CERTIFICATE OF LIABILITY INSURANCE (216)/L ®
.►E
COD
R CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
07/4/2013
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
Marsh USA Inc.
100 North Tryon Street, Suite 3600
Charlotte, NC 28202
Attn: T 704.374.8000 / F 704.374.8500
963191-ALL-CAS..-13-14 ASI
CONTACT
NAME:
(A/CC, N . EMI: (A/C, No):
POLICY EXP
IMM /DD/YYYYI
E -MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Charter Oak Fire Insurance Company
25615
INSURED
Andrew Systems Inc
3 Westbrook Corporate Center #900
Westchester, IL 60154
INSURER B Continental Casualty Company
20443
INSURER C : American Casualty Company Of Reading, Pa
20427
INSURER D : Allianz Global Risks Us Insurance Company
35300
INSURER E :
MED EXP (Any one person)
INSURER F :
CERTIFICATE NUMBER:
ATL- 002777524 -18
REVISION NUMBER: 4
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
JNSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
IMM /DD/YYYYI
LIMITS
A
GENERAL
X
UABIUTY
COMMERCIAL GENERAL LIABILITY
6604C185409 1"-'' ' 1�.^ ''
.` l _- i..'
t
07-/25I2013
07/25/2014
EACH OCCURRENCE
$ 2,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
1,000,000
$
MED EXP (Any one person)
$ 25,000
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMP /OP AGG
$ 4,000,000
GE
X
'L AGGREGATE
POLICY
LIMIT APPLIES
P
PRO-
RO
PER:
LOC
$
B
AUTOMOBILE
X
X
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
x
SCHEDULED
AUTOS
NON -OWNED
AUTOS
`
BUA2057345190
(i//25/2ti13
07/25/2014
COMBINED SINGLE LIMIT
(Ea accident)
2,000,000
_S____
$
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
D
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
ULA2004465
07/25/2013
07/25/2014
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
$
DED
RETENTION $
U I U m
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER/EXECUTIVE Y / N
OFFICER /MEMBER EXCLUDED? N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
WC2057341124 (AOS)
WC2057341141 (CA)
WC2098343073 ( OR & WI )
07/25/2013
07/25/2013
07/25/2013
07/25/2014
07/25/2014
07/25/2014
X
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
1,000,000
E.L. DISEASE - POLICY LIMIT $
B
Auto Physical Damage
Owned & Hired Vehicles
BUA2057341169
07/25/2013
07/25/2014
Comprehensive deductible 5,000
Collision deductible 5,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Certificate Holder is included as additional insured under the General Liability policy as their interest may appear, but only if required by written contract with the named insured, subject to the terms and conditions of
the policy.
NCELLATION
City of Clearwater
100 South Myrtle Ave
Clearwater, FL 33756
I
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
of Marsh USA Inc.
Paula J. Henry r�r - a - , - I..= ay,.^„ �_
ACORD 25 (2010/05)
1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD