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CERTIFICATE OF LIABILITY INSURANCE (791)FrankCrum 8/30/2016 07:50 Page2 /2 1a CERTIFICATE OF LIABILITY INSURANCE DATE Mme) 08/30/2016 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 po♦cy (lea) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condldons of the policy, certain polities may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Neu of such endorsement(s). PRODUCER FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME: PHONE (A/C, No, E t): 1 -000. 277 -1620 s4800 I FAX INC, No): (727) 797 -0704 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAICI INSURER A: Frank Winston Crum Insurance Ca 11600 INSURED FrankCrum UC/F Specialized Roofing & Contracting, Inc. 100 South Missouri Avenue Clearwater, FL 33756 INSURER B: INSURER C: INSURER 0: EACH OCCIItRENCE INSURER E: INSURER F: DAMAO! To RENTCD PREMISES /Ea occurrence) • MS M TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNRTHSTANDSIG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIUCII THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TIE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDr110NS OF SUCH POLICIES. LIMITS SNO'N MAY HAVE BEEN REDUCED BY PAID CLAIMS. N6R LTR TYPE OF RIBURANCE ADD/ NERD SUM VWD NUMBER POLICY POLICY W. WWDDNYWI POLICY (MIADNYPO Liam COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCIItRENCE 4 CLAIMS -MME DAMAO! To RENTCD PREMISES /Ea occurrence) S MEDEXP (Any one person) S PERSONAL EADJ INJURY S BENL AGGREGATE UNIT APPLES PER POUCY a PROJECT JLOC OTFER GENERAL AOOREGATE 5 PRODUCT9.COMPOOP AGO S S AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY AIRED AUTOS ONLY — — SCHEDULED AUTOS NON-OWNED AUTOS ONLY COMBINED SINGLE Lean (Ea accident) S BDOLY INJURY �raesan) S BODLY INJURY (Per aunt) I PROPERTY DAMAGE NP-a =Math S $ UMBRELLA LIAR EXCESS LIAR _ OCCUR C.AIOS-AIAOE EACH OCLRPENCE t AGGREGATE S DEO I RETENTION s $ A WORKERS COMPENSATION AND EMPLOYERS' UMIL TY Y/N ANY PROPMETONPARLNERIE)ECUTIYE El OFFTCERAISMER EXCLUDED? (XaedeM7 in NH) Ilya, disunite under DESCRIPTION OF OPERATIONS balm NIA WC201600000 01/01/2016 01/01/2017 x I PER ` STATUTE I°" ER El. EACH ACCIDENT =IA001000 El. DGFaca-EA EMPLOYEE St ,000,000 EL DISEASE-PQJCY UMW 51.000.000 DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more apace ie required) Effective 03/09/2015, coverage Is for 100% of the employees of FrankCrum leased to Spedalzed Roofing & Contracting, Inc. (Client) for whom the dient is reporting hours to FrankCrum. Coverage is not extended to statutory employees. CANCELLATION City of Clearwater 100 South Myrtle Avenue Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL RE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,�": . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ®1988 -2016 ACORD CORPORATION. AI rights reserved. FrankCrum 8/31/2016 07:30 Page2 /2 Accm- ii CERTIFICATE OF LIABILITY INSURANCE DATE ('d'"D°"W"') 08/31/2016 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 POUCIES 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 poky (les) must have ADDITIONAL INSURED provisions or 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 Neu of such endoreement(a). PRODUCER FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME: PHONE (A/C, No, Exl): 1 -000- 277 -1620 x4800 I FAX (A/C, No (727)797 -0704 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAM* INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED FrankCrum L/C/F Specialized Roofing & Contracting, Inc. 100 South Missouri Avenue Clearwater, FL 33756 INSURER B: INSURER C: INSURER 0: INSURER E: S INSURER F: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTFICATE NAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAM CLAIMS. INEA LTR TYPE OF WSURANCE Abel NERD sum MO P'OIJCY NUMBER POLICY FM NMIDDIYYYY) POLICY EIW (AN m,) LIMITS COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE S CLAIMS-MADE DAMAGE To RENT ED PREMISES (Ea omen.* S NED EXP(Anyo ) � $ GHNL PERSONAL E. ADV INJURY $ AGGREGATE UNIT APPLES PER POLICY PROJECT JLOC OTHER GENERA. AGGREGATE S PRODUCTS COMPOP ADO I I AUTOMOBILE LIABYJTY ANY AUTO OWNED AUTOS ONLY NEED AUTOS ONLY —QED — AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LAIIT ea fEa ide.di I — GODLY INJURY (Per mean) S _ — BODILY INJURY (Per mordent) S PROPERTY DAMAGE 1Pvabridv8 A A — UMBRELLA DAB EXCEED LAB —y OCCUR C ARTS -NAIN EACH OCURRENC£ $ AGGREGATE S DEO I I RETENTION S S A WORKERS COMPENSATION AM) EMPL0YERSE UABILRY Y M ANY PROPRIETORrPARTNEREXECUTIVE OFFICERAAEMBER EXCLUDED? (M.ndoto.y in NI N yes, decaBe under DESCRIPTION OF OPERATIONS below N/A WC201600000 01/01/2016 01/01/2017 X STATUTE 1 0TH. ER El. EACH ACCIDENT SUMO d90 El. DSEASE-EA EMPLOYEE 11,000,900 E.L DISEASE- POIJCY UNIT $1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Renmrka Schedule, may Effective 03109/2015, coverage Is for 100% of the employees of FrankCrum leased to Spedalized reporting hours to FrankCrum. Coverage is not extended to statutory employees. be attached N more apace is required) Rooting & Contracting, Inc. (Client) for whom the dient is City of Clearwater 100 Clearwater, South Myrtle Avenue Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) The ACORD name and logo are registered merits of ACORD ®1986 -2016 ACORD CORPORATION. All rights reserved.