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CERTIFICATE OF LIABILITY INSURANCE (685)ArcoRt CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 12/18/2015 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 Stahl & Associates Insurance Inc. RECEWED 3939 Tampa Road p Oldsmar FL 34677 DEC 3 tj» CONTACT Susan Goodman CPCU ARM PHONE (813) 818 -5300 FAx Ex: (A /C, No): (813) 618 -5396 t) E-MAIL ADDRESS :sue.goodman @stahlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Southern Owners Insurance Co 10190 INSURED A Plus Fireplaces Granite & Marble IncGAS MJMIN 8133 Ridge Road Port Richey FL 34668 INSURER B :Owners Insurance Co 32700 INSURERC:Bridgefield Employers Ins Co 10701 INSURER D : $ 1,000,000 INSURER E : INSURER F : X CERTIFICATE NUMBER:CL15121829496 • 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 W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP IMM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 20264567 .e!» 9/12/2015 9/12/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES 78-,- PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 Employee Benefits $ 1,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS Ori t^ I s IA e •r (. (_ OFFICIAL 4928099401 L'-�` 1 LL..... <_ ',l rL _' -:( 1),S tf'- S) '/ 4-X_y 19/12/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ BFCGL $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 4928099402 11/11/2015 9/12/2016 EACH OCCURRENCE $ 2,000,000 $ 2,000,000 $ AGGREGATE DED X RETENTION$ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER ry in NH) EXCLUDED? (Mandatory If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A 083049754 1/1/2016 1/1/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) General Liability and Auto Liability include a Blanket Additional Insured and Waiver of Subrogation, when required by written contract, and subject to policy terms, conditions and exclusions. Coverage is primary and non - contributory. Workers Compensation includes a Waiver of Subrogation when required by written contract. CERTIFICATE HOLDER CANCELLATION City Of Clearwater Development & Neighborhood Services Dept 100 S Myrtle Ave Clearwater, FL 34618 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 Mike Pagano, AAI /GOOD ' ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD