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CERTIFICATE OF LIABILITY INSURANCE (694)SOI7913 A D' CERTIFICATE OF LIABILITY INSURANCE DA ,/ YY) DATE 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 Commercial Lines Wells Fargo Insurance Services USA, Inc. 6100 Fairview Road Charlotte, NC 28210 CONTACT NAME: PHONE 888- 572 -2412 FAX O. Extl: (A/C, No): E-MAIL ADDRESS: certs@trinet.com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A : Indemnity Insurance Company of North America 43575 INSURED Strategic Outsourcing, Inc F/W/L Heath Consultants Incorporated PO Box 241448 Charlotte, NC 28224 INSURER B : .: 'hd INSURER C : m�4 INSURER D : $ INSURER E CLAIMS-MADE INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) GES CERTIFICATE NUMBER: 10075896 • 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 INSD SUBR VWD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY .: 'hd �,,. m�4 EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ GEN'L MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE POLICY OTHER: LIMIT APPLIES PER: PRO- JECT LOC GENERAL AGGREGATE S PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS a,�^rl�s -.(- '+ t Ctf'dL C.f. r ' ' � � ,. }Y.,. - �4 < : It a E d .-. �•.,, '1 s t, , '/ T t •`�• ,,,, .._. L ',r COMBINE. 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 RETENTIONS A AND EMPLOYERS' AND EMPLOYERS' LIABILITY YERS' LIABILITY A ILIT ANY PROPRIETOR /PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X WLRC48767448 03/01/2016 03/01/2017 X PER ER E.L. EACH ACCIDENT $ 1,000.000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Workers' Compensation coverage is limited to employees leased to Heath Consultants, Inc by Strategic Outsourcing, Inc. A Waiver of Subrogation applies in favor of City of Clearwater Gas Department as required by written contract. A 30 day notice of cancellation is endorsed to the policy for City of Clearwater Gas Department (Except for 10 days for non - payment of premium). CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn.: Clearwater Gas Systems P.O. Box 4748 Clearwater FL 33758 -4748 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 94"416.4- The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101) ©1988 -2014 ACORD CORPORATION. All rights reserved.