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CERTIFICATE OF LIABILITY INSURANCE (554)• ACOR� ® `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 2/12/2014 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 Jack Rice Insurance 13080 S Belcher Rd Largo FL 33773 CONTACT Commercial Lines Division NAME: (PHHCNN EXtt, (727) 530 -0684 FAX No): (727)532 -9602 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Southern— Owners Ins. Co. 10190 INSURED Scotto Plumbing Service, Inc. P.O. Box 1632 Clearwater FL 33757 INSURER B Auto—OWners Ins . CO . 18988 INSURERC: 2/18/2014 INSURER D : EACH OCCURRENCE INSURER E : X INSURER F : $ , 000 COVERAGES CERTIFICATE NUMBERCL1421233952 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 LTR TYPE OF INSURANCE ADDL INSR SUBFR III/VD VD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP IMMIDD/YYYYI A GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY OCCUR 20479726 2/18/2014 2/18/2015 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES PREMISES (Ea occurrence) $ , 000 I CLAIMS -MADE X MED EXP (Any one person) $ 5, 000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 171 PP ? n LOC PRODUCTS - COMP /OP AGG $ 1, 000 , 000 7 $ B AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS 4347972600 2/18/2014 2/18/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ --- X BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ Commercial Auto Plus Package $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE 4753990301 2/18/2014 2/18/2015 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED IRETENTON$ $ WORKERS COMPENSATION AND EMPLOYERS' UABIL TY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N I A WC STATU- 0TH - TORY LIMITS ER $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ A RENTED /LEASED EQUIPMENT 20479726 2/18/2014 2/18/2015 LIMIT: 22,000 DEDUCTIBLE: 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RECEIVED FEB 18 2014 GAS ADMIN CERTIFICATE HOLDER CANCELLATION ( ) City of Clearwater 400 N. Myrtle Ave Clearwater, FL 33755 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 Cynthia Webster /LPW L ACORD 25 (2010/05) I N SD25 (,m nns) m © 1988 -2010 ACORD CORPORATION. All rights reserved. Tho AI':(1Rn namo nrl Innn arcs rcnictor ,l market of A(^(1Rrl COMMENTS /REMARKS General Liability: Automatic Additional Insureds when required by Written Contract for Lessors (equipment) operations only per form 55183 12/04. Automatic Additional Insureds when required by Written Contract for Owners, Lessees, or Contractors per form 55373 01/07. Primary & Non - Contributory Coverage for Additional Insureds on an Automatic Basis when required by Written Contract per form 55373 01/07. Waiver of Subrogation for Additional Insureds on a Scheduled Basis per form CG2404 10/93. Automobile Liability: Scheduled Loss Payees per Policy. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.