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CERTIFICATE OF LIABILITY INSURANCE (695)UFFOU -1 OP ID: CR .•9'� —`'"' CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 03/18/2016 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 Ellett Insurance, P.L. 905 NW 56th Terrace, Suite A Gainesville, FL 32605 -6408 Ellett Insurance, P.L. • CONTACT P.L. NAME: Ellett Insurance, (A/C No. Ext):352- 331 -8044 fa, No): 352 -331 -2347 nI DRESS: elletta@bellsouth.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Owners Insurance Company 32700 INSURED Univ of Florida Foundation Inc Attn: Lorraine Burton P.O. Box 14425 Gainesville, FL 32604 -2425 INSURER B: 78586654 `a'¢112Q t Y 2 !r INSURER c .J,,$(01/2016 INSURER D : $ 1,000,000 INSURER E : INSURER F : X • (XI—V MVPs/ IV ,\Y,a,OGR. 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DO/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 78586654 `a'¢112Q t Y 2 !r �R1n 2n1 :, t , . , .J,,$(01/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR PREM S (RENTED PREMISES (Ea occurrence) $ 100,000 X Host Liquor Liab MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER LIMIT APPLIES JECOT- PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS �� pp 78586654 L..., '– I ', A,� .. '� '88/91,2®15-•a$JQ1112016 t' ``° COMBINED tSINGLE LIMIT $ 1,000,000 BODILYINJURY Per ( Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, escribe under DESCRIPTION OF OPERATIONS below / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Loan of a gas grill for Pinellas County Gator Club International Gator RECEIVED Day event on Saturday, May 21, 2016 at Bay Pines VA/C.W.BiII Young Medical Center. MAR 31 2016 GAS ADMEN R CANCELLATION Clearwater Gas System Attn: Mike Deegan 400 Maple Street Clearwater, FL 33770 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 cods 0,A e , olo ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD