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�� :y� OP ID: SG '4` °R° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DUlYYYY) 02/24/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS C�RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER 813-818-5300 NAMEACT Stahl & Associates Ins., Inc. 813-818-5396 PHONE Fax 3939 Tampa Road E MA I � ° E '� � ac, No : Oldsmar, FL 34677 ADDRESS: _ Michael Pagano, AAI cu io u: CJCAR-1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED C J Carvalho Construction, �r1C INSURERA Owners Insurance Company 32]QQ 728 Wesley Ave, Ste #1 INSURER 8 Southern Owners Insurance Co 10190 Tarpon Springs, FL 34689 INSURERC Bridgefield Employers Ins. Co. 10701 INSURER D INSURER E : INSURER F . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDlYYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ �,OOO�OOO B X COMMERCIAL GENERAL LIABILITY 2071004910 07/�5/� 0 07/05l11 pREMISES Ea occurrence $ 3 � 0 ,� 0 CLAIMS-MADE � OCCUR MED EXP (My one persanJ $ � ��0� X Per Project Aggre PERSONAL & ADV INJURY $ 'I,OOO,OO GENERAL AGGREGATE $ $�OOO,OO GEN'LAGGREGATELIMITAPPLIESPER� PRODUCTS-COMP/OPAGG $ $,OOO,OO POLICY X PR � LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANYAUTO 4791387700 03l11/10 03l11/11 �Eaaccident) $ _ 1,000�00 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIREDAUTOS (Peraccident) $ NON-OWNED AUTOS g $ UMBREILALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE � $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY X TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y � N � A 83034021 04101l10 04/01/11 E L. EACH ACCIDENT $ r J00�0� OFFICERlMEMBER EXCWDED� (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ $0�� If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ r JOO�OO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Phone # 813-780-0020 CERTIFICATE HOLDER CANCELLATION CITYZEP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephyrhilis ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 5335 8th Street AUTHORIZED REPRESENTATIVE Zephyrhills, FL 33542 �'>,G1��'/<��, "" O �O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD