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CERTIFICATE OF LIABILITY INSURANCE (504)AC•ROe CERTIFICATE OF LIABILITY INSURANCE 41..------- DATE(MM /DD/YYYY) 8/4/2014 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Maureen Rogan, CIC IAHCNN .Extl: (727)391 -9791 I IAC.No): (727) 393 -5623 ADDRESS:maureen . rogan@ stahlinsurance . corn INSURER(S) AFFORDING COVERAGE NAIC # INSURERAAmerisure Mutual Ins Co LIABIUTY COMMERCIAL GENERAL LIABILITY INSURED Ed Seifried Construction Inc 6985 1st Avenue North St Petersburg FL 33710 INSURER B : GL2039647 RECEIVE AUG 2014 1 INSURERC: 8/17/2015 INSURERD: $ 1,000,000 INSURER E : 100 000 $ r INSURER F : COVERAGES CERTIFICATE NUMBER:CL148422403 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 WVD POLICY NUMBER POLICY EFF IMM /DDIYYYY) POLICY EXP IMM /DD/YYYY) LIMITS A GENERAL X LIABIUTY COMMERCIAL GENERAL LIABILITY GL2039647 RECEIVE AUG 2014 1 7/2014 S f 8/17/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREMISES l (Ea occurrence) 100 000 $ r CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE POLICY LIMIT APPLIES PE PER: 7 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X — • X LIABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X` SCHEDULED AUTOS NON -OWNED AUTOS UM ICw& CORDS �/�� LEGISLATNE SRNCS CA2056886 AND DEPT 8/17/2014 8/17/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments $ 5 , 000 A X UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE CU2039142 8/17/2014 8/17/2015 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X RETENTION$ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N - ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC2039143 8/17/2014 8/17/2015 I TORY LIMITS I I 10TH- 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 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 Kelly Petzold/ROGAN i_ ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD