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CERTIFICATE OF LIABILITY INSURANCE (691)
Client #: 1192721 GASLOG1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 2/17/2016 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 USI Insurance Services, LLC 500 Columbia Drive, Ste 102 West Palm Beach, FL 33409 -2718 RECEWED 561 693 -0500 CONTACT Kim Alford PHONE FAX (A/C, No, E :t):813- 321 -7528 (A/C, No): 610 - 537 -2721 E-MAIL SS: kim.alford @usi.biz INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Arch Specialty Insurance Compan 21199 INSURED FEB 2 2 Gas Logistics, Inc. 2016 dba All American Gas Services PO Box 46007 GAS ADMIN Tampa, FL 33647 INSURER B INSURER C : AGL00230710 B +, ` � j v�,� -, d r'"` ' 1 r INSURER D : $150,000 INSURER E : INSURER F : X VERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MM} /D�Dp/�Y�YYYL(MM f411ii7/'2016 F.. ' " - \t' r r (r J - POLICY EXP /DD/YYYYZ 03/03/2017 LIMITS EACH OCCURRENCE $2,000,000 A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY AGL00230710 B +, ` � j v�,� -, d r'"` ' 1 r PREMISESO(ERENTED nce) $150,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $10,000 GE PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $ 2,000,000 'L AGGREGATE POLICY LIMIT APPLIES JET PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE 1 LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) ( ) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED j RETENTION $ $ 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 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) CERTIFICATE HOLDER CANCELLATION CLEARWATER GAS SYSTEM 400 N MYRTLE AVENUE 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 ACORD 25 (2010/05) 1 of 1 #S17266591/M17266552 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KXAEW