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CERTIFICATE OF LIABILITY INSURANCE (659)From Heather Weil FaxID (4041252-8834 Date 922015 11 0202 AM Paae2 of 2 /'� �„ :y��k� GUARFUE-01 HWEIL ,a►coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DDIVYYY) �' 912l2015 THIS CERTIFICATE IS ISSUEQ AS A MATTER OF INFORMATION ONLY ANQ 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 CQNSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDtTiONAL INSURED, the policy(ies� must be endorsed. If SUBROGATION IS WAIVED, sub]ect to the terms and conditions of the policy, certafn 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 CONTACT NAME: Tanner, Bailew and Maloof, I�FC. PHONE 404 252-8860 F'� Suite B-400 wc No ex:: i � ac, Ho :(404} 252-8834 5775 Glenridge Dr. NE aooa�ess: Atlanta, GA 30328 INSl1RED Guardian Fueling Technotogies LLC 9A52 Phifips Hwy Ste 5 Jacksonville, FL 32256 INSURER 5) AFFORDING COYERAGE NA �NSURee a: Mid-Continent Casualty Co i�suaER s: Travelers Indemnity Company of America 25658 �NSURea c: Travelers Property Casualty 25674 INSURER D : I � INSURER F: I I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 70 CERTIFY THA7 7HE POLICIES OF INSURANCE US7E� BEIOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO� INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIGATE MAY BE ISSUED OR MAY PERTAIN, 7WE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL 7HE TERMS, EXClUS10N5 AND CONDITIONS OF SUCH POUCIES. LIMITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �LTR TYPE OF INSURANCE �ffgp y �p POLICY NUMBER � MM/DD YYYY MMl U�YY LIMITS A X COMMERCIAL GENERAL LIA6ILITY EACH OCCURRENCE � 5 �,OUO�OOQ CLAIMS-MADE i� OCCUR 64 GL 936900 �9�0'�n�T$ 09f�1(2��6 pREMISES Ea occurrence 5 ��Qi�� X Pollution Liability MED EXP (Any one person) 5 Excluded X Professional Liab PERSONAl8 ADV INJURV 5 1,000,000 GEN'L AGGREGATE UMIT APPLIES PER: � GENERAI. AGGREGATE 5 Z,OOO�OOO POLICY ;� jE � � �0� PROQUCTS - COMPlOP AGG 5 2�0�0�000 OTHER: 5 AUTOMOBtLE LtABILITY - Ea aB�I�eDtSWGIE LIMIT g 1,00O,OOQ B X ANY AUTO 810-2G553Gi 3 ; 09101l2015 09/01/2016 BOOILY INJURY (per person) S ALl nWNED SCH£DULEp $pOtLY INJURY (Per accident) $ AUTOS AUTOS HIREDAl1T05 NON-OWNED PROPERTYDAMAGE � AUTOS Per accident S X UMBRELLA LIAB X pCCUR EACH OCCURRENCE 3 5,000�OOO A EXCESS UAB CLAIMS-MADE 04 XS 192595 i 09l0112015 O9/Di/ZDis qGGREGATE $ rJ,��0� oe� X RereNrioN s 10,006 � WORKERS COMPENSATION PER OTH- AND EMpLOYERS' LIA9ILITY X STATUTE ER C. ANYPRpPR�ETORfPAR7NERIEXECUTIVE Y�r � N�A UB-2G549651 ; 09l01Y1015 09/01I2016 E.LEACHACCIDENT $ i�0�0��00 OFFlCER/MEMBER EXCLU�ED7 U .. �Mandatory in NN) E.l. DISEASE - EA EMPLOYE $ '��OOO,OO If yes, describe under DESCRIPTION OF OPERATIONS below � E�. DISEASE - POLICY LIMIT 3 T,OOO,OOO �ESCRIPTION OF OPERATFONS ( LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) I CERTIFfCATE MOLDER CANCELLATION City of Clearwater Planning 8. Development Department 100 S Myrtle Avenue, Room 210 Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE t_:�� O 1988-2014 ACORD CORPORATIQN. All rights reserved. The ACORD name and logo are reglstered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 7HE POLICY pRQVISIONS. ACORD 25 (2Q14l01) From Heather Weil FaxID:(4041252-8834 ,-�� , y ; i, �� °��.' i,��tiE.f{, i�,�i.t.�:w .�.�� 1�ti,��.00r; �� . Date 9!2/2015 11 0202 AM Paae 1 of 2 5775 Glenridge Drive, NE, Suite B- 400 Atlanta, Georgia 30328 Phone:404-252-8860 F�x� 4(14-2i2-RRi4 FACSIMIGE To: From: Heather Weil City of Clearwater Pages: 2(including this cover} Fax: 727 5624576 Date: Wednesday, September 02, 2015 RE: Guardian Fuel Renewed C01 Piease find the attached certificate of insurance. Please let me know if you need anything else. Thanks, Neather Weil ( Technical Assistant Tanner, Ballew and Maloof, Inc. � Risk and lnsurance Services 0 404.917.1920 I F 404.252.8834 � �� r � �, � `�`- . �. � � ��, � �� "d � , � � �� '�. � ` � �� .� ��