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CERTIFICATE OF LIABILITY INSURANCE (449)ROOFWOR -01 VELAZQUEZA '`'� ""' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/22/2013 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 Insurance Office of America -TPA 4915 West Cypress Street Tampa, FL 33607 CONTACT NAME: PHONE . (A/C, No, Ext): (813) 637 -8877 FAX (A/C, No): (813) 637 -8484 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 10190 10701 INSURER A: Southern- Owners Insurance Company INSURER B : Bridgefield Employers Insurance Company INSURED Roof Works, Inc. 7610 Industrial Lane Suite 13 -M Tampa, FL 33637 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES 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 TYPE OF INSURANCE INSR , = POLICY NUMBER POLICY EFF 1MM /DD/YYYY) 11/1/2013 i^`). ' POLICY EXP (MM /DD/YYYY 11/1/2014 LIMITS A GENERAL LIABILITY 20316333 -13 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea $ 300,000 CLAIMS -MADE X OCCUR '-",7 J . r� " { occurrence) MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 £,, ; r �� ` " / ,..,1‘., ° 9 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: r- PRODUCTS - COMP /OP AGG $ 2,000,000 r AUTOMOBILE r j PRO- POLICY JECT , LOC LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS J SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS k _ PROPERTY DAMAGE (PER ACCIDENT) $ $ UMBRELLA LIAB 1 OCCUR CLAIMS -MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ r DED RETENTION $ $ B WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY N/A 0830 -46493 11/1/2013 11/1/2014 X ' WC STATU- I IOTH- I TORY LIMITS i ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yep, describe under DESCRIPTION OF OPERATIONS below Y/ E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE - —. - E.L. DISEASE - POLICY LIMIT $ 100,000 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater P.O. Box 4748 Clearwater, FL 33758 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 '� j ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD