Loading...
CERTIFICATE OF LIABILILTY INSURANCE (2)ACCORD OR� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 7/7/2016 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 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 CONTACT Debbie Santana PHONE 813- 933 -6691 FAX (AIC No Fxt)• to /C. No): kittss.debbies@adcock-insurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Auto- Owners Insurance Co. 18988 INSURED 1744 Interlock Electric Inc . David Strelser P 0 Box 82073 Tampa FL 33682 -0841 INSURER B :Main Street America Assurance 29939 INSURER C :Associated Industries 7/1/2017 INSURER D : $1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: 695142144 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 ADDLISUBR INSD WVD POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP IMM/DD/YYYY) LIMITS 8 X COMMERCIAL GENERAL LIABILITY MPG8463A KC ' \ n �.� L . I .. 1! a 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $500,000 _J GE X MED EXP (Any one person) $10,000 PERSONAL BADV INJURY $1,000,000 'L AGGREGATE LIMIT APPLIES POLICY JECT OTHER' PER J LOG GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO AUTOS�ED HIRED AUTOS x ~ SCHEDULED NON -OWNED AUTOS 99aF}' Ii AL RECORDS ;q llff RECORDS FA1V1 LVIJS./111 "(E LEGISLATIVE SRVCS DEPT /2016 ' I 8/20/2017 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $500,000 BODILY INJURY (Per accident) $500,000 PROPERTY DAMAGE (Per acodent) $500,000 $ A X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE 4346466700 7/1/2016 5/1/2017 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED x RETENTION$5,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN NIA AWC1066974 7/1/2016 7/1/2017 X PER LOTH - STATUTE ER E.L. EACH ACCIDENT $500,000 E L. DISEASE - EA EMPLOYEE $500,000 E DISEASE - POLICY LIMIT $500,000 B Installation Floater Rental Equipment MPG8463A 7/1/2016 7/1/2017 Limit 10,000 30,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCPR� CERTIFICATE OF LIABILITY INSURANCE DATE (MM�OD/YYYY) 7/8/2016 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 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 NAMEACT Debbie Santana PHONE 813- 933 -6691 FAX (A/C, No Fxt): (NC. No): E-MAIL debbies(�adcock- insurance.com ADDRESS INSURER(S) AFFORDING COVERAGE NAIC if INSURER A :Auto-Owners Insurance CO. 18988 INSURED 1744 Interlock Electric Inc . David Strelser P 0 Box 82073 Tampa FL 33682 -0841 INSURER B :Main Street America Assurance 29939 INSURER C :Associated Industries 7/1/2017 INSURER D : $1,000,000 INSURER E: INSURER F X COVERAGES CERTIFICATE NUMBER: 161654272 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL -SUBR INSD WVD POLICY NUMBER POLICY EFF (MM /DI�/WYY) POLICY EXP (MM /DD/YYYY) LIMITS B x COMMERCIAL GENERAL LIABILITY MPG8463A t '$ ,. ' L,)' r 1r( ��.(�� ( ''iy.:L.LiSi6Jr -r 7042016 ' i \ 3� ' I - 7/1/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $500,000 MED EXP (Any one person) $10,000 GE X PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PER: PRO L i LOC JECT PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO AUTOS NED HIRED AUTOS X SCHEDULED NON -OWNED AUTOS GIflt (2%.111V '�+ CC�l 9575041100 i 'GI , r ' ` 4 / Zp 8/20/2017 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $500,000 BODILY INJURY (Per accident) $500,000 PROPERTY DAMAGE (Per accident) $500,000 $ A X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE 4346466700 7/1/2016 5/1/2017 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ DED X RETENT ON $ 5,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A AWC1066974 7/1/2016 7/1/2017 X F PER I I OTH- STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 B Installation Floater Rental Equipment MPG8463A 7/1/2016 7/1/2017 Limit 10,000 30,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 (2014/01) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD