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COMPRESSED NATURAL GAS FILLING STATION UPGRADES RFP 10-13 - 13-0032-GA - CERTIFICATE OF LIABILITY INSURANCE (2)To: Page 2 of 2 4 , 2013-12-1 9 1 9:21 :39 (GMT) 1205991 0000 From: Mott Brannan `yam " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/2/2013 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 Brennan Agency, LLC 5120 Selkirk Drive Suite 230 Birmingham AL 35242 CONTACT Karen Thompson NQ ExB: (205) 981 -0500 I irc. No): (205) 981 -0501 ADDRESS: karen @brennanagency. com INSURER(S) AFFORDING COVERAGE NAIC i INSURER A:She££ield Fund LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Phoenix Energy, Inc. 100 25th Street South Birmingham AL 35233 INSURER B Essex Insurance Co INSURERC: INSURERD: $ INSURER E : $ INSURERF: CLAIMS -MADE OCCUR 14 We • 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 SubN WVD_ POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICYEXP (MMIDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE I RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n ,PIFt° [1 LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE — LIABILITY ANY AUTO ALL AUTOS HIRED AUTOS AUTOS SCHEDULED NON -OWNED AUTOS COWIN SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION S $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If yes, describe under D DESCRIPTION OF OPERATIONS below NIA 600 -2014- 25107 -00 3DR7709 01/01/2014 01/01/2015 Z I TORY WCSI TAIIMITU- S I IOTH- FR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) R 17275624052@myfax.com City of Clearwater Purchasing Division P 0 Box 4748 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 Matthew Brennan /KDT �:: ._ /' .. ......... ... . GAG INS095mmnnes m ©1988 -2010 ACORD CORPORATION. All rights reserved. Thu ACARn name anti Innn era ranictaraflfnarkc of ACr1Rn To: Page 1 of 2 FAX COVER SHEET 2013 -12 -19 19:21:39 (GMT) 12059510500 From: Meat Brennen To Council Press, Clerk OILS DEC 1 9 2013 Manager Attorney TO COMPANY FAX NUMBER 17275624052 FROM Matt Brennan DATE 2013 -12- 191921:11 GMT RE email print COVER MESSAGE Thank you Karen Thompson Karen Thompson Customer Service Representative Brennan Agency, LLC 205-981- 0500 (office) 205-981 -0501 (efax) 5120 Selkirk Drive, Suite 230 Birmingham, AL 35242 karen @brennanagency.com NOTICES: Coverage cannot be bound, altered or cancelled without written confirmation from an authorized representative of Brennan Agency, LLC. Coverage is governed by policies and endorsements. This email and any attached files are not encrypted and may contain privileged or other confidential information and is intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient or entity, or believe that you may have received this email in error, please reply to the sender indicating that fact and delete the copy you received. In addition, you should not print, copy, retransmit, disseminate, or otherwise use this information. Thank you. WWW.MYFAX.COM T. 6.436a 2 of 2 2013 -12 -19 19:18:37 (GMT) 12059810500 From Matt Brennan ACOR>D® CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDrYYYY) 12/2/2013 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 Brennan Agency, LLC 5120 Selkirk Drive Suite 230 Birmingham AL 35242 CONTACT Karen Thompson (PANG No Ems: (205) 981 -0500 I (ac. No): (205) 981 -0501 6ADDRESs :karen @brennanagency.com INSURER(S) AFFORDING COVERAGE NAIC INSURERA:Sheffield Fund LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Phoenix Energy, Inc. 100 25th Street South Birmingham AL 35233 INSURER B Essex Insurance Co INSURER C : INSURER D: $ INSURER E : $ INSURERF: $ COVERAGES CERTIFICATE NUMBER2014 WC COI 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 ADDL IN SR SUER WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: —I POLICY n PFC n LOC $ AUTOMOBILE _ _ — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident I. $ BODILY INJURY (Perperson) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENT ON $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY P OPRI ERO EXACRL DED7 CUTNE NN (Mandatory In NH) If yes, describe under DESRIPTION OF OPERATIONS below NIA 600 - 2014- 25107 -00 30R7709 01/01/2014 01 /01/2015 S WCSTATU- I TOT TORY I WITS FR E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 $ 1,000,000 E . DISEASE - EA EMPLOYEE E . DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CANCELLATION 17275624052 @myfax. ccan City of Clearwater Purchasing Division P 0 Box 4748 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 Matthew Brennan/KDT �!!�.' / .:. , .C.. ACORD 25 (2010/05) INS075oninnS1 m 01988 -2010 ACORD CORPORATION. All rights reserved. The Af:ARf name and Innn ara randctaradmarkc of ArAR11 a3go 1 of 2 2013 -12 -19 19:18:37 (GMT) 12059810500 Frorn: Matt Brennan FAX COVER SHEET TO To Council Press, Clerk 6�LS DEC 19 2013 Manager Attorney COMPANY FAX NUMBER 17275624052 FROM Matt Brennan DATE 2013-12-19 19:18:13 GMT RE email print COVER MESSAGE Thank you Karen Thompson Karen Thompson Customer Service Representative Brennan Agency, LLC 205-981-0500 (office) 205-981-0501 (efax) 5120 Selkirk Drive, Suite 230 Birmingham, AL 35242 karen @brennanagency.com NOTICES: Coverage cannot be bound, altered or cancelled without written confirmation from an authorized representative of Brennan Agency, LLC. Coverage is governed by policies and endorsements. This email and any attached files are not encrypted and may contain privileged or other confidential information and is intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient or entity, or believe that you may have received this email in error, please reply to the sender indicating that fact and delete the copy you received. In addition, you should not print, copy, retransmit, disseminate, or otherwise use this information. Thank you. WWW.MYFAX.COM