NATURAL GAS DISTRIBUTION MAIN & SERVICE LINE LOCATING - CERTIFICATE OF LIABILITY INSURANCEClient#: 12925
HEATCONSI
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE(MM /DD/YYYY)
7/23/2014
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
Dean & Draper Ins. Agcy., LP
3131 West Alabama
4th Floor
Houston, TX 77098
CONTACT Linda Fontenot
NAME:
PHONE 713 527 -0444 (A No):
Ext).
E-MA
713 527 -0457
Lo,
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Wausau Underwriters Insurance C
26042
INSURED
Heath Consultants Inc.
9030 Monroe Rd.
Houston, TX 77061
INSURER e : Liberty Insurance Corporation
42404
INSURER C : Steadfast Insurance Company
26387
INSURER D :
$1,000,000
INSURER E :
CLAIMS -MADE
INSURER F :
OCCUR
COVERAGES
CERTIFICATE 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
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
_(MM/DD/YYYY)(MM/DD/YYYY)
07/30/2014
POLICY EXP
07/30/2015
LIMITS
A
GENERAL LIABILITY
TBJZ91452436034
- - :
EACH OCCURRENCE
$2,000,000
X
COMMERCIAL GENERAL LIABILITY
PREMISES (EaEoNccur RENTED
$1,000,000
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$2,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP /OP AGG
$2,000,000
POLICY
X
JEC -
LOG
_. -
$.
A
AUTOMOBILE LIABILITY
ASJZ91452436024
07/30/2014
07/30/2015
COMBINED a accident) SI NGLE LIMIT
(E
1 000,000
$ s
X
X
ANY AUTO
BODILY INJURY (Per person) .
$
ALL OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS
BODILY INJURY (Per accident)
( )
$
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA UAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
TH7Z91452436064
07/30/2014
07/30/2015
EACH OCCURRENCE
$10,000,000
AGGREGATE
$10,000,000
DED X
RETENT ON $10000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
WC STATU-
TORY I IMITS
OTH-
ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
Y / N
N / A
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
C
Professional
Liability
E005932316
07/30/2014
07/30/2015
$10,000,000 Aggregate
and Each Claim
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The General Liability policy includes a blanket additional insured endorsement form LG3180 0907 to the
certificate holder only when there is a written contract between the named insured and the certificate
holder- that requires such status. Policy include a blanket 30 day notice of cancellation endorsement form
(See Attached Descriptions)
CERTIFICATE HOLDER
CANCELLATION
Clearwater Gas Systems
400 North Myrtle Ave
Clearwater, FL 33755 -0000 RECEIVED
RECEIVED
JUL 2 8 2014
!JUL 2 8 21 -s
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) 1 of 2
#S435458/M434858
GAS ADMIN Q 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD naneAs ADMtiliegistered marks of ACORD
VMA
DESCRIPTIONS (Continued from Page
LIM9901 0511 to the certificate holder only when there is a written contract between the named insured and
the certificate holder that requires such status.
SAGITTA 25.3 (2010/05) 2 of 2
#S435458/M434858