CERTIFICATE OF LIABILITY INSURANCE (702)AC Re
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
05/18/2016
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
Andrew Atsaves
do Artex Risk Solutions, Inc.
8840 E. Chaparral Rd.; Suite 275
Scottsdale, AZ 85250
CONTACT
NAME:
vCNNi , Ext): (480) 951 -4177 1 FAX No): (480) 951 -4266
E -MAIL
ADDRESS:
INSURED
A -1 HR a division of Oasis Outsourcing, Inc Alt. Emp: Scotto Plumbing
Service Inc.
3829 Coconut Palm Dr
Tampa, FL 33619
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : American Zurich Insurance Company
INSURER B:
40142
INSURER C:
INSURER D:
INSURER E :
INSURER F •
COVERAGES
CERTIFICATE NUMBER: 16FL275899889
•
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
ADt)L-SUBR
INSD
WVD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
;
CLAIMS -MADE
OCCUR
DAI�AGtTO RENTED
PREMISES
$
;
(Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
POLICY
PRO -
JECT L_ LOC
PRODUCTS - COMP/OP AGG
$
OTHER:
$
AUTOMOBILE LIABILITY
L
COMBINED SINGLE LIMIT
(Ea accident)
=
ANY AUTO
BODILY INJURY (Per person)
S
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
NON -OWNED
AUTOS
BODILY INJURY (Per accident)
( )
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
;
AGGREGATE
S
DED
RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
N/A
WC 02-79-166-01
06/01/2016
06/01/2017
X
PER
PETUTE
H
ER
OFFICER/MEMBEREXCLUDED?ECUTIVE
(Mandatory in NH)
If describe
Y/ N
E.LEACHACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
yes, under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
Location Coverage Period:
06/01/2016
06/01/2017
Client# 40- 1218 -FL
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required D
Coverage is provided for Scotto Plumbing Service Inc.
only those co- employees 1761 Carnegie Avenue
of, but not subcontractors Clearwater, FL 33756 MAY 2 6 2016
to:
CGS SALES DEPT.
CERTIFICATE HOLDER
CANCELLATION
Clearwater Gas Company
711 Maples Street
Clearwater, FL 33756
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 (2014/01)
e 1988 -2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Artex Risk Solutions, Inc. FL275
8840 E Chaparral Rd Suite 275
Scottsdale, AZ 85250
22143 1 AT 0.396
1111"111111 Iiiiiiilliiniiinlli 111111IIIJIIIIIIIIi,IIIIIIIIII
CITY OF CLEARWATER
400 N MYRTLE AVE
CLEARWATER, FL 33755 -4433
Q -22143
RECEIVED
MAY 2 6 2016
GAS ADMIN