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CERTIFICATE OF LIABILITY INSURANCE (700)Ac Rv' CERTIFICATE OF LIABILITY INSURANCE DATE(M�DDIYYYn 04/21/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE3 NOT AFFIRMATNELY 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 REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: H tha csrtlficatf holdar is an ADDITIONAL INSURED, the policy(ies) must bs andorsad. If SUBROGATION IS WM/ED, subj�ct to tho terms and condltions of tha poNcy, cortain polici�s may nquire an endonamant A stat�rrwnt on this c�rtificaN do�s not co�r ri�hts to tha cortiflcab hold�r in li�u M such andorsertwnt(s). Meooucae �E: Chris Crusey South Pante Insurance Services �E .(813) 661-0382 FmX �: 16637 Fishhawk Bivd Suite 104 �p��; denise�spisfla.com W8URER(S AFFORDING COVERAGE NAIC t Lithia FL 33547 u�sur�R �: Insurance Company of the West 27847 wsur�c a�sur�R s : Connor's Jet Age Fuel Inc 519 Pennsylvania Ave I a�sur�R e : Ciesrvvater F� 33755 �NSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE �ISTED BE�OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW(THSTANDING 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. IIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �R TYrE � IN3URANCE POIICY NUMBER M LICY EFF POLICY 0� V� COMI�RCIAL GENERAL LIA&LITY EACH OCCURRENCE i CLAIMS•MADE � OCCUR PREMISES ocauronor S MED EXP (My one psrson) S veRSONn� a nnv muursv s GEN'L AGORE(iATE LIMIT APPLIE3 PER: GENERAL AGGREGATE S ��' � JECaT � L� PRODUCTS - COMP/OP AGG f oTr+�: s AUT0110B�E LIA6NJTY � ,N� W . l 1 : ANY AUTO BOpIIY WJURY (Per peraan) s ALL ONMED SCHEDULED AUTOS AUTOS BODILY N�JURY (Per aaiderrt) f HIREDAUTOS ANOP40WNED PROPERTYDAMAGE : ac�dan[ i UM�Rd.I/� LIAB p�uR EACH OCCURRENCE i DICESf LIAB �Mg,MqpE AGGREGATE S � R�noNs s wo�es co�snna� AND EII�LOYERi' LJAB�RY Y/ N X STAME ER �rn aROwt�owrnarriea�curn� �.� ewc� �►cc�vr t 1.000,000 A OFFICERIMEMBER IXCLUDED? ❑N N� w WFL503351400 04/15/16 04/15N 7 �� ��) EL DISEASE - EA EMPLO S �,�.00O Nyes dpaiWundw E,(.,DISEASE-POLICY�IMIT S �,OOO,OOO DESCRIPTION OF RIITION3 below DEaCRIPTION OF O�ERATIONS / LOCATIONS / VONCLES (ACOIiD 101. Additlonal R�marks SeMduN. maY b� alddNd H ma� apse� M nqWnd) 30 days notice of cancellatiw� induded except 10 days for non-payment CERT�ICATE MOLDER C�cE�u►rina SHOULD ANY OF TFIE AdOVE DESCRiED ppLICEa dE CMICELLED sEFORE TNE EXPIRATION DATE THEREOF, NOTICE WILL dE DELIVERED W C1ty of Gearwater ACCORDANCE WITM 7HE POLICY PROVISIONS. PO Box 4748 A� ����A� ClQanvat� FL 33758 `"— a ACORD 2� (201�I01) m 1988,Z014 ACORD Th� ACORD nam. and l090 an rsgist�nd marks of ACORD a� ri�hb ns.rv.a. �'�1 � "4`°R° CERTIFICATE OF LIABILITY INSURANCE � �� ��� 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 POUCIES 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 endorsemeM. A statement on this certificate does not confer rigMs to the certificate holder in lieu of such endorsemeM(sl_ PRODUCER FEDERATED MUTUALINSURANCECOMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 INSURED CONNORS JET AGE FUEL INC, JET AGE FUEL 519 PENNSYLVANNIA AVE CLEARWATER, FL 33755 CONTACT NAME: PHONE FAX INSURER�S) AFFORDING COVERAGE iNSUReR a: FEDERATED MUTUAL INSURANCE COMPANY 237-735-6 �NSURER B: INSURER C: INSURER D: . INSURER E: INSURER F: NAIC # 13935 COVERAGES CERTIFICATE NUMBER: 45 REVISION NUMBER: 0 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 DL SUBR pOLICY NUMBER POLICY EFF POLICY EXP LTR INS WVD MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED $'IOO,OOO PR MISES Eaocwrrence MED EXP (Any one penon) A Y N 9178473 04/15/2016 04/15/2017 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2�000,000 POLICY ❑ PR� ❑ LOC PRODUCTS - COMP/OP AGG $?