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CERTIFICATE OF LIABILITY INSURANCE (402)ACCPRIff CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 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 SIHLE INS GROUP INC 2653 MCCORMICK RD CLEARWATER 28WRF FL 33759 CONTACT NAME: PHONE (A/C, No, Ext): I FAX (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE LIABILITY COMMERCIAL GENERAL ICLAIMS -MADE NAIC # INSURERA:FLORIDA W.C. JUA €((j""�, Ir47 t `._..,._.r: .. =-- INSURED HOLLANDER EXTERIORS INC DBA WEATHER TITE WINDOWS & 2119 WEST COLUMBUS DRIVE TAMPA FL 33607 INSURER B: $ INSURER C: $ INSURER D: MED EXP (Any one person) $ INSURER E: PERSONAL & ADV INJURY INSURER F: VERAGES CERTIFICATE NUMBER: 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 POLICY EFF (MM /DD /YYYYL POLICY EXP (MM /DD /YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL ICLAIMS -MADE LIABILITY €((j""�, Ir47 t `._..,._.r: .. =-- J� l ., \'+ - =- f EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence $ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN —I L AGGREGATE LIMIT APPLIES PER: POLICYn PROJECT n LOC PRODUCTS - COMP /OP AGG t s AUTOMOBILE LIABILITY ANY AUTO AUTOS AUTOS HIRED HIRED AUTOS NON-OWNED AUTOS .. .. � , ,i, :. -, „� ._.- I L U �- •- -- i COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ — _ — PROPERTY DAMAGE (Per accident) $ ^^ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDI IRETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? Y/N (Mandatory in NH) IT t.- If yes, describe under DESCRIPTION OF OPERATIONS below N/A - (6FR 13UB- 7D7501 3 -9 -1 4) 01 -03 -14 01 -03 -15 WC STATU- OTH- X TORY LIMITS' I ER E.L. EACH ACCIDENT $ 1,000,000 E.L.IJIJCN6E - EA EMPLOYEE $ 1 . 000 , 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C11 ADORD 101, Additional Remarks Schedule, If more space is require CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 100 S. MYRTLE AVE. CLEARWATER FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREFO, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD A FIORNAA WORKERS. COMPENSATION JO*4T lNN)ERWRRINC ASSOCIATION. NC. FWCJUA P.O. BOX 3556 ORLANDO FL 32802 -3556 03361 -AM CP 01 6640 G6640P0S 14025 03361 P1 CITY OF CLEARWATER 100 S. MYRTLE AVE. CLEARWATER FL 33756 ACORD CERTIFICATE OF INSURANCE (On Reverse)