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r l ® DATE(MMIDD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 10/8/2020 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). CONTACT PRODUCER WorkComp Solutions, Inc. NAME: 5143 South Lakeland Drive, Suite 1 a/c°Nr o Ext: 863 646-4642 ac No): 863-646-3521 Lakeland, FL 33813 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# www.workcompsolutionsfi.com INSURERA: American Interstate Insurance Company 31895 INSURED INSURER B: Goff Communications Inc. 6448 Parkland Drive INSURER C Sarasota FL 34243 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 58054153 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea occu ence $ MED EXP(Anyone person) $ PERSONAL BADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ IECT POLICY PRO LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident 1 L 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION AVWCFL2932752020 10/1/2020 10/1/2021 '/ STATUTE OERH AND EMPLOYERS'LIABILITY Y I N OFFICER/MEMBERPRIETR/PART ER/E ECUTIVE � NIA E.L.EACH ACCIDENT $1,000,000 EXCL(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 O 0 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 30 Day Notice of Cancellation Applies. James E Goff CGCO58267 Douglas Lyle Smith EC13004137 CERTIFICATE HOLDER CANCELLATION Clt of Ze h rhIIIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53 5 8th Street ACCORDANCE WITH THE POLICY PROVISIONS. Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE . . Darrell J.Mills �� "_� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 58054153 1 20/21 WC I Jennifer Foster 1 10/8/2020 11:34:41 AM (EDT) I Page 1 of 1 -•This certificate cancels and supersedes ALL previously issued certificates.