CERTIFICATE OF LIABILITY INSURANCE (704),�'►C � CERTIFICATE OF LIABiLITY INSURANCE DATE(MNVDD/YYW)
05/23/2016
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 ADDITfONAL 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 CONTACT
NAME:
---- —..._._.-- — --
Bauchard Insurance for Frank Crum PNONE ; Fax
NC, No,_ExtZ _ I (�C, No):
101 Starcrest Drive E-MAIL
Clearvuater, FL 33758 aopRES_s;_
INSURER(Sl AFFORDWG COVERAGE NAIC #
INSURED
FrankCrum 11, Inc. Alt. Emp: P& L Electric, Inc.
100 South Missouri Avenue
Clearvuater, FL 33756
wsuRERa: American Zurich Insurance
INSURER B :
INSURER D :
INSLIRER E :
� � WSURER F: I I
COVERAGES CERTIFICATE NUMBER: 16FL080857514 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 DESCR�BED HEREIN IS SUBJEC7 TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE ADDL SUBR � � -��-- ��� POLICY EFF POLICY EXP
LTR I POL�CY NUMBER MM/DD/YYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I 3
i AMAGE TO RENTED
CLAIMS-MADE � OCCUR � , pREMiSES (Ea occurrence E_____
j li� MED EXP (Any one person) E
-�-- ----- � ; ----
i PERSONAL & ADV INJURY S
— --- -- i I
GEN'L AGGREGATE LIMIT APPLIES PER: � GENERAI AGGREGATE E
� POLICY � jE � � LOC PRODUCTS - COMP/OP AGG E_
OTHER: E
AUTOMOBILE LIABILITY O B N SI GL LI $
Ea accident __ i _______ _
ANY AUTO BODILY INJURY (Per person) � 5
ALL OWNED SCHEDULED BODILY INJURY (Per accident) I S
AUTOS AUTOS —
NON-OWNED Per�acadentDAMAGE $
HIRED AUTOS AUTOS —
I$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE b
DED RETENT�ON 8 §
WORKERS COMPENSATION � X STATUTE •�ERH I
AND EMPLOYERS' LIABILITV
ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT S 1,000,000
A OFFICERlMEMBER EXCLUDED? � N/ A WC 47-58-512-05 06/Ol/2016 06/Ol/20� 7
(Mandatory in NHj E.L. DISEASE - EA EMPLOYEE S �,00�,��
Ify es, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT E �,OOO,OOO
Location Coverage Period: 06/01/2016 06/01/2017 Client# 50308-FL
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Coverage is provided for P& L EleCtriC, I11C.
only those co-employees 4765 Spring Avenue North
of, but not subcontractors CIealWatef, FL 33762
to:
CERTIFICA
City of Clearwater
P O Box 4748
Clearwater, FL 33758
CANCELLATION
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
` ���.._._—
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ACORD 25 (2014/01) The ACORD name and loqo are reqistered marks of ACORD