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CERTIFICATE OF LIABILITY INSURANCE (430)ACORO" CERTIFICATE OF LIABILITY INSURANCE OP ID: LA DATE (MM /DD/YYYY) 12/19/2013 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 GULF COAST COMMERCIAL INS 815B CYPRESS VILLAGE BLVD. SUN CITY CENTER, FL 33573 JOHN YOHO INSURED J.H.R. OF TAMPA, INC. DBA HOME IMPROVEMENT SERVICES PETER WOZNIAK LIC# CRC016377 JOSEPH RAYL LIC# CCC058227 RAYMOND MEAD #CVC056656 14377 US HWY 19 NORTH CLEARWATER. FL 33764 COVERAGES CFRTIFIf`ATF Al1IMRCD• CONTACT NAME: PHONE FAX (A /C. No Extl. , (A/C Not E -MAIL ADDRESS: PRODUCER ID #:J H RO F -1 INSURER(S) AFFORDING COVERAGE k NAIC # INSURERA:GEMINI INSURANCE COMPANY 10833 — INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : KtVIUIUN NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSRI LTR i IS TO CERTIFY THAT NOTWITHSTANDING MAY BE ISSUED AND CONDITIONS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER (MM/LDD //YYYY) (MM /DD //YYYY) LIMITS A GENERAL i X GEN'L - -I LIABILITY COMMERCIAL GENERAL LIABILITY t_- f CLAIMS -MADE LX OCCUR ,VFGP001525 .1-.1,,,,, " 3. [Vl� . 9�r !S a _ y + c aP itaj ?'gag. f: $ °��° -: F02013 1 q# ep�il"\.; 12/17/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES {Ea occurrence" $ $ 50,000 EXCLUDED 1,000,000 2,000,000 EXCLUDED MED EXP (Any one person) PERSONAL 8 ADV INJURY GENERAL AGGREGATE 4 $ $ r $ AGGREGATE LIMIT POLICY I I JECOT PER: PRODUCTS - COMP/OP AGG — I LOC $ AUTOMOBILE _1 LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS i 4..'0.vr�ar + M.:13. & DLn"`"iy ` i COMBINED SINGLE LIMIT r (Ea accident) $ r BODILY INJURY (Per person) - $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR i CLAIMS -MADE EACH OCCURRENCE $ $ AGGREGATE DEDUCTIBLE I RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- t f 0TH - TORY LIMITS I ER 1 E.L. EACH ACCIDENT $ $ below E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PETER WOZNIAK #CCC1327351 f`GnTICIn wTr . In, wow - CITY OF CLEARWATER 100 S. MYRTLE CLEARWATER, FL 33756 I vA11v GGGA I IVIY 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 Yleiw- w ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD