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09- 20 -'10 15:45 FROM- T -550 P0004/0006 F -745 CERTIFICATE OF LIABILITY INSURANCE 09/16/2010 PRODUCER Serial # 175662 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RISM E UPON THE CERTIFICATE FRANKCRUM INSURANCE AGENCY, INC. HOLDER. THIS CERTIFICATE ODES NOT AMEND, EXTEND OR 100 S. MISSOURI AVE. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CLEARWATER FL 33755 INSURERS AFFORDING COVERAGE NAIC!1 INSURED INSURER A• FRANK WINSTON GRUM INSURANCE. INC. 11600 , INSURER B. FrankCrum 1400.277-1620 INSURER C: 100 5 MISSOURI AVENUE INSURERO• CLEARWATER FL 33756 INSURER E: INS POLICIES OF INSURANCE LILTED DELOW HAVE BEEN ISSU60 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANT REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OP OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, T11E INSURANCE AFFORDED BY THE POLICIES DL OED 14E5515 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MA AMYL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE FoucT MDIMATION' LIMITS LTR PARC DATE 1MMI00IYY) • _w (MMIODM�i _ EI aENERAL IJAETY EACH OCCURRENCE ' S el MNERCIAL GENERAL UAaIUTV FIRE DAMAOE one AN) 3 El CLAMP NAGE OCCUR RED EIlP 1MYaIUP�w) S 5 PERSONAL IIADYINJURY =ERA AGGREGATE 5 OEN purr APPLIES ^ PEI: PRGOUCTS-COMPIOPMD S .� I /POLICY l 1PROJEDY I /LOG ..mmm.,.. AuTOMOIR,E WIKITT OOMBSEO SINGLE WHIT i LEA Ecc$640) ANY AUTO -4 ALL OWNED AUTOS BODILY MIYRY 3 ~_ SCHEDULED A11103 HIRED AUTOS "MOLYINJURY 1 romposeas NoN-01MIE0 AVTOO PROPERTY MA 5 -' IPo uMdM3 GARAGE uM MJIY AUTO oNLY • EA ACCIDENT E _ ?WV AUTO mil WEN EAAGG 5 AUTO MVP A CC EMUS U LIABILITY EAON OOGURRENCE S J occuR UCIADIS MADE AOGNECAIC 'S • S RETENro?' 3 �y S • CDMPEI A9 MON AND X I "'� A '� ( I pTHEii A anomie' Lyman WC201000001 07/01/2070 01101/2011 TORYlIMRB _ ANY PROPRIETOR / PARTNER I EXEDIRIVE OPPICER I MEMOEREKCLUDED7 E LEAOIAI'JGIOENT $ 1,000.000 U yogi dg.e•M wlAlf E l Damn . EA EMPLOYEE s 1 `00.000 SPEdAI PROWxpNO wlo.I E L DISEASE • POLICY I IT $ 1.000,000 OTHER • OEECRIPTION Oi OPERATIONS' LOCATIONS II VENUES / EIWWSIONO eV ENDORSINEiTI SPECIALPROMabRa EFFECTIVE 04/30/2006, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO ROLLSHIELD, LLC (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. CERTIFICATE HOLDER CANCELLATION _. :MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSIRNO RNAMRER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE ci]IIIROATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do SHALL IMPOSE CITY OF ZEPHYRHILLS NO oeu0A110N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ATTN: BUILDING DEPARTMENT REPRESENTATIVES. 5335 6TH 8T. AUTHORISED REPREIENTATRIE ZEPHYRHILLS, FL 33542 -/