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08/27/2007 01:25 8136627512 WORKERS CoMP CO oP PAGE 01/01 MdJJ1D.. CERTIFICATE OF LIABILITY INSURANCE t ct!"11FlC-' TE NO, IDA TI! 1IC07 -18000502-5""2 0/27/2007 12:10:18JlH PROIlUoeR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION H:l,;bpoint Rillk Sel:Y$.cea 3:.t.C ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 14160 Dal1.a ~a%k~ 1500 HOLDER. THIS CERT1F1CA TE DOES NOT AMEND EXTEND OR D&11.., TX 75254 ALTER THE COVERAGE AFFORDED BY THE POUtlES BELOW. (800) 632-5095 (972) 715-0959 INSURERS AFFORDING COVERAGE Fax: '972' "04 4450 INSURED: AMS lIeN:: INSURER A: companion Property and CaS\lalty Insurance Comp TLC ROOFING, LLC IN6URER B: 14138 18111 CT ~E CITY. P'L 33525 INSURER C: (352) $2;l.-0423 Fax: INSURER 0: INSURER E: COVERAGJ:.!il 'tHe POl.lClIS OF INSURANCE LISTED 8El.OW HAVE BEEN ISSUED TO THE INSURED NAMIlD ABOVi FOA nti POLICY PERIOD INDICATED. N01WlTHSTANDlNG ANV REQUIIt....eNT. T1!RII OR CONDlTIONOF AtN C~CT OR OntER DOCUMENT WITH RESPECT TO WHICH TMl$ CERTII'ICATE MAY 8EfSSueD OR MAY PERTAIN, THE INSURANCE "f'I'ORDED BY THE POUCIES DESCRlIED HI!R&1N IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIE&. AGGREGATE UMlTS SHOWN MAY HAW BEEN REDUCED BY PAID ~ ~ I m~ TVn Of' IN6\lRANCE POUCV' NU~IIR LIMns $NERAL UAElIUTV n.GI.061S9S 06/22/2007 08/22/2008 ElICH OCCURRENCE S !.. D&RClA~ GENERAL UA8ILlTY FIRE DllMAGE (Anp One "1nI) S _ CLAIMSNADE [!] OCCUR MEOElCP(I\ny__") S 5000 A - PeRSONAl. ~ AOV INJURY S - G~NEAALAGGR~~ S Ti~An LIMIT AnES P~R: PRODUCTS - COMPIOP AGG S X POLlCY I P..aQ: Lee AUTOMOBILE UAIIlUT'/' COMBINED SINGLE UNIT - (Sa .eaI.....) S - AN'/' AUTO - ALL O\MIIlltl AUTOS BODILY INJURY S SCHElUI..&O AUTOS !Per IlIrIlIII) - - HIREl AUTOS 800IL V INlIAY S NON-oWNI!D ^UTO& /Pet IICdd8ntI - - PROPERTY DAMAGe S II'ar_) ~GI!i UA8IUT'/' AUTO OIIIL Y - Ell ACCIDeNT ,. "NY AUTO OTHER 'lMAN fA ACe s AVTOONLY: AGel S EXCESS UA8IUTY El\CH OCCURRENCE S .: OCCUR DCLAlMS MADE AGGREGATE $ S OEDUCTlBl.E S I- RETI!NTlON S s WClRKEM COMPENSATION AND WC7777!19!10401 08/27/2007 04/01/2008 r,. I """""ATl'., I ION EMPLOYERS' ~IABILlTY I!.L I!ACH ^CC1D1NT . 10OOlrOO- A s 1000000 E.L DISeASe. fA EMPLOYEE e.L, OI8EA!le - POLICY LIMIT S 1000000 OTHER R J.lMlT5 S UMlTS S DESCRIPT10N OF DP!RATlONSlLOCATlOIGIIII!MICU!MlIlCLUSION8 ADElIlD 11'I' .NDOR$G~'I8PGCIAL ~$ 1. This certificate remains 1~ effect, p~ov~aea the cl1ent's account is in gooO stand~ng with AMS, coverage ~s ~ot pX'ovide4 for MY employee for which the client is not reporting wages to AMS. Applies to 100% of the employees of AMS leased to TLC ROOFXNG. LI.C. effect1ve 08/27/2007. 2. Insured is afforded Workers comp~at~on ~ ~loyer8 liability as a co~employer under the policy for employees leased from AMS Staff Leasing, Ine, CERTIFICATE HOLDER J J Al)DlllONAL INSURED: -.._lETlBI: CANCELLATION SHClUU) AN'/' ell' '!ME AIlO\IE Dl!SCItI8l!D POLICIES BE CANCELLEllIII!FOR. 1ME ~ 'r1OI't DA'lI! TIlI!RCM. TIl~ IHUINQ IN!llJRER WIll. eNlll!A~ 1'0 MAli, E P,.Y$ WIlITlEN CXTY O:f Zlni'l,nUUloLS BUJ:LPXPG DEPARTMENr NOTICE 10 'THE CI!RT1F1CA re HOLDER NAMeD 10 '!He U!FT. BU'T "AlLURE TO DO SO SMAll. Arm. KlUUlN MXLLE~ 5:3 55 8TH STREET IMPOft 1'10 OIIl.I~A"O~ OFt L1A1JlUTY OF AN'( I<INP UPON ntE! NlURI!Jt, ITS AGI!fI1$ OR ZEPHYRHILLS. PI. 33542 AU1ttOIlIZ!iD ~A11Vl! l J ..., ACORD 25.S (7/17) ~ ACORD CORPORATION 1988