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'a2 IYYY <br /> ® CERTIFICATE OF LIABILITY INSURANCE DATEWM/DOY) <br /> [[!! 10/30/2009 <br /> PRODUCER (727)530 -0684 FAX: (727) 532 -9602 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Jack Rice Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 13080 S Belcher Rd ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. <br /> Largo FL 33773 _ - INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A: Hermitage Insurance Co . 000053 <br /> American Professional Roofing, Inc., DHA: INSURER 13: <br /> -- ......... ._._... -- -- •-- - -.... .. ...-...__...--- - <br /> 17018 Ongar Ct <br /> INSURER C: <br /> INSURER 0: <br /> Land 0' ( Lakes FL 34638 INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> IN8R Fat - — POLIOY EFFECTIVE POLICY EXPIRATION ------ . <br /> LTR WATYPO QN�U <br /> RD TF-lpANCE POLICY NUMBER DATF IMM/OOIYYYYI DATF IMWDDIYYYY) -• -- LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED _PREMISES pREMISES (Ea =make) $ _ 50,000 <br /> A __ CLAIMS MAOE X OCCUR HGL56242209 8/13/2009 8/13/2010 MED EXP (Any one person) 3 5,000 <br /> _ - -_ -.. --- -_ .. ... ... PERSONAL & ADV INJURY 3 _ Z r- QQQ 000 <br /> — ._... - -_ _,,,,, .. GENERAL AGGREGATE 3 -.__ 2 1. 000 • , 000 <br /> GEN9. AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP /OP AGO $ 1, 000 , 000 <br /> X 1 POLICY n JFCT n LOC <br /> _AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> - .. ANY AUTO (Et accident) 3 <br /> - - ALL OWNED AUTOS BODILY INJURY 3 _ ........_._...____ <br /> SCHEDULED AUTOS (Per pnrson) <br /> MIRED AUTOS BODILY INJURY <br /> NON -OYNED AUTOS (Per e0ddenl) 3 <br /> — - <br /> PROPERTY DAMAGE 3 <br /> (Per accident) <br /> GARAGE UABILITY AUTO ONLY - EA ACCIDENT 3 <br /> ANY AUTO <br /> OTHER THAN EA ACC S - -_ - <br /> AUTO ONLY: <br /> AGO 3 <br /> EXCESS /UMBRELLA UABILITY EACH OCCURRENCE 3 <br /> OCCUR CLAIMS MADE AGGREGATE <br /> — <br /> __ DEDUCTIBLE <br /> - <br /> RETENTION $ - - -` _ <br /> WORKERS COMPENSATION I TORY.J IMIIS.i_ I E[L ..... _ __._._ ___ •_ <br /> AND EMPLOYERS' LIABILITY Y / N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L, EACH ACCIDENT 3 <br /> OFFICER/MEMBER EXCLUOED? <br /> (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE 3 <br /> N y ee, deecrtb under _— - -- <br /> S PROVISIONS Wow E.L. DISEASE • POLICY LIMIT 3 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED HY ENDORSEMENT I SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> City Of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> ATTid : Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> 5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 2ephyrhills, k'X, 33542 <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> Cynthia. Web,ater. /AMC . 7 .-"o C.-€. rn <br /> ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. AN rights reserved. <br /> INS025 (20 101) The ACORD name and Togo are registered marks of ACORD <br />