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CERTIFICATE OF LIABILITY INSURANCE (357)
CONNE -3 OP ID: DC ACc RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 04/08/2014 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 Lykes Insurance, Inc 400 N. Tampa St., Suite 2200 Tampa, FL 33602 Mike D. Johnson E093634 NAME: ACT Debbie Coad, CPIA PHONE FAX No, Ext): 813- 223 -3911 (A/C, No): 813- 221 -1857 n- MRLSS: dcoad @lykesinsurance.com INSURER(S) AFFORDING COVERAGE NAIL # INSURER A : HDI-Gerling America Ins. Co. 41343 INSURED Connor's Jet Age Fuel, Inc. 519 Pennsylvania Ave Clearwater, FL 33755 INSURER B : EGGCD00003271 , ._ INSURER C: J . . INSURER D : EACH OCCURRENCE INSURER E : DAMAGES ( RENTED PREMISES (Ea occurrence) INSURER F : MED EXP (Any one person) 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 TYPE OF INSURANCE IA SR WVD POLICY NUMBER (MM/DD //YYYY) (MM/ D/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X EGGCD00003271 , ._ - {1F>/2014 I J . . 04/15/2015 EACH OCCURRENCE $ 2,000,000 DAMAGES ( RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ NONE CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 X Primary & Non Con PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L X AGGREGATE POLICY LIMIT APPLIES PFo PER: LOC. Emp Ben. $ ' 2,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - X SCHEDULED AUTOS NAOTO-OW NED X ' _ . EAGCD0000 14 -'' " ' bltfi'5Y2014 04/15/2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY AMAGE S EACCIDE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ A 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 EWGCD000032714 04/15/2014 04/15/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is required) Certificate holder is listed as additonal insured for GL per form CG2010 & Auto Liability; 30 days notice of cancellation included except 10 days for non - payment City of Clearwater Box 4748 Clearwater, FL 33758 i CITYCLE 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 t A ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD