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CERTIFICATE OF LIABILITY INSURANCE (401)AMERELE -03 VELAZQUEZA '44 ROA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/29/2014 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 Insurance Office of America -TPA 4915 West Cypress Street Tampa, FL 33607 CONTACT NAME: PHONE 813 637 -8877 _WC, No, Est): ) FAX 813 637 -8484 (A/c, No): ( )- E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Southern- Owners Insurance Company 10190 INSURED American Electrical Services of Tampa Bay, Inc. 107 Whitaker Road Lutz, FL 33549 INSURER B : Owners Insurance Company 32700 INSURER C : Bridgefield Employers Insurance Company 10701 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 POLICY NUMBER 20098643 POLICY EFF (MM/DD/YYYY 2/1/2014 POLICY EXP 2/1/2015 2/1/2015 LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED (Ea occurrence) $ 300,000 1 CLAIMS -MADE i X OCCUR MED EXP (Any one person) $ 10,000 r ,. 1 PERSONAL & ADV INJURY $ 1,000,000 e, \,:_:., \ ii,_:-- r.. GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO - X JECT 1 LOC COMBINED SINGLE LIMIT (Ea accident.) $ 1000,000 $ , B AUTOMOBILE LIABILITY X X ANY AUTO 4873080N,± r a s t.d,r ) ,, f r^;`� I.' ' „ s d L.:a. ' LrJ i'21112014 . "'" r "... r BODILY INJURY (Per person) $ ALL OWNED I- AUTOS HIRED AUTOS r X 'H SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ A )( UMBRELLA LIAB EXCESS LIAB X ! OCCUR CLAIMS -MADE 2/1/2015 EACH OCCURRENCE $ 2,000,000 4873089101 2/1/2014 AGGREGATE $ 2,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE Y / N I OFFICER /MEMBER EXCLUDED? 1. i (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 830 -44244 3/1/2014 3/1/2015 X WC STATU- TORY LIMITS OTH- 1 ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE - -- -- _ - - -- - -, E.L. DISEASE POLICY LIMIT $ 1,000,000 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule H more space is required) CERTIFICATE HOLDER CANCELLATION City of Claarwntc,r 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 n 100 South Myrtle Avenue iClearwater, FL 33768 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD