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CERTIFICATE OF LIABILITY INSURANCE (582)65260)20)0)2 ACORD CERTIFICATE OF LIABILITY INSURANCE �.- DATE 12 /23 /2014 la /a3 /a01d 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 1- 813 -229 -8021 M. E. Wilson Co., Inc. 300 W. Platt St. Ste 200 Tampa, FL 33606 CONTACT NAME: Kelly B. Sutton, CIC PHONE 813 - 349 -2233 FAX No): 813-229-2795 UUC. No. EaU: E-MAIL keuttonClmewilson.com ADDRESS: INSURER(S) AFFORDING COVERAGE A NAIC it 10190 INSURER A: SOUTHERN OWNERS INS CO INSURED Fast of Florida, Inc. 13003 US 19 N. Clearwater, FL 33764 -7224 INSURER B: OHIO SECURITY INS CO 24082 INSURERC: NAXUN IND CO 26743 INSURERD: ZENITH INS CO 13269 INSURER E : INSURER F: X COVERAGES CERTIFICATE NUMBER: 42507359 R 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 INS° SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY 132312- 20694635 -14 12/28/14 12/28/15 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300, 000 GEN'L MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 AGGREGATE POLICY OTHER: x LIMIT APPLIES PRO- ECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 $ B AUTOMOBILEUABILITY X ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS BAS (16)56419607 12/28/14 12/28/15 COMBINED SINGLE LIMIT (Ea accident) i 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EXC- 6025701 -01 12/28/14 12/28/15 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED RETENTIONS $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I N I (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A 2126919801 12/28/14 12/28/15 PER H X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION CLEARWATER GAS SYSTEM 400 N MYRTLE AVE CLEARWATER, FL 33758 -4748 USA 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 f2o\ ACORD 25 (2014/01) thanks 42507359 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P5261012 &012 M. E. Wilson Co., Inc. 300 W. Platt St. Ste 200 Tampa, FL 33606 201112240140. Electronic Service Requested 3 -DIGIT 137 1492 0.5234 AT 0.403 11 1111111.111011111111111.111.11111.111111111111111111111111111 CLEARWATER GAS SYSTEM 15 400 N MYRTLE AVE CLEARWATER, FL 33755 -4433 This document was brought to you by CertificatesNow. - EBIX BPO If you have questions regarding the content of this document, please contact - the Producer /Agent listed on the certificate of insurance or the Insured listed on the notice of cancellation /reinstatement. - To find out how you can send and receive all of your certificates of insurance- either by email, high speed fax or standard mail, - email customercare@confirmnet.com, or visit our website at www.confirmnet.com- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 I'52(,(020002 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/23/2014 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 1- 813 -229 -8021 N. E. Wilson Co., inc. 300 W. Platt St. Ste 200 Tampa, FL 33606 INSURED Fast of Florida, Inc. 13003 US 19 N. CONTACT NAME: Kelly H. Sutton, CIC PHONE 8 (A/C No Extl: 13- 349 -2233 AD ADDRESS. ksutton5mewilson.com RE FAx (A/C No): 813 - 229 -2795 INSURER(S) AFFORDING COVERAGE NAIC • INSURER A: SOUTHERN OWNERS INS CO 10190 Clearwater, FL 33764 -7224 INSURER B: OHIO SECURITY INS CO 24082 INSURER C : MAXUM IND CO 26743 INSURER D : ZENITH INS CO 13269 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 42507299 • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIGAILD. NOTWITHSTANDING ANY REQUIREMENT, TERM CR 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 INSD SUBR WVD POLICY NUMBER 132312- 20694635 -14 POLICY EFF (YM/DDM'YYI 12/28/14 POLICY EXP (MMIDDIYYYY) 12/28/15 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX71 OCCUR DAMAGE TO RENTED PREMISES $ 300, 000 (Ea occurrence) MED EXP (Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 1 POLICY JE Q I I LOC I OTHER: PRODUCTS- COMPIOPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY BAS (16)56419607 12/28/14 12/28/15 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X _ ANY AUTO _ BODILY INJURY (Per person) E ALL OWNED AUTOS HIRED AUTOS _, SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per ( ) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EXC- 6025701 -01 12/28/14 12/28/15 EACHOCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOWPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? I N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Z126919801 12/28/14 12/28/15 X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N mom space Is required) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 100 S MYRTLE AVE CLEARWATER, FL 33758 -4748 USA 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 hV� ACORD 25 (2014/01) kbanks 42507299 ®1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD