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irom:Ashtin Be�ue _Fax:(87�265-1971 _To:+18137800021 _Fax:_+18137800021 Page_79of-7910C2612016 1:32 PM---..--..--------- <br /> 1 AC�� na�(Mnvoomrr� <br /> � � CERTiFlCATE OF LIABILITY INSURANCE 10/28/2016 <br /> j THIS CERTtFICAT@ I5 ISSUED AS A MA7TER OF INFORMATION ONLY AND CONFHRS NO RIGHTS UPON 7HE CERTIFICAT�HOL�ER. 7HIS <br /> ; CER FICATE DOES NOT APFiRMA71VELY OR NEGATIVELY AMEND, F.XTEND OR AtTER TE[E COVERAGE AFFORDED BY THE POLlCIES <br /> j BELO . 7HlS CERTIFICATE OF INSURANCE OQES AlOT CONSTITUTE A CONTRQCT BETWEflN THE ISSUlNG lNSURER(S), AUTHORIZED <br /> � REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> i IiU1PORTANT: If the certificate holder Is en ADDITIONAL INSURED,the policy(les)must be endorsed. If S UBROGATtON IS 1NAIVED,subJatt to <br /> tbe te�ms aod cond(ttons of the poltcy,certaln pollcles may requfre an endorsement. A statement on this certificate does not confer rights#o the ' <br /> certlflcate holder In Ileu of such endorsement s, <br /> rRoouce "Ta <br /> HAME: <br /> Greene= azel Insurance Group� Hub Intemationaf PHONE _ _ FAX <br /> NC Ne: <br /> 10739 eerwood Park elvd S 240 E.n�a,� <br /> Jackso� ille FL 32256 ADDR s ' ' <br /> iNSURERS AFFORDINOCOVERA6E NAICl1 <br /> �NSURER A• <br /> � INSURED ROOFCOR-01 rt�sur�R e: <br /> i RMX C nstruction,Inc. �esur�Rc: <br /> ! RooTma Corp iMsuRee o: <br /> j 4600 7duchton Road E.Ste. 1150 <br /> 1 JacEcsor�ville FL 32246 INSl1RER E: <br /> I iksur�R F: <br /> � COVERAGES CERTIFfCATE NUMBER:276845440 R�1/ISION NllMBER: <br /> � THIS IS TO C�RTIFY THAT THE POLICIES OF INSURANCE LIS7E�BELOW HAVE BEEN ISSUEO TO TNE tNSURED NAMEP ABOVE FOR THE POLICY PER10D <br /> INDICA'fED. NOTWITHS7AtVDING ANY REQUIRFJNEN7,7ERM OR CONDITION 0�ANY�ON7RACT OR O7H�R DOCUMENT WITH RESPECT TO VNilCH THlS <br /> CEftTI�ICATE MAY BE i55UED OR MAY PERTAIN,THE tNSURANCE AFFORDEO BY THE POLICIES �ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AMD CONDi1i0N5 OF SUCH POLICIES.LIMiITS SHOWN tNAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> iNSR TypE Of INSURANCE POLICY EFF POLICY EXP <br /> L R WSR WVD POLICYNUMBER MMlDO MM/D� uM1T3 <br /> 8 GENERALLIABfLITY CBC200013049U0 4/75/2076 4/15l2017 EqCHOCCURRENCE 51,00O,OOD <br /> X COMMERCWL6ENERALLIA&LITY <br /> PftEMISES Ea Occurrer�ce 5'100,000 <br /> CLAIMS•MA�fi a OCCUR MED EXP orre erson 510 000 <br /> PERSONALBADVINJURY 51,000,000 <br /> GEraERaLaGGREGATE 52,000,000 <br /> GENLAGQREGA7ELiMITAPPLIESPER: PRODL1CTb-COMPIOPAGCi 52,000,000 <br /> x POLICY PRO• L� S <br /> AU OM081LEUABILITY <br /> Ee acddent <br /> ANYAUTO 60DILY INJURY(PerpenonJ 5 <br /> � AUiO�3�E� AuiOSu�D BpDILYlNJURY(Pereeddent) S <br /> NON-0WNED RO E TY DAMA E S <br /> � HIRE�AUTOS AUTOS PetacUdent <br /> S <br /> uMBRELLAt1Ae OCCUR EACHOCCURRENCE S <br /> EXCESSUAB �q�MS.MADE AGGREGRTE S <br />' �ED RETEN710N5 S <br /> S p WORxERSCOMPENSAT1pN OB3055130 1f18I2016 7lS812017 X �SiATu- OTH- <br /> ; ANb EMPLOYERS'LIABILITY Y 1 N <br /> i ANY PROPRIETOR/PARTNER/EXEGUT{VE❑ N IA E.L EACH ACpD�M 51 OOO O00 <br /> OFFlCEWMEMBER FJCCLUOED7 <br />� (M�ndetOry In NH) E.L.DISEASE-EA EMPLOYE St,�00,000 <br /> IIY s.descnb9untl0r <br /> DESCRIPTIOfJ OF OPERATIONS below E.L.DISEASE-POLICY UMIT 51,0OO,ODO <br /> s <br /> � <br /> i <br /> OESCRIP ON OF pPERAt10N5 I LOCA710N51 VEHICLE9(Atla ch ACORD 707,Addlllonai Remarks Scbadulo,If more space b requlrad) <br /> I <br /> CERTI�ICATE HOLDER CANCELLATION <br /> SHOULD ANY OF 7HE ABQVE DESCRIBED POLICIES BE CANCHLLE�BEFORE <br /> Ciry of Zephyrhills Building Deparlment THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> � 5335 8th Street ACCORDANCE WITH THE PBLICY PROVISIONS, <br /> ; zephyrhills FL 33542 <br /> � AUTHORIZE�REPRESENTA77VE � <br /> � �+r� <br /> i l� <br /> 1 <br /> �1988-20'{0 ACORD CORPORATION. All rights reserved. <br /> ACOR 25(2010105) The ACORD name and togo are regtstered marks of ACORD <br />, I <br />