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CERTIFICATE OF LIABILITY INSURANCE (604)A p °® CERTIFICATE OF LIABILITY INSURANCE 2�5�2o D5 ) 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: PHONE (727) 530 -0684 FAX (727)532 -9602 (A/C. No. Extl: (A/C. No): ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A:SOUthern- Owners Ins. Co. 10190 INSURED Scotto Plumbing Service Inc. PO Box 1632 Clearwater FL 33757 -1632 INSURER B -Auto- Owners Ins. Co. 18988 INSURER C : 2/18/2016 INSURER D : $ 1,000,000 INSURER E : $ 50, 000 INSURERF: $ 5, 000 BER:CL152538987 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 TYPE OF INSURANCE JNSR SWVD POLICY NUMBER (MM /DDY!YYYY) (MM/DDY�) LIMITS A GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY 20479726 2/18/2015 2/18/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (Ea RENTED $ 50, 000 MED EXP (Any one person) $ 5, 000 CLAIMS -MADE X OCCUR PERSONAL 8. ADV INJURY $ 1,000,000 X PD- Deductible $10,000 GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP /OP AGG $ 1, 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: —1 POLICY ICI JI n LOC $ B AUTOMOBILE X X UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 4347972600 2/18/2015 2/18/2016 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PerOPERTYt) DAMAGE $ ADI $ A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE Underlying: Auto /GL 4753990301 2/18/2015 2/18/2016 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED .X RETENTON$ 5,000 WORKERS COMPENSATION AND EMPLOYERS' UABIL TY N ANY PROPRIETOR/PARTNER /EXECUTIVE IY / I OFFICER/MEMBER EXCLUDED? j (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A j A I TORY LIMITS I 10TH- D I FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE, $ E.L. DISEASE - POLICY LIMIT $ A RENTED /LEASED EQUIPMENT 20479726 2/18/2015 2/18/2016 LIMIT: 22,000 DEDUCTIBLE: 500 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RECEIVER c ) - City of Clearwater 400 N. Myrtle Ave Clearwater, FL 33755 FEB - 9 2015 GAS ADMIN 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 /rl. LA ACORD 25 (2010/05) INS025oolong�n1 ©1988 -2010 ACORD CORPORATION. All rights reserved. The. A(_fP11 namn and Irian ore. re.nicte.re.d marke of A(_f1Rrl COMMENTS /REMARKS GENERAL LIABILITY: Automatic Additional Insureds when required by Written Contract with Products /Completed Operations per form 55373 01/07. Scheduled Additional Insureds for Lessors (equipment) operations only per form 55183 12/04. 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. �. 1 ® ,4� ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 2/5/2015 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: PHONE (727)530 -0684 IFAX (727)532 -9602 (A/C. No. Eat): INC. No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :SOUthern-OwnerS Ins . CO . 10190 INSURED Scotto Plumbing Service Inc. PO Box 1632 Clearwater FL 33757 -1632 INSURER B Auto- Owners Ins. Co. 18988 INSURERC: INSURER D : 2/18/2015 INSURER E : EACH OCCURRENCE INSURERF: X NUMBER- CL152538987 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 TYPE OF INSURANCE AI SR�WVD Ctit� POLICY NUMBER IMM /DCD/YEYYY) (MMIDD /D�) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL 13 LIABILITY OCCUR 20479726 2/18/2015 2/18/2016 EACH OCCURRENCE $ 1,000,000 X PREMISES SES (EaEoccurrence) $ 50 , 000 CLAIMS -MADE I MED EXP (Any one person) $ 5, 000 X PD- Deductible $10,000 PERSONAL 8. ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Fl LOC PRODUCTS - COMP /OP AGG $ 1, 000 , 000 —I POLICY I I ECT $ B AUTOMOBILE LI ABILITY ANY AUTO ALLOWNED AUTOS HIRED AUTOS -OWNED 4347972600 2/18/2015 2/18/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X NON PROPERTY DAMAGE (Per accident) $ _AUTOS ADI $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Underlying: Auto /GL 4753990301 2/18/2015 2/18/2016 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X I RETENTON$ 5,000 $ 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 / A I TORY LIMITS I I TH ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ A RENTED /LEASED EQUIPMENT 20479726 2/18/2015 2/18/2016 LIMIT: 22,000 DEDUCTIBLE: 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ( ) - City of Clearwater Risk Management 100 S. 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 Cynthia Webster /LPW Tr . Ctit� ACORD 25 (2010/05) 1988 -2010 ACORD CORPORATION. All rights reserved. Tom_ . "run n __ �-_ __� i_- . .. MOIL .....•...,.a ......I,.. ,s nrnon COMMENTS /REMARKS GENERAL LIABILITY: Automatic Additional Insureds when required by Written Contract with Products /Completed Operations per form 55373 01/07. Scheduled Additional Insureds for Lessors (equipment) operations only per form 55183 12/04. 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.