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CERTIFICATE OF LIABILITY INSURANCE (424)A`ORbe CERTIFICATE OF LIABILITY INSURANCE ( DATE(MM/DD/YYYY) 11/21/2013 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 FRANKCRUM INSURANCE AGENCY, INC. 100 S. MISSOURI AVE. CLEARWATER FL 33756 CONTACT NAME: PHONE IA/C. Ns, 1-800-277-1620 x4800 Imo. Na 727-797-0704 ADDRESS: INSURER(S) AFFORDING COVERAGE NAICe INSURER A: FRANK WINSTON CRUM INSURANCE CO. 11600 INSURED FrankCrum 1- 800 - 277 -1620 100 S MISSOURI AVENUE CLEARWATER FL 33756 INSURER B: INSURER C: �"' , . .. s:. ~ ~_t INSURER D: EACH OCCURRENCE INSURER E: 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 SUBR WND POLICY NUMBER POLICY EFF (MM/THWYYY) POLICY EXP (MIA/OD/TWO LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE .., rrn t :�;;� / �"' , . .. s:. ~ ~_t EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE UNIT APPUES PER: nPROJECT I —�LOC PRODUCTS - COMP/OP AGG $ ]POLICY $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS -- E s w: + p L.. I...•'•"' "' _' • -; - COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ — AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Ii yes, describe under DESCRIPTION OF OPERATIONS below N/A WC201400000 1/1/2014 1/1/2015 WC STATU• OTH- X TORY OMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POUCY OMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is hired) EFFECTIVE 06 /29/2008, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO COOL AIR SOLUTIONS, INC DBA GRAHAM HEATING & AIR CONDITION (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. RE: (JAMES RAZZINO LICENSE #CMC 1249987 AND MICHAEL LECCESE LICENST #CMC 1239954 ARE COVERED UNDER THIS POLICY 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 THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ..7-7-,..-------....-- ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. A�C,�RO° CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDWYYYY) 11/26/2013 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 FRANKCRUM INSURANCE AGENCY, INC. 100 S. MISSOURI AVE. CLEARWATER FL 33756 NAME: NAME: (NC, Na. Ect): 1 -800 -277 -1620 X4800 J No): 727- 797 -0704 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: FRANK WINSTON CRUM INSURANCE CO. 11600 INSURED FrankCrum 1- 800 - 277 -1620 100 S MISSOURI AVENUE CLEARWATER FL 33756 INSURER B: INSURER C. I ,.., 1 la '1 ,_% Z IF.j 4:i 4 t 3 INSURER D: INSURER E: 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 SUER WVD POUCY NUMBER POLICY EFF (� /YYYY) POLICY EXP (MMIDD/YYYY) UNITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY (CLAIMS -MADE I ,.., 1 la '1 ,_% Z IF.j 4:i 4 t 3 1 " EACH OCCURRENCE $ DAMAGE EMI TO (RENTED PREMISES (Ea occurrence) $ OCCUR MED EXP (My one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEM, AGGREGATE UMIT APPLIES PER POLICY nPROJECT PRODUCTS - COMP /OP AGG $ [ 1LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED"' AUTOS NON -OWNED AUTOS 4 ,,„. ,.,a , ,,° n �,. a 1.,LJ"'• "F �fi 4.�_, •, w✓ _.J.+J"ti ... COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ - AGGREGATE $ DED I I RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC201400000 1/1/2014 1/1/2015 WC STATU- X TORY LIMITS OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 $1,000,000 E.L. DISEASE - POLICY UMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THIS CERTIFICATE REMAINS IN EFFECT PROVIDED THE CLIENTS ACCOUNT IS IN GOOD STANDING WITH FrankCrum. COVERAGE IS NOT PROVIDED FOR ANY EMPLOYEE FOR WHICH THE CLIENT IS NOT REPORTING HOURS TO FrankCrum. COVERAGE IS NOT PROVIDED FOR STATUTORY EMPLOYEES OF THE CLIENT. EFFECTIVE 06/29/2006, APPLIES TO 100% OF THE EMPLOYEES OF FrankCrum LEASED TO GLASS SERVICE 8, INC. 727 -446 -0554 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER P 0 BOX 4748 CLEARWATER FL 33758 - 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 y ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ©1988 -2010 ACORD CORPORATION. All rights reserved.