CERTIFICATE OF LIABILITY INSURANCE (610), 1 � � .,; � u,rr p: r: �.
ACORO C E RT I F I CAT E O F LIA B I LITY I NS U RA N C E DATE (MM/DD/YYYY)
�� 03/03/2015
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 DAVID FRAYER, AGENT coNracr Jamie or Victoria for Certificates
NAME:
Commercial & Home Insurance Inc PHONE �727� 527-5700 FAx
.(727) 527-6285
5635 49th Street N E�MA�� vbuchanan or filion @cehinsurance.com
ADDRESS� �
St Petersburg FL 33709-
INSURED Deichman Construction LLC
Gregory A.Deichman
2710 ALT 19 NO, STS 301-120
Palm Harbor FL 34683-2600
CASUALTY
COVERAGES C�RTIFICATE 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 ADD UBR POLICY EFF POLICY EXP
�7R TYPE OF INSURANCE POLICY NUMBER LIMITS
j,� GENERAL LIABILI7Y 4GL000923886 02/26/2015 2/26/2016 EACH OCCURRENCE $ 1� 000 � 000
X COMMERCIAL GENERAL LIABILITY / / / / DAMA E ENT
CLAIMS-MADE a OCCUR � � � � �
MED EXP Anaone erson $ 100 � 0�0
� � � � PERSONAL & ADV INJURY $ 1 � OOO � OOO
� � � � GENERAL AGGREGATE $ 2 � OOO , OOO
GEN'L AGGREGATE LIMIT APPLIES PER: � � � � PRODUCTS - COMP/OP AGG $ 2� OOO , 000
X POLICY PR� LOC � � � � NOWND $
AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT
ac iden
ANY AUTO � � � � BODILY INJURY (Per pereon) $
ALL OWNED SCHEDULED / / / / BODILY INJURY Per accident $
AUTOS AUTOS ( )
HIRED AUTOS p�Tpg�ED / / / / PROPERTY DAMAGE $
Per accident
/ / / / g
UMBRELLALIAB OCCUR � � � � EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE � � � �
AGGREGATE $
DED RETENTION � � � � $
WORKERS COMPENSATION / / / / WC STATU- OTH-
AND EMPLOYERS' LIABIIITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N � � � �
OFFICER/MEMBER EXCLUDED? � N� A E.L. EACH ACCIDENT $
(Mandatory in NH) � � � � E.L. DISEASE - EA EMPLOYE $
If yes, describe under � � � �
DESCIti'r'TIOW Ur OPEr"v1'� iv�vu �vluw E.I DISEASE - POLICY LIMIT $
� � � �
� � � �
DESCRIPTION OF OPERATIONS / IOCATIONS / VEHICLES (Attach ACORD 107, Additional Remarks Schedule, if more space Is required)
GENERP,L CONTRACTOR
DAVID FRAYER, AGENT
GANGELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CITY OF CLEARWATER
AUTHORIZED REPR NTATNE _
100 SOUTH MYRTLE AVENUE ��
CLEARWATER FL 33756-5520 � �
t�{�-.i�'�
ACORD 25 (2010/05) �O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025 �zoioos�.oi The ACORD name and logo are registered marks of ACORD
- S� �0 ����Q
� `
�• . f ,�.
�� �� Q ��� s��� C��, �
� � �-
�
�� � � (�/l�
���
. . S
�Z ,�S � �
X�
�� � �
S��C�<'��� � ����-o� ;.�Cr��
��� � �w� .����, �4-� -