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CERTIFICATE OF LIABILITY INSURANCE (410)RCARR -1 OP ID: KB A`C.° -R° CERTIFICATE OF LIABILITY INSURANCE DATE 06(24 /2014 Y) 06/24/2014 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 Phone: 727 - 784 -8554 Stahl & Associates Insurance 727 - 789 -2823 3939 Tampa Road Oldsmar, FL 34677 Michael Pagano, AAI NAME: CT Kim Bromaghim PHONE g13- 818 -5320 FAX (A/C. No. Ext): (A/C, No): 813 - 818 -5396 ADDRESS: kim.bromaghim @stahlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Southern Owners 10190 INSURED R. Carr, Inc. Tom Shores 250 9th Avenue North Safety Harbor, FL 34695 INSURER B: Owners Insurance Company 32700 INSURER C : FFVA 07/01/2015 INSURER D : $ 1,000,000 INSURER E : $ 300,000 INSURER F : COVERAGES CERTIFICATE 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. INR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 20118419 j ', = °'Ei 71Q1ROT4 , 07/01/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY X LIMIT APPLIES VT- PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS 9652061902 u t J _ 07/01/20'14 07/01/2015 COMBINED SINGLE LIMIT (Ea accident) 1000,000 $ , BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 9652061903 07/01/2014 07/01/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENT ON $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A WC84000252002014A 01/01/2014 01/01/2015 X WC CY STATU- 0TH- ER E.L. EACH ACCIDENT $ 1,000,000 E . DISEASE - EA EMPLOYEE. $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Equipment Floater 20118419 07/01/2014 07/01/2015 Leased & 50,000 Rented Eq 500 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101,/Additional Remarks Schedule if more space is required) License Holder: Rodney M. Carr License #CFC019221 CERTIFICATE HOLDER CANCELLATION CLEAR -5 City of Clearwater 100 Myrtle Ave. 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 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD