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CERTIFICATE OF LIABILITY INSURANCE
ARb® `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 7/22/2015 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 Insgroup, Inc. RE N�•D C� 1455 W. Loop South, 9th Floor 'I Q Houston TX 77027 JuL 2 8 :,5 CONTACT Linda Fontenot NAME: (A/C. No, Est): (713)541-7272 (A FAX /C, No): (713) 772 -5224 ADDRIess:lfontenot @insgroup.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURERA:Liberty Mutual Fire Ins. Co. 23035 INSURED Heath Consultants Inc. 9030 Monroe Rd. GAS ADMIN Houston TX 77061 INSURER B :Steadfast Insurance Company 26387 INSURER C : 7/30/2016 INSURER D : $ 2,000,000 INSURER E : INSURER F: X COVERAGES CERTIFICATE NUMBER:CL1572272005 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 IN SD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY1 POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X TB2Z91452436035 7/30/2015 7/30/2016 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO PREMISES (Ea oN�ED nce) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES NT- PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 Employee Benefits $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS AS2Z91452436025 7/30/2015 7/30/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X TH7Z91452436065 7/30/2015 7/30/2016 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY OFFICER/MEMBER OPR1ETOO/EXCLUDED? ER/EXECUTIVE I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Pollution Liability E005932316 7/30/2015 7/30/2016 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The general and auto liability policies include a blanket automatic additional insured, waiver of subrogation and 30 day notice of cancellation endorsement #LC04430512, #CA20481013, #CA04441013, & #LIM99010511 that provides these features to the certificate holder only when required by written contract between the named insured and the certificate holder that requires such. The general liability policy contains an endorsement #LC24200213 with primary & non - contributory wording. The umbrella policy is follow form and contains a blanket automatic waiver of subrogation and 30 day notice of cancellations #LC24070807 & #IC99991011 that provides these features to the certificate holder only when required by CERTIFICATE HOLDER CANCELLATION City of Clearwater Gas Attn: Brian Langile 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 Henry Hochman /JR02 }-z ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMENTS /REMARKS written contract between the named insured and the cetificate holder that requires such. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.