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CERTIFICATE OF LIABILITY INSURANCE (646)eC - Fng►(.Q -L 'rs Q`,0956 ' FLORGAS -01 MATERAT A`COR0 `r...+� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 7/912015 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 tl4i,L INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ce al Cis nLiy require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Insurance Office of America, Inc. AUG 31 015 4915 West Cypress Street Tampa, FL 33607 GAS ADMIN CONTACT Debbie Da NAME: Day PHONE 813 637 -8877 FAX No): (813) 637 -8484 IA/C, No, Est): ( ) ADDRESS: Debbie.Day @ioausa.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A : National Fire Insurance Co of Hartford 20478 INSURED Florida Gas Contractors, Inc. �"' ^ L f � 0() P 0 Box 280 I• v�• / U c bC 1) Dade City, FL 33526 INSURER B : Continental Casualty Company 20443 INSURER C : 01/01/2016 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : I IMRFR• 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. NOTVVITHSTANDING 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-SUBR INSD WV Q POLICY NUMBER (MM/ D/YYYY) (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 5099135473 01/01/2015 01/01/2016 EACH OCCURRENCE $ 1,000,000 PREM SESO(Eaoocccurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Agg. $2,000,000 PERSONAL & ADV INJURY $ 1,000,000 X for Poll /Prof GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES 78: PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Poll /Prof $ 1,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED NO AUTOS N -OWNED X 5099135490 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP $ 10,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X 5099135487 01/01/2015 01/01/2016 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 $ DED X RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N N /A 6014563480 01/01/2015 01/01/2016 X I STATUTE I I EORH E.L. EACH ACCIDENT $ 1,000,00 0' E.L. DISEASE - EA EMPLOYEE $ 1,000,000 1 000,000 E.L. DISEASE - POLICY LIMIT $ , A Equipment Floater 5099135473 01/01/2015 01/01/2016 $2,500 ded 3,644,499 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is requIred) The City of Clearwater is named as an additional insured as respects to general liability, on a primary and non contributo uired un er written contract. Umbrella policy is excess over primary policies. RECE Date JUL 132015 RECEIVED art m ent .._.....crg De CERTIFICATE HOLDER CANCELLATION City of Clearwater Engineering, lffQ-# 3+46., P.O. Box 4748 CI learwater, FL 33758 -4748 SEP 13 2015 QTr C Al. RECORDS AND Las! IVE swa DER tearvf 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 tp © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD