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CERTIFICATE OF LIABILITY INSURANCE (460)AC•R;ID CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 6/27/2014 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 Adcock - Adcock Insurance Agency 315 W. Fletcher Ave. Tampa FL 33612 -3414 INSURED Interlock Electric Inc David Strelser P 0 Box 82073 Tampa FL 33682 -0841 1744 NAME: Tina Burton IA/C. "N o. Ext):813- 933 -6691 FAX No1:813- 932 -6287 E -MAIL ADDRESS:thaliak@adcock- insurance corn INSURER(S) AFFORDING COVERAGE NAIC if INSURER A Old Dominion INSURER B Auto-Owners Insurance Co 40231 18988 INSURER C Associated Industries Ins Co. INSURER 0 : 23140 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1 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 MA Epoc BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUN(B'Eld -� `:,: ELF ) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY MPG8463A .»„ .... te - ° �_ B/20/2013 ,... ..,' — ,_ , 3/20/2014 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $500,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: il POLICY PRO LOC JFCT PRODUCTS - COMP /OPAGG $2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X _ SCHEDULED AUTOS AUT NON OS -OWNED 9575041100 8/20/2013 3/20/2014 Es CO as den SINCTE LIMIT $ BODILY INJURY (Per person) $500,000 BODILY INJURY (Per accident) $500,000 PROPERTY DAMAGE (Per accidert) $500,000 PIP $$10,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4346466700 6/20/2013 3/20/2014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED X RETENT ON $5,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE i OFFICER /MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A AWC1034229 7/1/2014 7/1/2015 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $500,000 C.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) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 100 S MYRTLE AVE CLEARWATER FL 33756 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) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD