The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (515)'4� °� CERTIFICATE OF LIABILITY INSURANCE 8/29/2014 ' 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 Lassiter -Ware Insurance of Tampa Bay 4401 West Kennedy Blvd Suite 200 Tampa FL 33609 CONTACT BJ Small NAME: (Pa"/coNlu Ext): (800) 845 -8437 FAX No): (888)883 -8680 E -MAIL ADDRESS: BJSmall@lassiter- ware.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:United Fire & Casualty Company 13021 INSURED H &H Mechanical, Inc. Joni's Supply, Inc. P. 0. Box 1196 Brandon FL 33509 INSURER B :North River Insurance Company 21105 INSURERC:COmp Options Insurance Co. 10834 INSURERD: $ 1,000,000 INSURER E : $ 000 INSURER F: COVERAGES CERTIFICATE NUMBER:2014 -2015 Master 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 (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) UMITS A GENERAL X UABILITY COMMERCIAL GENERAL LIABILITY , 60451296 RECEIVED014 c SEP 0 2 2 )14 9/1/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES PREMISES (Ea occurrence) $ 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X X Contractual PERSONAL & ADV INJURY $ 1,000,000 XCU Included GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY I ZI jF n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X NON SCHEDULED AUTOS -OWNED AUTOS OFFICIAL RECORDS 60451296 LE�gLATI��E SRVCS AND DEPT 9/1/2015 COMBINentSINGLE LIMIT $ 1,000 000 INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Uninsured motorist combined $ 100,000 B X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE 581- 103294 -3 9/1/2014 9/1/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N N/A H &H Mechanical, Inc. WC810- 007835 -001 Joni 's Supply, Inc. WC810- 007836 -001 9/1/2014 9/1/2014 9/1/2015 9/1/2015 rr r X I TORY I STATU- 1 1OPR 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) Re Blanket / All Projects CERTIFICATE HOLDER CANCELLATION City of Clearwater P. O. Box 4748 Clearwater, FL 34618 -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 Kirk Bramlett /BJSMAL ACORD 25 (2010/05) NS025 (201005).01 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD H &H Mechanical, Inc. and Joni's Supply, Inc. Certificate Notes for Policy Term: September 1, 2014 to September 1, 2015 General Liability: 1. Blanket Additional Insureds when required by written contract for Ongoing Operations per Form CG7207 (03/13) and Products & Completed Operations per Form CG7131 (03/12). 2. Blanket Waiver of Subrogation when required by written contract per Form CG7207 (03/13). 3. Primary & Non - Contributory when required by written contract per Form CG7207 (03/13) for ongoing operations and Form CG7131 (03/12) for Products & Completed Operations. 4. General Aggregate Limit Applies Per Project per Form # CG7207 (03/13). Automobile Liability: 1. Blanket Additional Insureds when required by written contract Per Form #CA7109 (01/06) 2. Blanket Waiver of Subrogation when required by written contract Per Form #CA7109 (01/06) 3. Automobile is a statutory coverage mandated by State Law. As such, coverage is primary and non - contributory. Workers' Compensation: 1. Blanket Waiver of Subrogation when required by written contract per Form #WC000313 (04/84). 2. Workers Compensation includes coverage for all employees including owners & officers. 3. Workers' Compensation provides coverage for the Workers' Compensation benefits in the State of Florida. 4. Workers Compensation is a statutory coverage mandated by State Law. As such, coverage is primary and non - contributory. Umbrella: 1. General Liability, Automobile and Employers Liability policies are listed in the underlying schedule on the Umbrella Policy. 2. The Umbrella Policy contains its own terms and conditions, however, the following endorsement has been added: a. Per Project Aggregate per Form 101.0.2203 (01 /011) 3. Additional Insured with Primary & Non - Contributory part of main umbrella form 101.0.1108 (08/05) when required by written contract. 4. Transfer of Rights of Recovery if prior to loss. General Information: 1. The General Liability, Automobile and Umbrella policies all contain a Severability of Interest Provision. 2. The General Liability Policy contains no specific residential exclusions and is subject to ISO Form CG0001 (12/07). 3. The certificate notes shown above reference the following policies: a. 60451296, WC810- 007835 -001, WC810- 007836 -001, 581- 103294 -3 ALL COVERAGE IS SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS.