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CERTIFICATE OF LIABILITY INSURANCE (730)AEG o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD /YYYY) 6/30/2016 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 Lassiter-Ware Insurance of Tampa Bay 1300 N. Westshore Blvd Suit@ 110 Tampa FL 33607 CONTACT NAME: Peggy Amos (A /C.No.Ext): FAX (pJC,No):(asa)aa3 -8680 E -MAIL PegA@lassiter-ware.com ADDRESS: g INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Southern Owners Insurance Co. 10190 INSURED Peninsular Mechanical Contractors, Inc. 13690 Roosevelt Blvd Clearwater FL 33762 INSURER B :Owners Insurance Company 32700 INSURERC: 7/1/2017 INSUF.ERD: $ 1,000,000 INSURER E : INSURERF: X ERAGES CERTIFICATE NUMBER:16 -17 All Lines 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 INSn SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X Y B1663022465 RECEIVED JUL w, 7/1/2016 201b 7/1/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES PREMISES (Ea occurrence) $ 000 MED EXP (Any one person) $ 10,000 GEN'L X PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE POLICY OTHER: LIMIT APPLIES ECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X __ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS O��FF/FFyI�QC'IwAL RECCRDS B16630224p GISLANES AND % eEpr 6/Cr 1 7/1/2017 (Ea COMaccideen SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Personal Injury Protection $ 10, 000 A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE B1663022463 7/1/2016 7/1/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTON$ 10,000 $ 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 - I N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Leased /Rented Equipment 31663022465 7/1/2016 7/1/2017 $50,000 Policy Limit $500 Ded. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Clearwater The certificate holder is an additional insured under the terms and conditions of the general liability policy with respect to work being performed by the named insured as required by written contract. The general liability policy contains a Waiver of Subrogation in favor of the certificate holder providing the contract is executed prior to any loss. CERTIFICATE HOLDER CANCELLATION City of Clearwater P.O. Box 4748 Clearwater, FL 34618 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 Tee Grizzard /PEGR ACORD 25 (2014/01) INS025 /9014011 ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD