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• <br /> AcoRf�r CERTIFICATE OF LIABILITY INSURANCE C10- 1 600050 -9292 0 <br /> A C10- 1000502929280 <br /> 10/01/2010 12:45 PN <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Righpoiat Risk Services LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 14160 Dallas Parkway 8500 HOLDER. THIS CERTIFICATE DOES NOT (WEND, EXTEND OR <br /> Dallas, TX 75254 - <br /> (800) 632 -5096 (972) 715 -0959 <br /> INSURERS AFFORDING COVERAGE <br /> INSUAED: AMS l /c /f: INSURERA: Companion Property and Casualty Insurance C <br /> TLC ROOFING, LLC INSURERS: Companion Property and Casualty Insurance C <br /> PO BOX 1745 <br /> DADE CITY, FL 33526 INSURER C: <br /> (352) 437 -4073 Fax: () - INSURER D: <br /> INSURER E: <br /> COVERAGES <br /> THE POUCIES OF INSURANCE UBTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTYNTII8TANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI8 CERTMICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN B SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> p � R POUCIES. AGGREGATE URNS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAMML p p�� <br /> I rp TYPE OF INSURANCE POUCY NUMBER R A Y NIS tI 0NN UMTS <br /> 5ENERALuAaI.ITY 08/22/2010 08/22/2011 BACHOCCURfENCE $ 1000000 <br /> FLG3081595 <br /> }( 100000 <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (My One Fire) a <br /> "-'.- CLAIMS MADE © OCCUR MED EXP (Any one person) $ 5000 <br /> A �... PERSONAL aADVINJURY $ 1000000 <br /> GENERAL AGGREGATE $ 2000000 <br /> GEN'L AGGREGATE LIMIT APPLES PER: PRODUCTS - COMP/OP AGO $ 2000000 <br /> 71 POLICY n n LOC <br /> AUTOMOBILE UABIUTY <br /> COMBINED SINGLE LIMB $ <br /> ANY AUTO (Ea accident) <br /> INJURY <br /> ( <br /> ALL OWNED AUTOS BODILY INJ <br /> ) <br /> HIRED AUTOS BODILY INURY <br /> NON -OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> $ <br /> (Per accident) <br /> GARAGE UABIUTY AUTO ONLY - EA ACCIDENT $ _ <br /> R ANY AUTO EA ACC $ <br /> OTHER THAN <br /> AUTO ONLY: AGO $ <br /> EXCESS LABILITY EACH OCCURRENCE $ <br /> OCCUR ❑ CLAIMS MADE AGGREGATE _` S <br /> _ s <br /> _ <br /> DEDUCTIBLE ' E <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND x 1.%& Tim' O i <br /> EMPLOYERS'LIABLITY WC77779991701 04/01/2010 04/01/2011 <br /> E.L. EACH ACCIDENT $ 1000000 <br /> El. DISEASE - EAEMPLOYEE $ 1000000 <br /> E.L. DISEASE• POLICY Lett $ 1000000 <br /> OTHER <br /> LIMITS <br /> LM.1ITS , $ <br /> DESCRIPTION OF OPERA11ON$ LOCATONSNEHq.ESIEXcLUSION8 ADDED BY EI1ORBEIENTBPECIAL PROVISIONS <br /> 1. This certificate remains in effect, provided the client's account is in good standing with AMS. <br /> Coverage is not provided for any employee for which the client is not reporting wages to AMS. <br /> Applies to 100% of the employees of AMS leased to TLC ROOFING, LLC effective 04 /01/2010 2. Insured <br /> is afforded Workers Compensation & Employers liability as a co- employer under the policy for <br /> employees leased from AMS Staff Leasing, Inc. <br /> CERTIFICATE HOLDER 1 1 A OfflONIAL imam; "URER LETTER' CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIM EXPIRATION <br /> DATE THEREOF, THE IBSUBI0 M.I. ENDEAVOR TO MAL 30 DAYS WRITTEN <br /> CITY OF ZEPHYRHILLS BUILDING DEPARTMENT NOTICE TO THE CERTWICATEHOLDER NAMED TOTE LEFT, BUT FALURETODO808HAU. <br /> H <br /> ATTN: KAREN MILLER OSE NO OBIGATIONOR UABLRY OF ANY KIND UPON THE ENSURER, TTSAT8ENT80R <br /> 5355 8TH STREET REPRESENTATIVES. <br /> ZEPHYRHILLS, FL 33542 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25.5 (7/97) ® ACORD CORPORATION 1988 <br />