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CERTIFICATE OF LIABILITY INSURANCE (154)A9Rb® `..� CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 6/12/2013 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 Lassiter -Ware Insurance of Tampa Bay 4401 West Kennedy Blvd Suite 200 Tampa FL 33609 CONTACT Shelia Robertson NAME: ac °NNo ). (800) 845 -8437 IA/C. Not: (888)883 -8680 ppREss :sheliar @lassiter- ware.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:United Fire & Casualty Company INSURER B : 13021 INSURED Marshall Electricworks, Inc. 16143 Ivy Lake Dr Odessa FL 33556 INSURERC: 60393793 k .. ,F �: v V INSURERD: 6/2/2014 INSURER E : $ 1,000,000 INSURERF: $ 100, 000 IFICATE NUMBER:13 -14 GL /AU /UM 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 AWL INSR SUBR W VD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP IMM/DD/YYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 60393793 k .. ,F �: v V 6/2/2013 6/2/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES Ea occu RENTED $ 100, 000 MEDEXP(Anyoneperson) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY I i I j jR7r fl LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED HIRED AUTOS X SCHEDULED NON -OWNED -•.. 60393793 6/2/201 ,. ,. - 6/2/2014 (EaacidenSINGLELIMIT t $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ROaccident) E Y DAMAGE $ $ A X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE 60393793 6/2/2013 6/2/2014 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ X DED RETENT ON $ I 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABIL TY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A I WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYES $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (7 2 7) 5 6 2 - 4 5 7 6 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 Dana Snyder /SHELIA ACORD 25 (2010/05) INS025 (9mnnai m © 1988-2010 ACORD CORPORATION. All rights reserved. The. At' lQl1 name. and Inn^ ar% reniatmrorl marke of A(:fRIl