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CERTIFICATE OF LIABILITY INSURANCE (639)ACORO® 9 CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 7/29/2015 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 CGB Insurance, LLC 2531 Green Forest Lane #101 Lutz FL 33558 CONTACT Audra Browder NAME: lA/c No. Ext); (813) 749 -7948 (ac No): (813)200 -2120 gDORIESS:audra @cgbinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Ohio Casualty 24074 INSURED Florida Gas & Plumbing, Inc 3200 Park St St Petersburg FL 33710 INSURER B Ohio Security Insurance Company 03491 INSURERC: 9/8/2016 INSURER D: $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER:2015 -2016 Master 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 INCn SUBR wvn POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD /YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY BKS 56241692 9/8/2015 9/8/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 GEN'L X MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS BAS54246855 9/8/2015 9/8/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE USO 54246855 9/8/2015 9/8/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Clearwater Gas is listed as additional insured for general liability purposes only CERTIFICATE HOLDER CANCELLATION bruce.griffin @clearwaterga Clearwater Gas Bruce Griffin 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 Kraig Blancher /AMANDA -_ yam �- ACORD 25 (2014/01) IN5025 (2014011 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD