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CERTIFICATE OF LIABILITY INSURANCE
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 06/21/2013 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 MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 Birmingham, AL 35202 CONTACT NAME: A /CNNo, Ext): 800 476 -2211 FAX C, No)• POLICY EXP (MM/DDIYYYY) E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC Ir INSURER A :Zurich American Insurance Company INSURER B Associated Electric & Gas Ins. Svcs. 16535 INSURED Peoples Gas System TECO Energy, Inc. 702 North Franklin Street Tampa, FL 33602 INSURER C :LM Insurance Corporation 33600 INSURER D : 07/01/2013 .,a INSURER E : EACH OCCURRENCE INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) CERTIFICATE NUMBER:HM48MKBM 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY XL5129402P Self- Insured Retention $1,000,000 'MD �.j„ ^•� '" " 07/01/2013 .,a 07/01/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ X CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OP AGG $ GE 'L AGGREGATE LIMIT APPLIES POLICY n PRO- JECT PER: LOC $ B AUTOMOBILELIABI&IY X — _ — ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS XL5129402 ' ;} ,, , Self- Insured $250,000 ;i � , ; r r i- ..i ei„ r l... w.o''�� /" �)1 �,1, , - • , .. 6" r �r;--r ::: / 07/01/2014 CO MaBINeDtS INGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XL5129402P 07/01/2013 07/01/2014 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED I RETENTION $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A Excess Workers' Compensation: EWS9318597 -02 (Statutory Limit is excess of $35,000,000 insured by LM Insurance Corporation) Employer's Liability: XL5129402P 07/01/2013 07/01/2014 X WC CY LIMITS I OER E.L. EACH ACCIDENT $ 1,000,000 - - - - - -' -- - - -- -- E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Excess Workers' Compensation EW5 -64N- 004918 -123 07/01/2013 07/01/2014 Each Accident or Each Employee for Disease $ $ 35,000,000 $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Excess Liability policy provides insurance in excess of Peoples Gas System's Self- Insured Retention as stated above. CANCELLATION City of Clearwater 100 South 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 .../24.4y sF ACORD 25 (2010/05) Page 1 of 1 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD McG +S +W MCGRIFF, SEIBELS & WILLIAMS, INC. ENERGY & MARINE DIVISION 2211 7TH AVENUE, SOUTH BIRMINGHAM, AL 35233 PHONE - 205/581 -9067 OR 800 - 476 -2211 EXT. 9067 FAX - 205/581 -9297 E -MAIL - RPLUMB @MCGRIFF.COM ATTENTION: IF THE ENCLOSED CERTIFICATE IS NO LONGER REQUIRED, PLEASE RETURN THIS FORM WITH THE CERTIFICATE BY MAIL, FAX OR EMAIL TO THE ATTENTION OF ROBBY PLUMB. ALL CONTACT INFORMATION LISTED ABOVE.