CERTIFICATE OF LIABILITY INSURANCE (553)'`' " CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DD/YYYY)
9/15/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
HOLDER. THIS
BY THE POLICIES
AUTHORIZED
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
Chris Coleman Agency
1255 Belcher Road
Dunedin FL 34698
CONTACT BNI- Chris
NAME:
PHONE
wC. No. Ext): (727) 441 -9911 I ra No): (727)941 -9566
E -MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :Travelers Insurance Co.
INSURED
Powerhouse Pro LLC
4867 Blue Jay Circle
Palm Harbor FL 34683
ne.w irsn,%ea ------- _- _.___ ____ __ _ - _ -______
INSURER B :Hartford
9/14/2014
INSURER C :
EACH OCCURRENCE
INSURERD:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
INSURER E :
INSURERF:
CLAIMS -MADE
•
n vuJIVI\ a uIuo ;
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)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
660- 2C918847
9/14/2014
9/14/2015
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100, 000
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY n PE n LOC
PRODUCTS - COMP /OP AGG
$ " 2,000,000
$
AUTOMOBILE
LIABIUTY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
_
SCHEDULED
AUTOS
NON-OWNED ED
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS UAB
_
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' UABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
....
Y
N / A
21WECAC4178 01
9/14/2014
9/14/2015
T
(TORY IMU- I I T
8 ER
E.L. ACCIDENT
$ 100, 000
E.L. DISEASE - EA EMPLOYEE
$ 100 000
r
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Electrical contractor.
City of Clearwater
400 N.;Myrtle Avenue
Clearwater, FL 33755
Annon ne rnfAninen
RECEIVED
SEP 7 2014
GAS ADMIN
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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
----,.
Jack Miller /JACK ` —_
z— -
INS025 (201005).01
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