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�� ' DATE (MMIDDIYYYY) `ACO�R'C7 CERTIFICATE OF LIABILITY INSURANCE io/os/soii THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 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 certi£cate 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 certifcate holder in lieu of such endorsement(s). PRODUCER 1-813-229-8021 CONTACT MiChelle LiWOSz NAME: M. E. Wilson Co., Inc. PHONE ,g13-229-8021 FAX 813-739-6036 N E . AIC No : E�MIAIL mliwosz@mewilson.com 300 W. Platt St. ADDRESS: Ste 200 PRODUCER Tampa, FL 33606 C TOMERIDp: 920 Dwi ht Wilson INSURER S AFFORDING COVERAGE NAIC # INSURED INSURERA. FCCI COMMERCIAL INS CO 33472 McEnany Roofing, Inc. INSURERB. NATIONAL TRUST INS CO 20141 8803 Induatrial Drive INSURERC. AMERICAN GUAR & LIAB INS 26247 Tampa, FL 33637 INSURERD. BRIDGEFIELD CAS INS CO 10335 INSURER E INSURER F . COVERAGES CERTIFICATE NUMBER: 23493999 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 ISSUEO 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 7ypE OF INSURANCE D U R pp�ICY NUMBER M OL pY EFF M' O pCD EXP LIMITS LTR iA A GENERALl1ABILITY GL0011181 O1/O1/1 O1/O1/12 ACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA E TO RENTED 100, 000 PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1, 000, 000 GENERALAGGREGATE $ 2,000,000 GEN'IAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY X PRO- LOC $ 8 AUTOMOBILELIABILITY CA0017356 O1/O1/1 O1/O1/12 COMBINEDSINGLELIMIT $ 1,000,000 X ANY AUTO (Ea acadent) __ BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURV (Per accident) $ SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ C X UMBRELLA LIAB X OCCUR AIIC591802605 O1/O1/1 O1/O1/12 EACH OCCURRENCE $ 5, 000, 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5, 000, 000 DEDUCTIBLE $ X RETENTION $ � $ D WORKERSCOMPENSATION 0196179270 O1/O1/1 O1/O1/12 X WCSTATT- OTH- AND EMPLOYERS' LIABILITY �. � N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500, 000 OFFICER/MEMBER EXCLUDED? � N � A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 500, 000 If yes, describe under 500, 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sehedule, if more space is required) General Liability and Umbrella Liability policies do not contain Residential Excluaion with respects to roofing operationa. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Zephyrhills-Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8th Street AUTHORIZED REPRESENTATIVE Zephyrhills, FL 33592 _ ` USA `--" - �-- >- „�.�4 - — srsooi OO 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 23493999