CERTIFICATE OF LIABILITY INSURANCE (1101) PRECMET-01 ON E
Q DATE(MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 1211312.021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND, 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(les)must have ADDITIONAL INSURED provision's or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and condition's 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 endorsemenrt(s)
PROD CIA � A✓cw n Eger:(S13 S8$ 12 _.�_........__�t' _ ._m��. ... � __.........._,
ASSOCIATES AGENCY INC, PIioNE FAx
11470 N 53rd St I ).._.._... 34 Aac Nrr 813 9'88-'09$9
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Temple Terrace,FL 33617 certs assoc eslnsxorn
..�. __... INsuRE�rs�AFI�t7RI9INCa cl�vRaaE_ .IT....�_ NAIc#
................. - _ ......_. __...__.... INSURER ASouthern Owners Insurance Co _ 10190,
INSURED INSURER 8:Auto Owners_Insurance Gv.... _�............ 18999 eX._._....
Precision Meter Repair,Inc.&Ronald E SYwilley _INsuFERC:RetalilFirst Insurance Com rt�rr _ 10700
4701 Reece Rd INSURE D�- _
Plant City,FL 33566 ....... _. ..._ m..............
......
INSDRER E
INSURER F
COVERAGES CERTIFICATE NUIMBER, 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.LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR...... .._.__w_. ---------- ............... ...._ .....__.
DDL BklBR mmPOLICY EFF POLICY EXP LIMITS
TYPE OF INSURANCE POLICY NUMBER
A X COMMERCIAL GENERAL LIABILITY 1,000 000
CLAIMS-MADE OCCUR 20'705479 121812021 121912022 DAMAGE TO E RENTED�NCS �IT 300,0.00
PREM E9..Ij.Po
MED EXP Ara.Chia rson $ "10,000
.___ _.x _ _...______.w.
. �. 1,t100,0I7(b
GEN"L AGGR"GATE LIMIT....P
PERSONAL,&ADV INJURY 3_ _m. ....._.....__..
APPLVES
PER: GwMERALAGGREGAT ......, $ 2,000,000
POLICY 1LOC 2 000,000
PR
PROC�IJCTS COm,_.._._.... ..........._
OTHER. EPLI x01000
AUTOMOBILE LIABILITY JCIMIIN
Iu INGLE LNArwIr " 1,000,000
}C ANYAUTC94370149001 12/812021 121912022 BODILY IWA41Y,w(Iber rsom _
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILYINJURY(!1q aa„cade uI
X ZEES ONLY X 001 C9!EY 1 22
®AN1A aE _mm
PIP $ 10;000
A X UMBRELLA LIAR X OCCUR EACH 6,000,000
IIO�GICY�RftEN'CE ._.�..�
EXCESS I.IAS CUMMS-MADE 4370149002 121912021 12181"8 2022 5,000,000
_.. ....
...._. ....... AGGREGATE
DEC X RETENTION$ 10,000 _._ ...............
WORKERS COMPENSATION
Y I N 991851 12/812021 12/812022
5' DTH- "
C ANYPROPRIE OW'E RTNEEWEXECUTIVE EACH TF _......... 1,000,006
.
AND EMPLOYERS'LIABILITY
ACCNCI;EN"
C}FFICEI2d�hiENIBEp�'EHCLLRrJEDa � N 4A ...... _..._._._.
( amdatory m ANN® E L DISEASE E.A EM'.PLOYEE� $ 1,000,000
if yytts,describe cruder
OE'SCRIPTION OF OPERATIONS below ... .. _ 1,�Q1) W4100
E.L.ELDISEASE-POLICY LIMIT $' �
_...... _.....
DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES(ACORD 101,Additional Remarks&hedarie,may be attached It me sPa�ce Is required)
C'ERTIFICAT'E HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Clearwater OBS Systems p THE EXPIRATION DATE THEREOF„ (NOTICE WILL BE DELIVERED IN
777 Maple Street 1".1V.�y � �N e`0 en 1 ACCORDANCE WITH THE POLICY PROVISIONS,
Clearwater,FL 33755 � _...
AUTHORIZED REPRESENTATIVE
GAS ADMIN
ACORD 25(2016103) 01988-2+016 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered imarks of ACORN)
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