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.Aco 12/20/2018 Y) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ 018 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 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 Debra Guidry,CPCU NAME: ry, FRSA Self Insurers Fund,Inc. aHc0Nr o Ext•(800)767-3772 Fn/c No): (407)671-2520 4099 Metric Drive E-MAIL Winter Park,FL 32792 ADDRESS:cent@frsasif.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: FRSA Self Insurers Fund/Evanston Insurance Co. 35378 INSURED INSURER B: Quality Roofing,Inc. INSURER C: 1905 N 40th Street Tampa,FL 33605 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. I�7R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER MMIDDIYYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ OCCUR DAMAGE S(RENTED CLAIMS-MADE PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S ALL AUTOS AUTOS N/A N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION X STATUTE OERH AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N�NIA N 870-033644/3DY3150 01/01/2019 12/31/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) REMARKS:Non-cancelable,without 30 days prior written notice,except for non-payment of premium which will be a 10 day written notice. Richard C Jenkins,License Holder Lic#CGC1507166&CCC042846 CERTIFICATE HOLDER CANCELLATION Attn: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills 5335 8th Street Zephyrhills,FL 33542 AUTHORIZED REPRESENTATIVE Debra Guidry CPCU 04,�gp Underwriting Manager @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD