OF LIABILITY INSURANCE io /2i2ols ) 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 Jack Rice Insurance 13080 S Belcher Rd Largo FL 33773 CONTACT Commercial Lines Division NAME: (TOIL. Extt: (727) 530 -0684 ((NC. No): (727) 532 -9602 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC X INSURER AAuto- Owners Ins. Co. 18988 INSURED Randy Eggers Roofing, LLC 394 Ulelah Avenue Palm Harbor FL 34 683 INSURER la :Bridgefield Employers Ins. Co. 10701 INSURERC: 10/1/2014 INSURER D : $ 300,000 INSURER E : $ 50,000 INSURER F : COVERAGES CERTIFICATE NUMBER:CL1310231571 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 POUCY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 2058051513 10/1/2013 10/1/2014 EACH OCCURRENCE $ 300,000 DAMAGE TO PREMISES (Ea RENTED $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 300,000 GENERAL AGGREGATE $ 300,000 PRODUCTS - COMP/OP AG G $ 300,000 GEN'L AGGREGATE LIMIT APPLIESPER: A I POLICY n PF Q n LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALLOWNED AUTOS HIRED AUTOS _ x _AUTOS SCHEDULED AUTOS NON -OWNED 9671150000 10/1/2013 10/1/2014 (EO aBBIINED SINGLE LIMIT 500 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Commercial Auto Plus Package $ UMBRELLA UAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ _ $ DED I I RETENTION $ B 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 / A 083024670 3/1/2013 3/1/2014 X I TORY LIMIT - I I ER E.L. EACH ACCIDENT $ 100, 000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICL)=S (Attach:ACORO 101, Additional Remarks Schedule, if more space is required) i CERTIFICATE HOLDER CANCELLATION (727)726 -2228 City of Clearwater 100 South Myrtle Avenue Clearwater, FL 33756 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 Cynthia Webster /MMR C7-17"t7,4-‘--,6 I ACORD 25 (2010/05) INS025 (201005)01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMENTS /REMARKS AUTOMOBILE LIABILITY Scheduled Additional Insureds for Lessors per form 19020 10/80. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.