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� �"1 NEUMA-1 OP ID: KS '`��°ROm CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YWY) 03/05/12 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 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 endorsement(s). PRODUCER 727-784-8554 NAMEACT Stahl Ross 8 Associates Inc. 3939 Tampa Road 727-789-2823 ac No Ext: aC No: Oldsmar,FL 34677 E-MAIL Sandie Grimes ADDRESS: INSURER�S)AFFORDING COVERAGE NAIC# INSURERA Starr Indemnity&Liability Co 38318 INSURED Neumann Roofing�LLC. INSURERB Amerisafe Insurance Group P.O.Box 1207 San Antonio,FL 33576 INSURER C. 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMlDD/YYYY MMlDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ��OOO�OO A X COMMERCIAL GENERAL LIABILITY SIPGGL0032600 03/04/12 03/04/7$ pREMISES Ea occurrence $ 10�,�� CLAIMS-MADE ❑X OCCUR MED EXP(Any one person) $ 5,0�� PERSONAL f:ADV INJURY $ 'I�OOO,OOO GENERALAC;GREGATE $ Z,OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPlOP AGG $ Z,OOO,OOO POLICY PR� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE: $ DED RETENTION$ $ WORKERS COMPENSATION WC STPTU- OTH- AND EMPLOYERS'LIABILITY �,�N TORY LIMITS X ER B ANY PROPRIETORlPARTNERlEXECUTIVE AVWCFL2074322012 01/01/12 01/01/13 E.L.EACH AC;CIDENT $ ��0�� OFFICER/MEMBER EXCLUDED? � N�A (Mandatory In NH) E.L.DISEASE:-EA EMPLOYEE $ �,��,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE:-POLICY LIMIT $ ��OOO�OO DESCRIPTION OF OPERATIONS/LOCATYON5/VEHICLES (Attaeh ACORD 701,Additional Remarks Schedule,if more space is required) Jason Neumann-License CCC1326166 CERTIFICATE HOLDER CANCELLATION ZEPHYRH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephyrhills ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Fax 87 3-780-0021 AUTHORIZED REPRESENTATNE 5335 8th Street �C� � �1�� Q / Zephyrhills,FL 33540 "�UL`— O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD