CERTIFICATE OF LIABILITY INSURANCE (1039)% D
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
08/10/20
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(s).
4ODUCER
kLL BUSINESS UNDERWRITERS
30X 3075
)UNNELLON
SURED
FL 34430
ROLLSHIELD, LLC
GREG MOORE, OWNER / OPS MGR
1151 KAPP DRIVE
CLEARWATER FL 33765
OVERAGES CERTIFICATE NUMBER:
NAME: AALL BUSINESS UNDERWRITERS
PHONE FAX
jou. (727) 403-9470 (AIC, No):
E-MAIL
ADDRESS: ALLBIZUNDERWRITERS BELLSOUTH.NET
INSURER(S) AFFORDING COVERAGE NAIC
INSURER A: SECURITY NATIONAL INSURANCE CO
INSURER B:
INSURER C
INSURER D :
INSURER E
INSURER F :
{
REVISION NUMBER:
v �.cr< r rr r I rug i Inc rt./Lit-4th or INSUKP,NGt LISA I u BELOW HAVE BEEN
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN
ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
REDUCED BY PAID CLAIMS.
POLICY EFF POLICY EXP
IMWDDIYYYY) (MM/DD/YYYY) UMITS
'IkR TYPE OF INSURANCE I W8R"
INSD WVD 1 Y NUMBER
X COMMERCIAL GENERAL UABILITf
+
EACH OCCURRENCE1,000,000
CLAIMS MADE I x I OCCUR !
SES -1780-014-01 ,
PREMISES {Ea occurrence) $ 100,000
08/09/20 1 08/09/21 I MED EXP (My one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,E
GENII .
X RECEIVES
POLICY PECT LOC
OTHER
SEP '04
EGENERALAGGREGATE '$ 2,000,000
PRODUCTS COMPIOP AGO s 2,000,000
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED OFFICIAL RECORDS
AUTOS ONLY ,, AUTOS
HIRED NON -OWNED LEGISLATIVE
__ , AUTOS ONLY _ , AUTOS ONLY
LU OMBINED SINGLE LIMIT (s
(Ea accident)
BODILY INJURY (Per person) $
}BODILY
AND INJURY (Per acadent) $
SRVCS D. PR(PePocderrt) $___-_--___
PROPERTY DAMAGE
UMBRELLA UAB I t
OCCUR
EXCESS LIAR I
I CLAIMS MADE
=
EACH OCCURRENCE $
E AGGREGATE $
DEO RETENTION$
i WORKERS COMPENSATION j 1 PER � OTH-
AND EMPLOYERS' UABIUTY , , STATUTE ER
Y / N s
ANYPROPRIETOR/PARTNERIEXECUTIVE
`OFFICER/MEMBER EXCLUDED? NIA/ EL EACH ACCIDENT i $
�in Nef I C_
ldpya�ddatory descri
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - EA EMPLOYEE $
{ E L DISEASE -POLICY LIMIT j $
I
� a
[ 3
ESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Ad Stianal Remarks Schedule, may be attached H more space is requirsd)
.ICENSED AGENT - GREGORY V. MOORE FLORIDA GENERAL CONTRACTOR LICENSE # CGC-1513024 - SPECIALIZING IN THE SALES AND
NSTALLATIONS OF STORM SHU I 1 tRING, SUN ROOMS, WINDOWS & DOORS, BATHROOM RENOVATIONS
ERTIFikATF lieu nGo _--.___ - ____
CITY OF CLEARWATER
100 SOUTH MYRTLE AVENUE
CLEARWATER, FL, 33756
BRIAN-LANGILLEQMYCLEARWATER.COM
CORD 25 (2016/03)
The ACORD na
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORS/ED REPRESENTATIVE
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