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■1 ■ ■■ /30/2009 1 :59 P.M_ FROM: Fax AMS Sta££ Leaainc 172 PAGE: 001 OF 002 ■ ■ ■ • ■ • . • ■ ■ ACORD TV CERTIFICATE OF LIABILITY INSURANCE CERTIFICATENO./DATE Ac09- 16000507- Ei2439 07/30/2009 01:5E PM PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Highpoint Risk Services LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 191 60 Dallas Parkway 0500 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Dallas, TX 75254 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (8001 632 -5096 (972) 715 -0959 Fax: (972 ; 904-4950 INSURERS AFFORDING COVERAGE INSURED: AMS 1%c /t: INSURERA Companion Property and Casualty Insurance Comp WINDOW SOLUTIONS TAMPA BAY, INC INSURER 1730 S PINELLAS AVE STE 0 TARPON SPRINGS, FL 39 689 INSURER C (727) 943 -7800 Fax: (727) 993 - INSURER INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POU CY 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE fMM/DD/YYI DATE INMNDD/YY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE 4 COMMERCIAL GENERALUAEILITY FIRE DAMAGE (Any One Fire) $ 1 CLAIMS MADE OCCUR MED EXC' (Ary one person) S PERSONAL B ADV INJURY 4 GENERAL AGGREGATE 4 _ GEN'LAGGREGATE _IMIT APPLIES PER PRODUCTS - COMP /OP AGG - 4 — 1 POUCY fl 2 f _0„ . AUTOMOBILE LIAB'UTY COMBINED SINGLE LIMIT 4 ANY AUTO (Ea accident) ^^ A:-:_ OWNED AUTOS - B NJURY $ SCHEDULED AUTOS (Per er pers person! HIRED AUTOS BODILY INURY 4 NON -OWNED AU TOG' (Per acoderrt; — PROPERTY DAMAGE (Per accees) 4 GARAGE LIABILITY AUTO ONLY- EAACODENT 4 Arum AUTO , . OTHER AUTOO THAN EA ACC 4 AUTO GNLY AGG EXCESS LIABILITY EACH OCCURRENCE $ — - OCCUR n n AIMS MADE AGGREGATE 4 — — 4 — DEDUOTIBLE - $ ^_ RETENTION 6 _ $ — WO.KERS COMPENSATION AND WC 77779990901 X 1 ARV OMITS 1OIRr- A EMPLOYERS' LIABILITY 04/01/2004 019/01/2010 E.'. EACH ACCIDENT $ 1000000 E . DISEASE - EA EMPLOYEE S 1000000 E DISEASE - POL CY LIMIT 4 1000000 OTHER R —_. LIMITS $ - LIMITS 5 DESCRIPTION OF OPERATIONS /LOCATIONevEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 1. This cert:ficate remains in effect, provided the client's account is in good standing with AMS. Coverage is not provided for any employee for which the client _s not reporting wages tc AMS. Applies to 100 of the employees of AMS leased to )SC NDOW SOLUTIONS TAMPA BAY, INC, effective 09/01/2009 2. Insured is afforded Workers Compensat-on & Employers liability as a co- employer under the policy for employees leased from ANS. CERTIFICATE HOLDER I l ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN CITY OF ZEPHYRH_LLS ELDG DEPT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 5335 8TH STREET 7,EPHYRHIL' S, FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE { ACORD 25 -S (7/97) C ACORD CORPORATION 1988 Rece ved Time Jul. 30. 2009 2:-53PM No, 5344