The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (451)A` RL? CERTIFICATE OF LIABILITY INSURANCE DATE 3') 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 Lassiter -Ware Insurance of Tampa Bay 4401 West Kennedy Blvd Suite 200 Tampa FL 33609 CONTACT BJ Small NAME: IAHCNN .Extr (800)845 -8437 I ia.No): (888)883 -8680 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Amerisure Mutual Insurance Co. 23396 INSURED Southern Electric of Tampa, Inc. Post Office Box 15208 Tampa FL 33684 -5208 INSURERB:Amerisure Insurance Company 19488 INSURERC: 1/1/2015 INSURER D: $ 2,000,000 INSURER E : $ 300 , 000 INSURERF: COVERAGES CERTIFICATE NUMBER:2014 -2015 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR M/D POLICY NUMBER POLICY EFF IMM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 7-4E �'�y �'s +hl CPP2059129 LL J` /� l id, °? 1/1/2015 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300 , 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 X X GEN'L Contractual PERSONAL &ADVINJURY $ 2,000,000 XCU Included GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY I i i JI 0 Ti LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X _ X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X NON _ SCHEDULED AUTOS -OWNED AUTOS , la', i., E a 1 Lal. CA2059125 ' �. .'/ E.; (,, +__, 1/1/2014 1/1/2015 Ea accident) SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY Peraccident ( ) $ PROPERTY DAMAGE (Per accident) $ $ A C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU2059127 1/1/2014 1/1/2015 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I'1C2059126 1/1/2014 1/1/2015 WC X I TORY I IAM U- 1 10TH- TS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Design Professional Liability CPP2059129 1/1/2014 1/1/2015 Per Occurrence $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater P.O. Box 4748 Clearwater, FL 33758 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 Kirk Bramlett /BJSMAL ir= /6.�wr„ ACORD 25 (2010/05) INS025 (201005).01 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Southern Electric of Tampa, Inc. Certificate Notes for Policy Term: January 1, 2014 to January 1, 2015 General Liability: 1. Blanket Additional Insureds as required by written contract including Products & Completed Operations per Form CG7048 (06/13). 2. Blanket Additional Insured Form #CG7048 (06/13) will convert to Form #CG2010 (11/85) if specifically required by written contract. 3. Blanket Waiver of Subrogation as required by written contract per Form CG7049 (11/09). 4. Primary & Non - Contributory as required by written contract per Form CG7048 (06/13). 5. General Aggregate Limit Applies Per Project per Form # CG7049 (11/09). Automobile Liability: 1. Blanket Additional Insureds as required by written contract Per Form #CA7171 (05/08) 2. Blanket Waiver of Subrogation as required by written contract Per Form #CA7171 (05/08). 3. Automobile is a statutory coverage mandated by State Law. As such, coverage is primary and non- contributory. Workers' Compensation: 1. Blanket Waiver of Subrogation as required by written contract per Form #WC000313 (04/84). 2. Workers Compensation includes coverage for all employees including owners & officers. 3. Workers Compensation is a statutory coverage mandated by State Law. As such, coverage is primary and non - contributory. Umbrella: 1. General Liability, Automobile Liability and Employers Liability policies are listed in the underlying schedule on the Umbrella policy. 2. The Umbrella Policy contains its own terms and conditions, however the following endorsements have been added: a. Umbrella Per Project Aggregate subject to a Maximum Aggregate limit of twice the All Other Hazards Aggregate Limit shown in the policy per form CU7257 (11/07) b. Primary & Non- Contributory when required by written contract per form CU7467 (11/07) 3. Umbrella Policy allows for Transfer of Rights if prior to a loss. General Information: 1. The General Liability, Automobile and Umbrella policies all contain a Severability of Interest Provision. 2. The General Liability policy contains no specific residential exclusions and is subject to ISO form CG0001 (04/13) 3. The certificate notes shown above reference the following policies: a. CPP2059129, CA2059125, WC2059126, and CU2059127. ALL COVERAGE IS SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS.