CERTIFICATE OF LIABILITY INSURANCE (406)A` °� b CERTIFICATE OF LIABILITY INSURANCE
9/19/2013 '
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
VermOSt & Associates, LLC
1120 Belcher Rd S
Suite 1
Largo FL 33771
CONTACT
NAME: Maryanne Gillespie
(A//C.N No. Ext): (727) 748 -2886 I FaC Noll (727)748 -0168
ADDRIESS:mjillespie @vermost.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA:OWnerS Insurance Company
32700
INSURED
A T Communications Inc.
Stephen J. Lockard
2561 Sweetgum Way W
Clearwater FL 33761 -3923
INSURER B :Southern Owners Insurance
10190
INSURERC:Retailfirst Insurance Company
INSURER D:
7/6/2013
INSURER E :
EACH OCCURRENCE
INSURERF:
X
CERTIFICATE NUMBER:Master
•
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.
IKSR
LTR
TYPE OF INSURANCE
ADDL
itISR
SUER
WVD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL
LIABILITY
OCCUR
and
20589182
r ...
7/6/2013
7/6/2014
EACH OCCURRENCE
$ 1,000,000
X
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 50 , 000
CLAIMS -MADE
X
MED EXP (Any one person)
$ 5,000
X
Includes Hired
PERSONAL & ADV INJURY
$ 1,000,000
Non -Owned
AGGREGATE LIMIT
Auto
Liability
APPLIES PER:
GENERAL AGGREGATE
$ 1,000,000
GEN'L
PRODUCTS - COMP /OP AGG
$ 1,000,000
POLICY X PRO-
LOC
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
AWNED
OMBIN D IN LE LIMI
(Ea accident)
$
—
BODILY INJURY (Per person)
$
SCHEDULED
NON-O
BODILY INJURY (Per accident)
$
_ANON
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA LAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
.
4237998700
7/17/2013
7/6/2014
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED I I RETENTION $
$
C
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
052035702
4/17/2013
4/17/2014
r
X I TORY I IM ITS I I ER
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)
ELECTRICAL WORK
STEPHEN J LOCKARD. LIC# C -9803 [PINELLAS]. STATE REGISTRATION #et11000781
CERTIFICATE HOLDER
CANCELLATION
CITY OF CLEARWATER FL
PO BOX 4748
Clearwater, FL 33718 -4748
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
M Gillespie /GILLMA
ACORD 25 (2010/05)
INS025 (201005).01
CO 1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD