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' © DATE(MM/DDIYYYY) ACC o CERTIFICATE OF LIABILITY INSURANCE 02/05/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER 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). PRODUCER CONTACT Josephine Mansur NAME: Roe Insurance Inc. PHONE 7 -0030 -2262 x : FAX ANe: 9851 State Road 54 E-MAIL jo@roeins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# New Port Richey FL 34655 INSURERA: Southern Owners Insurance Co. 10190 INSURED -INSURERS: Auto Owners Insurance Co. 18988 West Coast Windows And Exteriors Inc. INSURERC: American Builders Insurance Company 11240 8106 Temple Terrace Hwy INSURER D: INSURER E: Temple Terrace FL 33637-5302 INSURERF: COVERAGES CERTIFICATE NUMBER: 18-19 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000.000 DAMAGE L:NIW CLAIMS-MADE 7 OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 10,000 A 20108570 04/12/2018 04/12/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE UMITAPPUES PER: GENERALAGGREGATE $ 2,000,000 POLICY❑PRO ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: Voluntary Property $ 5,000 AUTOMOBILE LIABILITY GOMBINED SINGLE LIMIT $ 500.000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 4945603100 06/21/2017 06/21/2018 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY IX AUTOS ONLY Per accident Uninsured motorist BI $ 250,000 UMBRELLA LIAR OCCUR FACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X ER STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? � NIA WCV 0166004 04 03/02/2018 03/02/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation applies to Florida operations only RE:NORMAN D.DOLLBAUM LIC#CBC1255462 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF ZEPHYRHILLS ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8TH STREET AUTHORIZED REPRESENTATIVE ZEPHYRHILLS FL 33543 '. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD