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, • Issue Date: 12/21 /2010 <br /> FLORIDA ROO�ING, SHEET METAI & AIR CONDITIONING CONTRACTORS ASSOCIATION, INC. <br /> S RSA • - , <br /> 1-800-767-3772 • FAX (407} 671-2520 <br /> CERTIFICATE OF INSURAI�CE <br /> ISSUED TO: COPY PROVIDED TO: <br /> Alan's Roofing 8� Alan's Alan's Roofing & Alan's Roofing, Inc. and Adco <br /> Roofing Inc Et AI 14498 Ponce De Leon Blvd. <br /> 14498 Ponce De Leon Bivd Brooksville, FL 34601 <br /> Brooksville, FL 33601 <br /> Attention: To Whom It May Concern <br /> Alan's Roofing & Alan's Roofing, Inc. and Adco et al <br /> This is to Certify that: 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 compensation <br /> by insuring their risk with the F�ORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS <br /> ASSOCIATION SELF INSURERS FUND, P.O. Box 4907, Winter Park, FL 32793. <br /> COVERAGE NUMBER: 870-0 33049 LIMITS <br /> Workers' Compensation: Statutory - State of Florida <br /> EFFECTIVE DATE: 1/1/201 <br /> Employers' Liability: $1,000,000.00 Each Accident <br /> EXPIRATION DATE: 1/1/2012 $1,000,000.00 Disease, Each Employee <br /> $1,000,000.00 Disease, Policy Limit <br /> REMARKS: 1Von-cancelable, without 30 days prior written notice, except for non-payment of premium which will be <br /> a 10 day written notice. <br /> Complete named insured to read: Alan's Roofing & Alan's Roofing, tnc. and Adco Construction, Inc. and BHD <br /> Construction LLC and Spring Hill Construction, Inc. <br /> Alan Field as Qualifier, License #CCC046942 <br /> For Informational Purposes Only <br /> This certificate is issued as a matter of information only, is not a policy and of itself does not afford any insurance. <br /> Nothing contained in this certificate shall be constructed as extending coverage not afforded by the policy(ies) shown <br /> above or as affording insurance to any insured not named above. This provides coverage for Florida policyholders <br /> and Florida domiciled employees only. <br /> � � <br /> By� By _ <br /> Brett Stiegel, Administrator Debra Guidry, CPCU, Un erwriting Manager <br /> FRSA-SIF FRSA-SIF <br />