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CERTIFICATE OF LIABILITY INSURANCE (2)Accmil CERTIFICATE OF LIABILITY INSURANCE L.../ DATE(MM /DD/YYYY) 07/01/2014 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 MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 Birmingham, AL 35202 CONTACT NAME: (A/CNNo, Ext): 800-476-2211 FAX No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 INSURED Peoples Gas System TECO Energy, Inc. 702 North Franklin Street Tampa, FL 33602 INSURER B :Associated Electric & Gas Ins. Svcs. XL5129403P Self- Insured Retention $1,000,000 -- - ' -- INSURER C :LM Insurance Corporation 33600 INSURER D : $ 1,000,000 INSURER E : $ INSURER F : X ERAGES CERTIFICATE NUMBER:CYLU8FJE • 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 (MMIDD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY XL5129403P Self- Insured Retention $1,000,000 -- - ' -- 07/01/2014 07/01/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ X CLAIMS -MADE OCCUR MED EXP (Any one person) $ GEN'L PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY PRO- II LOC JECT PRODUCTS - COMP /OP AGG $ $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS XL5129403P Self - Insured` Retention $250,000 07/01/2014 07/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 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 XL5129403P 07/01/2014 07/01/2015 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENT ON $ $ A B 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 Excess Workers' Compensation: EWS9318597 -03 (Statutory Limit is excess of $35,000,000 insured by LM Insurance Corporation) Employer's Liability: XL5129403P 07/01/2014 07/01/2015 X I WC STATU- • OTH TORY LIMITS ER 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 -124 07/01/2014 07/01/2015 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. 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 ACORD 25 (2010/05) *SF Page 1 of 1 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD