CERTIFICATE OF LIABILITY INSURANCE (1051) LATE lMMIoorxYYY)
CERTIFICATE F LIABILITY INSURANCEF.
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THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NCITAFFIRMATIVELY IOR NEGATIVELY AMEND,EXTEND OR ALTER THE,COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOER NOT CONSTITUTE A.CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE 07R PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT-. If'the certffIcate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed
it 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)„
PPODUCIER Shaman Burt n-1-1;icks
Itrouvm Et Brown of FlCdrrda,Inc PHONEIA(C.NoEstl� (800)765J297 FAX
P'O Bo'x 1730386 F-MAIL sburtonhicks@b1itarnpa.com
AranRESS.
INSURER(S)AFFORDING COVERAGE MAIC"0
Tadrrpa Fl. 33672 INSURER A, Instirance Cornpany ct the West 27847
INSUREDINSUREbWSk&RER a
Smith Landscape.Services Ince. MNSURER C;
10700 471h Street N
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Clear atePFL 33762' INSURER F;
COVERAGES CERTIFICATE NUMBER: 420-21 COI R'EV'ISION NUMBER,
THIS IS TO CERTIFY TWAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN,ISSUED TC THE INSURED NAMED ABOVE,FOR THE.POLICY PERIOD
INDICATED, NCO"I"WTHSTANDINCr ANY REQUIREMENT;TERM OR CONDITION`I OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO" EACH THIS
CERTiFICAT'E MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED EY T'FIE(POLICIES DESCRIBED FIEREMN IS SUBJEC:T'MTO ALL THE TERMS,
EXCLUSIONS AND C.ONIDI"I'uONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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DESCRaP ION OF OPERATIONS d LOCATIONS I KDEHICLES (ACC RD 101,Additional Raised%Schedule,may be attached It macre apace Is req Ired) �
**Mrkers-Comp Information** . „
Other'States Coverage
Proprietors/Par"tners(Exectitive Officers/Members Exolurd'edl
FrankSmith,President NOVISN V5` 110'20
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CERTIFICATE!HOLDER CANCELLATION u *, _._. ..
$WOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC'E',LLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Cly of Clearwaler Engineering Dept Attn:Ccnstw'UC1ion Office Speciailsl ACCORDANCE WITH THE POLICY(PROVISIONS,
PO Box 47400
AUTHORIZEO REPRESENTATIVE
CIealwater FL 70758
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