�OOO,OOO X JECT OTHER: AUTOMOBILE LIABILITY � COMBINED SINGLE LIMIT Ea aeeident $�,0��,000 X ANY AUTO � BODILY INJURY (Per penon) ALLOWNED SCHEDULED A AUTOS AUTOS Y N 9178473 04/1$/2016 04/�5/20�7 BODILY INJURY (Per aceident) HIRED AUTOS NON-OWNED PROPERTY DAMACE AUTOS Per acciden X UMBRELLA LIAB. X OCCUR EACH OCCURRENCE �I�OOO,OOO A EXCESS LIAB CLAIMS-MADE N N 9178475 04/15/2016 04/15/2017 AGGREGATE $4,000,000 DED RETENTION WORKERS COMPENSATION OTH- AND EMPLOYERS' LIABILITY Y � N PER STATUTE ER ANY PROPRIETORlPARTNERIEXECUTIVE ❑ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under 6E5CRIP710N OF OPERATIONS below E.i. DISEASE - PO�ICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Affich ACORD 701, Additional Remarks Sdiedule, if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED FOR GENERAL LIABILITY AND BUSINESS AUTO LIABILITY. CERTIFICATE HOLDER 237-735-6 CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 33758-4748 ACORD 25 (2014/01) 45 0 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLJCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLJCY PROVISIONS. AUTHORIZED REPRESENTATIVE o �si The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. All rights reserved. #BWNDHBS 237-735-6 45 #XWXW0021XXXXXXX5# R�oo2-02 - oo�s cITY OF CLEARWATER PO BOX 4748 CLEARWATER FL 33758-4748 '4 °� CERTIFICATE OF LIABILITY INSURANCE I DATE7/ 5/2016YY) 07/05/2016 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 CONTACT NAME: CLIENT CONTACT CENTER PHONE (A/C, No, Eat): 888 - 333 -4949 FAX No): 507 - 446 -4664 E -MAIL ADDRESS: CLIENTCONTACTCENTERCa1FEDINS .COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 237 -735 -6 CONNORS JET AGE FUEL INC, JET AGE FUEL 519 PENNSYLVANIA AVE CLEARWATER, FL 33755 INSURER B: 9178473 INSURER C: 04 /15/2017 INSURER D: $1,000,000 INSURER E: INSURER F: X COVERAGES CERTIFICATE NUMBER: 45 REVISION NUMBER: 2 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 INSR SUER WVD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP (MMIDD /YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y N 9178473 04/15/2016 04 /15/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 A AUTOMOBILE X _ - LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON-OWNED AUTOS Y N 9178473 04/15/2016 04/15/2017 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 9178475 •' 04/15/2016 ,' 04 /15/2017 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED I 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 I A G�t'®lT^s^P • ) 1., r .„jj.��� ` ",-'' • ', ,! ,. PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT -, iA IE".. ASIA 1.17 E. ]] _ ,.6 /Cs )EFT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED FOR GENERAL LIABILITY AND BUSINESS AUTO LIABILITY. CERTIFICATE HOLDER CANCELLATION 237 -735 -6 45 2 CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 33758 -4748 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD