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CERTIFICATE OF LIABILITY INSURANCE (222)SAMSE -1 OP ID: LW A4. -- CERTIFICATE OF LIABILITY INSURANCE DATE 0(M28/200/13 113YY) 0 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 Phone: 727 -461 -6044 Brown & Brown of Florida, Inc. Fax: 727 -442 -7695 83 Park Place Blvd., Ste 101 P.O. Box 2456 (33757 -2456) Clearwater, FL 33759 Candida Lamberson, CIC, CRM NAMEACT PHONE FAX (A/C. No. Ext): (NC, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Auto-Owners Insurance Co* 18988 INSURED Sam's Electrical Contractor, Inc. 712 Wesley Ave., Ste A Tarpon Springs, FL 34689 -6729 INSURER B : Southern- Owners Ins. Co. 10190 INSURER C : Bridgefield Employers Ins. Co. 10701 INSURER D : American States Insurance Co. 19704 INSURER E : CLAIMS -MADE INSURER F : OCCUR COVERAGES CERTIFICATE 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 JMM /DD/YYYYUMM 08/30/13 POLICY EXP /DD/YYYYL 08/30/14 LIMITS EACH OCCURRENCE $ 1,000,000 B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 20591585 DAMAGES ( RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GE GENERAL AGGREGATE $ 2,000,000 'L AGGREGATE POLICY X LIMIT APPLIES Fire,: PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ D AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 01C158044420 05/08/13 05/08/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4346570000 08/30/13 08/30/14 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENTION $ 5,000 .70 TORY L M TS TH- OER $ C WORKERS AND EMPLOYERS' L ABII COMPENSATION ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 083050336 03/01/13 03/01/14 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),-, CERTIFICATE HOLDER CANCELLATION CITYC -1 City of Clearwater P. O. Box 4748 Clearwater, FL 33756 -5520 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD