CERTIFICATE OF LIABILITY INSURANCE (300)'4 °® CERTIFICATE OF LIABILITY INSURANCE
I DATE03/21�14
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 POUCIES 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
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
OWATONNA, MN 55060
NAME: CT CLIENT CONTACT CENTER
PHONE FAX
(A /C, No, Ext): 888- 333 -4949 (A /C, No): 507-446 -4664
ADDRESS: CLIENTCONTACTCENTERaFEDINS.COM
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED 367 -251 -6
EAST -WEST ELECTRIC INC, GULFCOAST LIGHTING MAINTENANCE
2111 SUNNYDALE BLVD
CLEARWATER, FL 33765
INSURER B:
9909508
F.
INSURER C:
03/21/2015
INSURER 0:
$1,000,000
INSURER E:
$100,000
INSURER F:
EXCLUDED
•
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
POUCY NUMBER
POLICY EFF
(MMIDD /YYYYI
POLICY EXP
(MMIDDIYYYY) ,
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
N
N
9909508
F.
0312-112014
03/21/2015
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$100,000
MED EXP (My one person)
EXCLUDED
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$1,000,000
-
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGG
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY n JECT ri LOC
A
AUTOMOBILE
X
_
-
LIABILITY
ANY AUTO
AUTOS
HIRED AUTOS
_
AUTOSULED
NON -OWNED
AUTOS'
N
N
-
9909508- - ` '"
+ r
�- -
•
'Q3/21/2014 .
„ , - --
03/21/2015
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
N
N
9909509
03/21/2014
03/21/2015
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1,000,000
DED I RETENTION
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N / A
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
367 -251 -6
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER, FL 33758 -4748
11
0
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE Qie.47
ACORD 25 (2010/05)
® 1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD