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ACOR CERTIFICATE OF LIABILITY INSURANCE CERTFICATENO./DATE <br /> AC11-38300067-1096388 <br /> 11/21/2011 10:14 SOAM <br /> Pr�nuc�rt TF9S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> aighpoiat Risk Servicea LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 5501 i.sJ ��mY, SUITE 120o HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> Dallas, TX 75240 <br /> (800) 728-0623 (972) 404-0380 <br /> Faa: (972) 404-0380 INSURERS AFFORDING COVERAGE <br /> INSURED: �S 1/c/f• INSURERA. <br /> KEITH MEIIIDY ROOFING INC. INSURERB: <br /> 7912 BLACKEIAWK TR <br /> INSURER C: <br /> SPRING HILL, FL 39606 <br /> (352) 683-8789 Fax: (727) 817-1505 INSURER D: <br /> INSURER E. <br /> THE POLIqES OF INSURANCE LJSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEWOD INDICA7ED. NO7YKiHST/WpNG <br /> ANY REQUIREMEHT, TERM OR CONDIiION OF ANY CONTRACT OR OTHER DOCUMENT YMTH RESPECT TO YYHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, iHE INSUR/WCE AFFORDED BY THE POLK.'IES DESCRIBED HEREIN IS SUBJECT TO ALL TNE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIE3. AGGREGATE LIMITS SHOYYM MAY HAYE BEEN REDUCED BY PAID CWMS. <br /> N R TypE pF INSURANCE POLlCY NUYBER �CY EFFECTNE POLICY EXPIRA V �� <br /> GENERAL�WB��TY FLGL105227 09/26/2011 09/28/2012 EnCHOCCURReNCE t 1000000 <br /> COMMERCIAL GENERAL LWBIIfN FIRE DAMNGE (Arry One F�e) S 1 O O O O O <br /> CWMS MADE � OCCUR MED EXP (Any one person) i S O OO <br /> A a�tsoru�BnoVIruURY S 1000000 <br /> G��rtnLAC�cRECnre S 2000000 <br /> GEN'L AGGREGATE LIMR APPUES PER: PRODUCTS - CdNP/OP AGG S Z O O O O O O <br /> POLICY �a LOC <br /> �T� �TY COMBINED SINGLE LIMR <br /> ANYAUTO «�� S <br /> ALL OWNED AUTOS BODILY INJURY <br /> 9CHEDUIEDAUTOS (p�P°� S <br /> HIRED AUTOS <br /> BODILY INURY s <br /> NON-0WNED AUTOS (� �K) <br /> PROPERI"Y DMAAGE s <br /> 1� a�) <br /> GARAGE IJABILITY AUTO ONLY- EA ACCIDENT S <br /> ANY AUTO <br /> OTHER THAN � � <br /> AUTOONLY� A � s <br /> EXCESS LIABtIlTY EACH OCCURRENCE S <br /> OCCUR ❑CWMSMADE AGGREGATE S <br /> S <br /> oEOUC7I�E S <br /> RETENTION i i <br /> WORKERSCOMPENSATION/WD DPE26272740060 09/21/2011 04/O1/2012 X W �� A X� <br /> EMPtAYERS' uABIL1TY 10 0 0 0 0 0 <br /> EL EACH ACCIDENT i <br /> A E.L. oisensE - en v.t�OVEE i 1 O O O O O 0 <br /> El. DISEASE - POLICY LIMIT S 1 O O O O O O <br /> OTHER <br /> LIMRS S <br /> LIMRS S <br /> . This certificate remains in effect, provided the client's account is in good standing with AMS. <br /> �*�*PLEASE�SEE�ATTACAEDe MPlOYEE s R o�f P AMS e leased w to c REITH MELADY ROOFING 09/21/2011. <br /> CERTIFICATE HOLDER A�AL NSURED; NSURER LETfER CANCEILATION <br /> DATETHEREOF, THE ISSUNGNSURHt WILBJDEAVOR TOMAL 30 DAYS WRffTEN <br /> CITY OF ZEPHYPHILLS NO7ICETOTHECERTFICATEHOLDER NAMm TOTHELEFT, BUTFALURETODOSOSHALL <br /> ATT; BILL BURGESS MAPOSE NO OBLK'.ATIONOR lJpBIITY OFANY KMID UPON THENSURER, fTSAGENTSOR <br /> 5335 8TH ST. R�J7ATTIE& <br /> ZEPHYRHILLS, FL 33592 <br /> AUTHOR�D REPRESENTATNE _ � q _ <br /> �� � <br /> ACORD 25-S (7/97) OO ACORD CORPORATION 1988 <br />