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CERTIFICATE OF LIABILITY INSURANCE (547)Acc, °® CERTIFICATE OF LIABILITY INSURANCE DATE /2014 /YYYY) 06130/2014 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 Marsh USA Inc. 1717 Arch Street Philadelphia, PA 19103 -2797 Attn: Philadelphia.certs@marsh.com / Fax: 212 - 948 -0360 272145- Ameri -'GAW -14-15 CONTACT NAME: PHONE FAX (A/C. No. Ext): (A/C. No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ACE American Insurance Company 22667 INSURED AmeriGas Propane, L.P. and Subsidiaries PO Box 858 Valley Forge, PA 19482 INSURER B Indemnity Ins Co Of North America 43575 INSURER C : ACE Fire Underwriters Insurance Company 20702 INSURER D : $ 2,500,000 INSURER E : $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: CLE- 003459760 -13 REVISION NUMBER:0 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 HDOG27335123 07/01/2014 07/01/2015 EACH OCCURRENCE $ 2,500,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,500,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO - JFCT PER: LOC PRODUCTS - COMP /OP AGG $ 5,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X SCHEDULED AUTOS NON -OWNED AUTOS ISA H08826778 07/01/2014 07/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,500,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WLRC48013041 (AOS) W (CA, MA) LRC48013053 CA, MA SCFC48013065 �) I 07/01/2014 07/01/2014 07/01/2014 07/01/2015 07/01/2015 07/01/2015 / X WC STATU- TORY I IMITS OTH- FR E.L. EACH ACCIDENT 2,000,000 $ .L5 E. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 2,000,000 $ 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 St. City of 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 of Marsh USA Inc. Manashi Mukherjee h .,,ara$ -. .,1w.a -ex- ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACO OR AGENCY CUSTOMER ID: 272145 LOC #: Philadelphia ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA Inc. POLICY NUMBER CARRIER NAIC CODE NAMED INSURED AmeriGas Propane, L.P. and Subsidiaries PO Box 858 Valley Forge, PA 19482 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The above- referenced automobile liability and general liability policies provide that, if the insurer cancels the applicable policy prior to the expiration date by notice to UGI Corporation or the first named insured under the policy for any reason other than non - payment of premium, the insurer will endeavor to send written notice of cancellation to the certificate holder at least 30 days prior to the cancellation date of the applicable policy. Failure to provide advance notice of cancellation to the certificate holder will impose no obligation or liability of any kind upon the insurer, its agents or representatives, will not extend any policy cancellation date and will not negate any cancellation of the policy. The Named Insured on this certificate is a subsidiary of UGI Corporation. RECEIVED JUL 31 2014 GAS ADMIN ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD