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CERTIFICATE OF LIABILITY INSURANCE (3)ACOR�® `./ CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 07/01/2016 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 MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 Birmingham, AL 35202 CONTACT NAME: CA/C. No, Ext): 800 476 2211 FAX No): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Everest National Insurance Company 10120 INSURED Peoples Gas System TECO Energy, Inc. 702 North Franklin Street Tampa, FL 33602 INSURER B Associated Electric & Gas Ins. SVGS. XL5129406P Self- Insured Retention $1,000,000 �Mipyr ^.� RECEIVED ii ; --If �� INSURER C: 07/01/2017 INSURERD: $ 1,000,000 INSURER E : $ INSURER F : - X COVERAGES CERTIFICATE NUMBER:CB3ETAR9 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 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 ADDLSUBR INSD VD POLICY NUMBER POLICY EFF (MDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY XL5129406P Self- Insured Retention $1,000,000 �Mipyr ^.� RECEIVED ii ; --If �� 07/0112016 ;; -:�C. ,���;y' 07/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ X CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ — SCHEDULED AUTOS NON -OWNED AUTOS XL5129406P Self -InSU �{iAry r y $250,00 !/11 RECORDS Rr LEGISLATIVE C LEGISLATIVE r� r 07/01/2016 AND A `1 l DEPT T ' 07/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 (Per BODILY INJURY Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XL5129406P 07/01/2016 07/01/2017 EACH OCCURRENCE - $ 2,000,000 AGGREGATE $ 2,000,000 $ DED RETENTION $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N r— ANY PROPRIETOR/PARTNER /EXECUTIVE I l OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Excess Workers' Compensation: EN4GL00054 -161 Employer's Liability: XL5129406P 07/01/2016 07/01/2017 X PER OTH- I STATUTE ER F.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) Excess Liability policy provides insurance in excess of Peoples Gas System's Self- Insured Retention as stated above. CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 South Myrtle Ave. 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) Page 1 of 1 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD