The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (588)KCPETRO -01 JSMITH ACORL1 44.....---- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/10/2014 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 Cecil W. Powell & Company 219 N. Newnan Street Jacksonville, FL 32202 NAMEACT Joanne Smith, CIC PHONE 904 353 -3181 F X (A/C. No. Extl ( ) (ac, No): (904) 353 -5722 ADDRESS: Jsmith @cwpowellins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Colony Insurance Company COMMERCIAL GENERAL LIABILITY INSURED KC Petroleum Inc P 0 Box 60742 Jacksonville, FL 32236 INSURER B : Owners Insurance Co EPK301696 INSURER C : FCCI Insurance Company 10178 INSURER D : $ 1,000,000 INSURER E $ 50,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 POLIC ES 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 W1/0 POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DDYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EPK301696 09/11/2014 09/11/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES {Ea occurrence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES Tei PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS 4203213901 03/11/2014 03/11/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA UAB EXCESS LAB X OCCUR CLAIMS-MADE EXC301697 09/11/2014 09/11/2015 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,000 $ DED I RETENTION $ C _ WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y/N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 001WC14A42788 05/06/2014 05/06/2015 X STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Each Claim 1,000,000 9/11/2000 retro date A A General Liability General Liability EPK301696 EPK301696 09/11/2014 09/11/2014 09/11/2015 09/11/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CANCELLATION 1 City of Clearwater ty 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 ,1/ 01 iZE.. 0[GT t... ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORLf, CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DDNYTY) 04/30/2014 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 Cecil W. Powell & Co. P.O. Drawer 41490 219 Newnan St. Jacksonville, FL 32203 -1490 CONTACT NAME: ( o,Eat): 904.353.3181 FAX No): • 904.353.5722 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC it INSURERA: Colony Insurance Company LIABILITY COMMERCIAL GENERAL UABIUTY INSURED KC Petroleum Inc P 0 Box 60742 Jacksonville, FL 32236 INSURER B: Owners Insurance Co EPK301696 INSURER C : FCC! Insurance Company 10178 INSURER D : $ 1,000,000 INSURERE: $ 50,000 INSURER F: CLAIMS -MADE f X I OCCUR OVERAGE CERTIFICATE NUMBER: 2014 WC 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. IN R TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS '4 GENERAL X LIABILITY COMMERCIAL GENERAL UABIUTY EPK301696 09/11/2013 09/11.12014 EACH OCCURRENCE $ 1,000,000 HUI PREMISES Eatoccurrence) $ 50,000 CLAIMS -MADE f X I OCCUR MED EXP (Any one person) S 5,000 PERSONAL & ADV INJURY $ 1, 000,000 GENERAL AGGREGATE S 2,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n 1,11 187 n LOC PRODUCTS - COMP/OP AGG $ 2, 000, 0017 $ B AUTOMOBILE X LIABILITY ANY AUTO AUTOS OWNED UTOWNED HIRED AUTOS , AUTOSDULED NON -OWNED AUTOS 420321390103/11 /2014 03/11/2015 l'UMEINEU SINGLE LIMI I (a aI,t) 5 1, 000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPER tY DAMAGE (Per accident) 5 S A X UMBRELLA MB EXCESS UAB X OCCUR CLAIMS -MADE EXC301697 09/11/2013 09/11/2014 EACH OCCURRENCE S 8,000,000 AGGREGATE S 8,000,606 OED I RETENTONS S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICER/ME BER EXCLUDED ECUTIV� (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 001WC14A42788 05/06/2014 05/06/2015 X I vNC KATU- I IV' TORY LIMITS ER E.L. EACH ACCIDENT $ 1, 000, 000 E.L. DISEASE - EA EMPLOYEE S 1, 000, 000 E.L. DISEASE - POLICY LIMIT $ 1 , 000, 000 A Pollution Liability- Claims Made EPK301696 RETRO DATE: 9/11/2006 09/1112013 09/11/2014 $1,000,000 each claim 7 imit $5,000 deductible per claim DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 South Myrtle Ave Clejarwater, FL 33756 ACORD 26 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE :Susan Jordan /HJS Fxi fs.�.. © 1988-2010 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD