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CERTIFICATE OF LIABILITY INSURANCE (799)LRSIMMO -01 LALLEN '4�RO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/6/2016 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 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 Florida Insurance Center, Inc. 414 N Alexander St Plant City, FL 33563 CONTACT Linda Allen NAME: PHO No. ExNE FAX No): E-MAIL ADDRESS: linda @floridainsurancecenter.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance Company 24112 INSURED L R Simmons Plumbing Inc 333 Falkenburg Rd Unit A -103 Tampa, FL 33619 INSURER B : CWP3985240 r }'` � INSURER C : 09/08/2017 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS I` SR TYPE OF INSURANCE ADDL -SUBR INSD WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYYi LIMITS A X COMMERCIAL GENERAL LIABILITY CWP3985240 r }'` � 09/08/2016 � � ` � 09/08/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR DAMAGE PREMISES Ea occurrence) $ 150,000 MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS PIP X SCHEDULED AUTOS NON -OWNED AUTOS CWP3985240 __ -' • �!! 09/08/2016 s'` ' _ 09/08/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1000,000 , BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP $ 10,000 A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE CWP3985240 09/08/2016 09/08/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED X RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A STATUTE ERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Leased /Rented Equip CWP3985240 09/08/2016 09/08/2017 Maximum 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) License #CFC044167- Leon Ray Simmons CERTIFICATE HOLDER CANCELLATION City of Clearwater tY 100 S. Myrtle Ave 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 RE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD