CERTIFICATE OF LIABILITY INSURANCE (814)FrankCrum
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• CERTIFICATE OF LIABILITY INSURANCE
D 1117 6
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.
TI-IS 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 (les) must have ADDmONAL 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 lieu of such endaaement(a}
PRODUCER
FrankCrum Insurance Agency. Inc.
100 South Missouri Avenue
Clearwater, FL 33756
CONTACT NAME:
PHONE (A/C, No, E)d): (8001277 -1620 X4800 I FAX (A/C, NO (727) 797 -0704
E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAICT
INSURER A Frank Winston Crum Insurance Company
11600
INSURED
FrankCrum UC/F Specialized Roofing & Contracting, Inc.
100 South Missouri Avenue
Clearwater, FL 33756
INSURER B:
INSURER C:
V i
INSURER D:
EACH OCCURRENCE
INSURER E:
INSURER F:
DMAAOE TO RENTED
PREMISES lEa occurmcel
RAGES
CERTIFICATE NUMBER:
410358
2
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 REOLIREMENT, 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.
TR
Tuff OF INSURANCE
N ADM
W W
POLICY NUMBER
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DD,1,M,M,)
UNITS
COMNH2CIAL GENERAL
LIABIUN
OCCUR
. $ .'
a
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EACH OCCURRENCE
4
I .A
DMAAOE TO RENTED
PREMISES lEa occurmcel
S
MED EXP fAm one Person)
S
PERSONAL a ADV INJURY
$
GENT AGGREGATE LIMIT APPLES PER
POLICY Q PROJECT OLUC
OTFETL
GENERAL AGGREGATE
S
PROOUC1SCO1NP/OP AGO
S
S
AUTONO81LS
_
-ONLY
LIABILITY
,
ANY AUTO
OWNED Auras
ONLY
HIRED AUTDS
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SCHEDULE
AUTOS
NON-DINNED
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RDS p
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COMBINED SINGLE UMR
tEe modem) COMBINED
GODLY INJURY (Per psam)
S
BODILY INJURY (Perld9Een)
S
PROPERTY DAMAGE
lPye+ _1
$
S
UMBRELLA LIAR
EXCESS LIAR
_OCCUR
CLA/MS-MACE CLAMS—MACE
EACH OCURPENCE
S
AGGREGATE
A
DED I RETENTIONS
$
A
WORKERS COMPENSATION AND
n i ovERS uABIUTY Y/IV
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Qlandatay in NE)
Ryes, dmenhe under
DESCRIPTION OF OPERATIONS below
NIA
WC201700000
01)01 /2017
01101/2018
X STATUTE I I"
I
El. EACH ACCIDENT
81.000 OM
El. DISEASE-EA EMPLOYEE
$f,000,000
EL DISEASEFOUCY LIMIT
51,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is 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.
CERTIFICATE HOLDER
CANCELLATION
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 WLL BE DELIVERED N ACCORDANCE WITH THE
POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103)
The ACORD name and logo are registered marks of ACORD
®1988 -2016 ACORD CORPORATION. Al rights reserved.