CERTIFICATE OF LIABILITY INSURANCE (305)A� �® CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDDIYYYY)
03/04/2014
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 W.F. DAVISON, AGENT
Commercial & Home Insurance Inc
5635 49th Street N
St Petersburg FL 33709-
.
CONT
NAMEACT For Certificates: Victoria or Jamie
PHOE FAX
(Arc, No, Ext): (727) 527 -5700 IA /C, NO (727) 527 -6285
ADDRESS:
PRODUCER
CUSTOMER ID ti" R400f Masters Preferred Inc
INSURER(S)AFFORDINGCOVERAGE
NAIC#
INSURED
Roof Masters Preferred Inc-
7301 6th Avenue N
St Petersburg FL 33710 -7535
INSURER A WESTERN WORLD
INSURER B :BRIDGEFIELD
PGPO 1
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INSURER c :OLD DOMINION INSURANCE CO
03/04/2015
/ /
/ /
/ /
/ /
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INSURER D :
$ 300, 000
INSURER E :
DAMAGE TO
PREMISES (EaEoccurrence)
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
INSR
SUB 11
VD
POUCY NUMBER
POUCY EFF
(MM /DDIYYYY)
POLICY EXP
(MM /DDIYYYY)
OMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
OCCUR
PGPO 1
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03/04/2014
/ /
/ /
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03/04/2015
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EACH OCCURRENCE
$ 300, 000
X
DAMAGE TO
PREMISES (EaEoccurrence)
$ 100,000
CLAIMS -MADE
X
MED EXP (Any one person)
$ 5, 000
PERSONAL & ADV INJURY
$ 300,000
GENERAL AGGREGATE
$ 600,000
GEN'LAGGREGATE LIMIT APPLIES PER:.���.
PRODUCTS - COMP /OPAGG
$ 600, 000
POLICY j 7 LOC
NOVND
$
AUTOMOBILE
UABIUTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
ai�l�
07/09/2013
/ /
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/ /
/ /
/ /
/ /
07/09/2014
/ /
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COMBINED SINGLE LIMIT
(Ea accident)
$ 100, 000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
—J
B
UMBRELLA UAB
EXCESS UAB
OCCUR
CLAIMS -MADE
/ /
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EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
WORKERS
AND
ANY
OFFICER/MEMBER
(Mandatory
I eSsC
$
COMPENSATION
EMPLOYERS' LIABILITY
PROPRIETOR/PARTNER/EXECUTIVE Y / N
EXCLUDED? [j
In NH)
dRITO uOnF O PERATIONS below
N/A
0830 -44737
04/13/2013
/ /
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/ /
04/13/2014
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X TORY LIMITS W-
E.L. EACH ACCIDENT
$ 100,000
$ 100,000
$ 500,000
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
/ /
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
ROOFING CONTRACTOR
W.F. DAVISON, AGENT
VGR 1 rrwfl I L. "VimLIL.II
( ) —
CITY OF CLEARWATER
100 S. 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
ACORD 25 (2009/09)
INS025 (200909)
- LUUD f1VVRV VVRt- Vr \AIrV II. .
The ACORD name and logo are registered marks of ACORD