CERTIFICATE OF LIABILITY INSURANCE (301)DANDR -1
OP ID: GD
A EY
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
03/27/2014
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 -447 -6481
Bouchard - Clearwater Fax: 727 -449 -1267
101 Starcrest Drive
P Box 6090
Clearwater, FL 33758 -6090
J Raymond Bouchard, CIC
NAME:
FAX
PHONE (A/C, No):
(A/C, N), Ext):
E-MAIL SS: cicerts @bouchardinsurance.com
INSURER'S) AFFORDING COVERAGE
NAIL #
INSURER A : Westfield Insurance Company
24112
INSURED D'Andrea Electric Inc
8100 Ulmerton Road
Largo, FL 33771 -3921
INSURER B : Bridgefield Employers Ins Co
10701
INSURER C :
EACH OCCURRENCE
INSURER D :
X
GEN'L
INSURER E :
DAMAGE TO RENTED
PREMISES R occurrence)
INSURER F :
•
kola V CR/it7 Co VB.,' I II IV," I •- , • v,.. vr. ■• - - -.
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
• ..
INSR
I : 1
WVD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
GENERAL LIABILITY
TRA5168224
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} .:T ` : ". ' '
04/01/2014
04/01/2015
EACH OCCURRENCE
$ 1,000,000
X
GEN'L
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES R occurrence)
$ 500,000
CLAIMS
X
OCCUR
MED EXP (Any one person)
$ 10,000
-MADE
PERSONAL & ADV INJURY
$ 1,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2,000,000
POLICY
X
jF a
LOC
$
A
AUTOMOBILE LIABILITY
e
a., ,
TRA516822 ` "`'`
( —+
,'.04/01/2014
04/01/2015
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
X
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
_
X
SCHEDULED
AUTOS
-OWNED
NON AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
UMBRELLA LIAB
EXCESS LIAB
$
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED
RETENTION
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUT1VE Y / N
083052520
04/01/2014
04/01/2015
X
WC STATU-
OTH-
ER
ER
E.L. EACH ACCIDENT
$ 1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N / A
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
It yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Equipment Floater
TRA5168224
04/01/2014
04/01/2015
Leasd /Ren 50,000
Ded. 1,000
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule it more space is required)
VCR I irIVM I C r7VCNR
CICLEAR
CITY OF CLEARWATER
PO Box 4748
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
_
ACORD 25 (2010/05)
The ACORD name and logo are registered marks of ACORD