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CERTIFICATE OF LIABILITY INSURANCE (289)ACORD® `„■� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/11/2014 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 CGB Insurance, LLC 2531 Green Forest Lane # 101 Lutz FL 33558 CONTACT Audra Browder NAME: WC. PHNN p4); (813) 749 -7948 (FAAIC, No): (813)200 -2120 E DD IIESS:audra @cgbinsurance.Corn INSURER(S) AFFORDING COVERAGE NAIC # INSURERA Nationwide LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Bayshore Plumbing of Pinellas, Inc. 1491 S Missouri Ave Clearwater FL 33756 INSURERB FCCI Commercial Insurance 33472 INSURERC: /11/2014 i INSURERD: EACH OCCURRENCE INSURER E : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURERF: MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER:2014 -2015 Master 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 /DD /YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ACP 59 OSp �I 4`a: - If± I� , i /11/2014 i 3/11/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100 000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE I POLICY LIMIT APPLIES PRO -- PER: LOC $ A UTOMOBILE AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS ; - a�. ��+> }% ACP 5py54888,T�'�L' : v,,y,, L... •vim - 1.1./2014 3/11/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments $ 2,000 UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ 3 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 001 -WC13A -63872 3/11/2014 3/11/2015 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 $ 500,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER 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 Kraig Blancher /AMANDA ACORD 25 (2010/05) INS025 /2mnnRt 01 ©1988 -2010 ACORD CORPORATION. All rights reserved. Tha At^ARr1 n2ma mnrl Innn nra ranic*arari m rlrc of A!`ARrt