CERTIFICATE OF LIABILITY INSURANCE (914) a DATE(MMIDDIYYYY)
- CERTIFICATE OF LIABILITY INSURANCE
7161201$
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 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 lieu of such endorsement($).
PRODUCERCONTACT
SUNZ Insurance SOIUtIOnS, LLC. ID: VenSUre HR) NAME: Tiffany Meyer
2[+4,2.5 Commerce Ave PHONE FAX _._
Suite 300 AIC No.Ext!: .........__._ (AIC,Nal:
E-MAIL
Duluth, GA 30096 ss: tiffany.Ineyer(rD_vensure.corn
INSURERIS)AFFORDING COVERAGE NAIC
INSURP.R A; United Wisconsin Insurance CompanV 29157
INSURED INSURER B
Vensure 1-IR
2425 Commerce Acle .,INSURER C:
Suite 300 INSURER D:
Duluth GA 30096
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 43009110 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 ADSL SUBR. POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE IVSD WVD POLICYNUMBER MWDD"YY) MMIDDIYYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED-
' CLAIMS-MADE 171 OCCUR PREMISES Ea oeeurrernce $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN`L AGGREGATE LIMIT APPLIES PER: J GENERAL AGGREGATE _ $
POLICY JECT LDC PRODUCTS $
- _.
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ivs accident
ANY AUTO BODILY INJURY(Per person) $ _
l� OWNED SCHEDULED �..—....'.._.__._."`"
1 AUTDS ONLY AUTOS I BODILY INJURY(Per accident) $
jm . HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY ..Per accident $
$
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB ._._. ,CLAIMS-MADE AGGREGATE $ _ ...
DED RETENTION$
A WORKERS COMPENSATION WC516-00001-018 2/19/2018 11112019 STATUTE ERH-
AND EMPLOYERS'LIABILITY Y I N
ANYPROPRIEToR/PARTNERlEXECUTIVE E.L.EACH ACCIDENT $1,000�0aa
OFFICERtMEMBER.EXCLUDED? ❑ NIA .._ _._
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 aaa m
If yes,describe under
DESCRIPTION OE OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,()()(),000
i
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Coverage provided for all leased employees but not subcontractors of:JW Harris Contractors Inc
Client Effective:712/2018
CERTIFICATE HOLDER CANCELLATION
11641
Cit Of Clearwater Administrative THE
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
C Ce and South Area Service Center ACCORDANCE WITH THE POLICY PROVISIONS.
400 NorthMyyrtle Ave
Clearwater FL 33755
AUTHORIZED REPRESENTATIVE
Glen J Distefano
071988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
434031.10 1 Vensure HR PEO 516 MASTER CERT I Shawna Calcatera 7/6/2018 8:38:45 AN (EDT) I Page 1 of 1.