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CERTIFICATE OF LIABILITY INSURANCE (153)ACORO® �� CERTIFICATE OF LIABILITY INSURANCE DATE QMM /DDnrvY) 6/18/2013 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 Adcock - Adcock Property & Casualty Agency, Inc. 315 W. Fletcher Ave. Tampa FL 33612 -3414 CONTACT Tina Burton NAME: IA /CO."IO .Extl: (813) 933 -6691 (A /C. Not: (813)932-6287 E -MAIL tinab@adcock- insurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Old Dominion 40231 INSURED Interlock Electric Inc David Strelser P 0 Box 82073 Tampa FL 33682 -0841 INSURER B:AUtO-Owners Insurance Co. 18988 INSURER C :Technology Insurance Co. 42376 INSURERD: $ 1,000,000 INSURER E : $ 500,000 INSURERF: $ 10,000 COVERAGE CERTIFICATE NUMBER:CL1361806181 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP IMM /DD/YYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY MPG8463A ^.7.) , �t �I ?�9 4"= .,r • -� .,... _ . ... .. ..... 4820/2012 v 8/20/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GE X 'L AGGREGATE POLICY LIMIT APPLIES PRO- JFS:T PER: LOC $ B AUTOMOBILE — X — X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — X SCHEDULED NON -OWNED AUTOS r'''''—'( , A, 9575041iaQ0. L., a 4/- 2012'012 8/20/2013 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 500,000 BODILY INJURY (Per accident) $ 500,000 PROPERTY DAMAGE (Per accident) $ • 500,000 000 Medical payments $ 5,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 43646466700 8/20/2012 8/20/2013 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENTION $ 5,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED'? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N/A AWC1022887 7/1/2013 7/1/2014 WC STATU- I OTH- X TORY I IMITS ER E.L. EACH ACCIDENT $ 500, 000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CITY OF CLEARWATER 100 S MYRTLE AVE CLEARWATER, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Adcock /TW r- ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD