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CERTIFICATE OF LIABILITY INSURANCE (405)A�_°R°® CERTIFICATE OF LIABILITY INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BEL -OW. THIS CERTIFICATE OF- INSURANCE-DOES NOT CONSTITUTE-A-- REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. AND CONFERS NO RIGHTS UPON THE CERTIFICATE EXTEND OR ALTER THE COVERAGE AFFORDED HOLDER. THIS BY THE POLICIES -AUTHORIZED-- CONTRACT BETWEEN THE ISSUING1NStJRER(S); 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Dot Vry, ry, CIC CISR :MIL Ertl: (727) 391 -9791 I A/C. No): (727) 393 -5623. ADDRESS: dot.w y @stahlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Ameri sure Mutual Ins Co CPP2024094 e:.t_, " ' INSURED A. Randy 's Electric, Inc. P 0 Box 42577 St Petersburg FL 33742 INSURER B :Amerisure Insurance Co EACH OCCURRENCE INSURERC: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURERD: INSURER E : MED EXP (Any one person) INSURERF: COVERAGES CERTIFICATE NUMBER:CL1391318861 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 POLICY EFF IMM /DD/YYYY) POLICY EXP IMM/DD/YYYY) UNITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPP2024094 e:.t_, " ' 9/30/2013 9/30/2014 EACH OCCURRENCE $ 1, 000, 000 DAMAGE TO RENTED PREMISES (Ea occurrence) 300 000 $ , I CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n 7,9,, n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X X _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _ SCHEDULED AUTOS NON -OWNED AUTOS w CA20240 ,- 9/30/2013 . •- - -- . 9/30/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000.000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Broad Form Endst $ A X UMBRELLA LIAR EXCESS LIAB _ OCCUR CLAIMS -MADE CU2024096 9/30/2013 9/30/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5, 000, 000 DED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC2040900 9/30/2013 9/30/2014 I R Ul IOT X TOY LIMITS E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER CANCELLATION City Of Clearwater Licensing Dept. 100 South Myrtle Ave Clearwater, FL 33756 1 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 Kelly Petzold /VRY % '=l �� ' ' �-___- ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD