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CERTIFICATE OF LIABILITY INSURANCE (452)STATE -4 OP ID: AJ AL`...- RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 10/25/2013 THIS CERTIFICATE IS ISSUEDAS 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:386- 252 -9601 Brown & Brown of Florida, Inc. Fax: 386 239 5729 Daytona Beach Office - - P.O BOX 2412 Daytona Beach, FL 32115 -2412 Richard Fulton NAME: PHONE FAX (A/C No, Ext): (NC, No): (MM /DD //�) ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Auto Owners Insurance Co. 18988 INSURED STATEWIDE CONSTRUCTION RICK PATTERSON, INC. DBA 5458 HOFFNER AVENUE SUITE 308 ORLANDO, FL 32812 INSURER B :Association Insurance Company 11240 INSURER C: First Mercury Insurance 10657 INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) 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. ILTR TYPE OF INSURANCE IANSR WVD POLICY NUMBER (MM// DYE) (MM /DD //�) LIMITS C GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY NJCGL000 U t • • "` OCT ! 213 fop°�5 n i►I »� }a 'lm 10/29/2013 yr p +I ti 10/29/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ EXCLUDED CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 X PER PROJECT AGG PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO- JFCT PER: LOC�'� Em Ben. p $ 1,000,000 A AUTOMOBLE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X X SCHEDULED AUTOS AUTOS fNEJ AUTOS �^'�,�+�;, S��ATIVE SR CJ 463220 >r Dar i 04/18/2013 04/18/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY accident) ( ) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NJEX000000101602 10/29/2013 10/29/2014 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED X RETENTION $ 0 B WORKERS COMPENSATDN 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 WCV050074906 04/16/2013 04/16/2014 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITYCI0 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 REPRESENTATWE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of PCORD