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CERTIFICATE OF LIABILITY INSURANCE (533)ACORO® L� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/2/2014 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 Jack Rice Insurance 13080 S Belcher Rd Largo FL 33773 CONTACT Commercial Lines Division NAME: IA /C N Extl: (727) 530 -0684 FAX Not: (727)532 -9602 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC If INSURERAAuto- Owners Ins. Co. 18988 INSURED Randy Eggers Roofing LLC 394 Ulelah Ave Palm Harbor FL 34683 -1815 INSURERB:Bridgefield Employers Ins. Co. 10701 INSURERC: 10/1/2015 INSURERD: $ 300 , 000 INSURER E : $ 50, 000 INSURERF: $ 5,000 COVERAGES CERTIFICATE NUMBER:CL1410236386 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 SUER WVD POLICY NUMBER POLICY EFF (MDD/YYYY) POLICY EXP (MMIDDIYYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 20580515 ECE ED0/1/2014 ca % 2014 OCT 0 1 2014 10/1/2015 EACH OCCURRENCE $ 300 , 000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50, 000 MEDEXP(Anyoneperson) $ 5,000 CLAIMS -MADE IX OCCUR PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300,000 PRODUCTS - COMP/OP AGG $ 300 , 000 G AGGREGATE LIMIT APPLIES PER: X I POLICY n .IIF(.T Ti LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS x SCHEDULED AUTOS NON -OWNED AUTOS p� C OFFICIAL RECORDS J���+ 1 /�Tn,/C SRVCS 96717S9B09� DEPT 10/1/2014 10/1/2015 COMBINED SINGLE LIMIT (Ea accident) 500 r 000 BODILY INJURY (Per person) _I_ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Commercial Auto Plus Package $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ B WORKERS COMPENSATION AND EMPLOYERS' LIABIL TY ANY PROPRIETOR/PARTNER /EXECUTIVE IY I NI OFFICERMEMBER EXCLUDED? (Mandatory In NH) I If yes, describe under DESCRIPTION OF OPERATIONS below N / A 083024670 3/1/2014 3/1/2015 X WC STATU- I I OT FR E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION (727)726 -2228 City of Clearwater 100 South Myrtle Avenue 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 Cynthia Webster /LPW � /mil. L4 ACORD 25 (2010/05) INSO25 r?nlnnsl 01 ©1988 -2010 ACORD CORPORATION. All rights reserved. Tha Ar f1R11 nnma nnrl Innn 2rn ranictarari mrsrlrc of enriar1 COMMENTS /REMARKS AUTOMOBILE LIABILITY: Scheduled Additional Insureds for Lessors per form 19020 10/80. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.