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• FLORIDA ROOFING. SHEET METAL &AIR CONDITIONING CONTRACTORS ASSOCIATION. INC. <br /> RSA 11111031201EMERERS FUND <br /> P.O. BOX 4907 • WINTER PARK . FL 32793* (407) 671 -FRSA <br /> 1-800-757-37724 FAX (407) 671 - 2520 <br /> CERTIFICATE OF INSURANCE <br /> ISSUED TO: COPY PROVIDED TO: <br /> Alan's Roofing & Alan's Alan's Roofing & Alan's <br /> Roofing Inc et al Roofing, Inc. and Adco et al <br /> 14498 Ponce de Leon Blvd 14498 Ponce de Leon Blvd. <br /> Brooksville FL 33601 Brooksville FL 34601 <br /> ATTN:To whom it may concern Date: 01/14/2010 <br /> This is to certify that <br /> Alan's Roofing & Alan's Roofing, Inc. and Adco et al <br /> 14498 Ponce de Leon Blvd. <br /> Brooksville FL 34601 <br /> being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of <br /> compensation by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING <br /> CONTRACTORS ASSOCIATION SELF INSURERS FUND. <br /> COVERAGE NUMBER: : 870 - 033049 LIMITS <br /> Workers' Compensation Statutory - State of Florida <br /> EFFECTIVE DATE: 01/01/2010 <br /> Employers' Liability $100,000 - Each Accident <br /> EXPIRATION DATE: 01/01/2011 $100,000 - Disease, Each Employee <br /> $500,000 - Disease, Policy Limit <br /> REMARKS: Non - cancelable without 30 days prior written notice, except for non - payment of premium Which <br /> will be a 10 day written notice. <br /> Complete named insured to read: <br /> Alan's Roofing & Alan's Roofing, Inc. and Adco Construction, Inc. <br /> and BHD Construction LLC and Spring Hill Construction, Inc. <br /> Employers Liability Coverage is amended to: <br /> 1,000,000/1 /1,000,000 <br /> This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be <br /> constructed as extending coverage not afforded by the policy(ies) shown above or as affording insurance to any <br /> insured not named above. This provides coverage for Florida policyholders and Florida domicile employees only. <br /> 6 ...4 -- Sat gsr Akwag <br /> Brett Steigel, Administrator Debbie Kemmerer - Underwriting Manager <br /> FRSA -SIF FRSASIF <br />