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CERTIFICATE OF LIABILITY INSURANCE (423)FLORGAS -01 BROWND A ORL7" DATE (MM /DDmrYY) �.., CERTIFICATE OF LIABILITY INSURANCE 12/23/2013 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 ;Insurance Office of America -TPA ;4915 West Cypress Street (Tampa, FL 33607 - INSURED Florida Gas Contractors P O Box 280 Dade City, FL 33526 CONT NAMEACT Debbie Day _ PHONE g13 637 -8877 FAX JA/C, No, Ext): ( ) 1 (A/c, NJ: (813) 637 -8484 ADDRESS: Debbie.Day @ioausa.com INSURER(S) AFFORDING COVERAGE NAIC # JJNSURER A: National Fire Insurance Co of Hartford 20478 INSURER B : Valley Forge Insurance Company 420508 I INSURER C : Continental Casualty Company 20443 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. S LTR GENERAL LIABILITY INSURANCE NSR SWVD POLICY NUMBER (MM DD/YYM AMM /DD/YYYY) ! LIMITS I EACH OCCURRENCE $ 1,000,000; A X COMMERCIAL GENERAL LIABILITY 15099135473 1/1/2014 1 1/1/2015 DAMAGE TO RENTED— PREMISES (Ea occurrence) 1 $ 100,0001; CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,00011 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JERI° LOC AUTOMOBILE LIABILITY B X ANY AUTO ALL OWNED ' SCHEDULED AUTOS AUTOS NON -OWNED X AUTOS X HIRED AUTOS X UMBRELLA LIAB j X ' OCCUR 15099135490 EXCESS LIAB CLAIMS -MADE 5099135487 DED X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N A ANY PROPRIETOR/PARTNER /EXECUTIVE -- - OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) -- - If yes, describe under DESCRIPTION OF OPERATIONS below N/A PERSONAL & ADV INJURY i $ 1,000,000'', GENERAL AGGREGATE i $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000',, 'Prof /Poll $ 1,000,000', COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ 1/1/2014 ' 1/1/2015 BODILYINJURY(Perperson) $ 1/1/2014 15099135506 BODILY INJURY (Per accident) ! $ PROPERTY DAMAGE (PER ACCIDENT)__ PIP $ 10,000 EACH OCCURRENCE 1/1/2015 ',AGGREGATE 4,000,0001 4,000,000 WC STATU- 0TH X TORY LIMITS ER 1/1/2014 1/1/2015 E.L. EACH ACCIDENT 1 $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION Clearwater Gas 400 North Myrtle Ave Clearwater, FL 33758 RECEIVED DC .X42013 GAS ADM 1,000,006 1,000,000'' 1,000,000; 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 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORL7" FLORGAS -01 BROWND DATE (MM /DD/YYYY) PHONE 813 637 -8877 (A/ No, ExtJ: ( ) j CERTIFICATE OF LIABILITY INSURANCE 12/23/2013 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 Insurance Office of America -TPA 4915 West Cypress Street Tampa, FL 33607 CONTACT Debbie Day INSURED Florida Gas Contractors P 0 Box 280 Dade City, FL 33526 FAX Nod: (813) 637 -8484 a DRess: Debbie.Day @ioausa.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Fire Insurance Co of Hartford 20478 INSURER B :Valley Forge Insurance Company 20508 INSURER C : Continental Casualty Company 20443 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 ;ADDLSUBRT I POLICY EFF ; POLICY EXP LTR TYPE OF INSURANCE ! _INSR W1/D4 POLICY NUMBER A I (MM /DDNYYY) )MM /DD/YYYY) LIMITS GENERAL LIABILITY ! EACH OCCURRENCE DAMAGE TO RENTED is 1,000,000', A X ! COMMERCIAL GENERAL LIABILITY �t s ti j2O14 PREMISES (Ea occurrence) $ 100,000, CLAIMS- MADE !; l' OCCUR MED EXP (Any one person) , $ 5,000, X' GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- I, LOC JECT I AUTOMOBILE LIABILITY B I X ! ANY AUTO ALL OWNED SCHEDULED AUTOS ;AUTOS NON -OWNED A j HIRED AUTOS X AUTOS X UMBRELLA LIABX OCCUR C ! EXCESS LIAB '.. CLAIMS -MADE DED X RETENTION $ 10,000'! WORKERS COMPENSATION i AND EMPLOYERS' LIABILITY Y / N A ANY PROPRIETOR /PARTNER/EXECUTIVE ! l I OFFICER/MEMBER EXCLUDED? N 1, N / A ; (Mandatory in NH) ! If yes, describe under DESCRIPTION OF OPERATIONS below 5099135473 t CS ,5099135490 I 1/1/2014 G`)a� 1/1/2015 PERSONAL & ADV INJURY I $ 1,000,000', GENERAL AGGREGATE'. $ LPRODUCTS - COMP /OP AGG $ 2,000,000 !Prof /Poll $ 1,000,000 COMBINED SINGLE LIMIT 1,000 000,' (Ea accident) $ _ 2,000,000 15099135487 j5099135506 1/1/2015 1/1/2014 1/1/2015 1/1/2014 1 /1 /2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Certificate holder is additional insured with respect to general liability. CERTIFICATE HOLDER City of Clearwater Attn: City Clerk PO BOX 4748 1Clearwater,FL 34618 -4748 CANCELLATION BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE !, $ (PER ACCIDENT) PIP $ 10,000, EACH OCCURRENCE AGGREGATE 4,000,000', 4,000,000, XOW N:1 ! OTH TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE„' $ E.L. DISEASE - POLICY LIMIT $ 1,000,000 1,000,000 1,000,0001, 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 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD