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CERTIFICATE OF LIABILITY INSURANCE (2) ® DATE(MWDDIYYYY) AC® C" CERTIFICATE OF LIABILITY INSURANCE 7/22e2015 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 CONTACT Linda Fontenot NAME: Insgroup, Inc. afc°H o Exi; (713)541-7272 FAX No:(713)772-5224 1455 W. Loop South, 9th Floor ADDRESS:lfontenot @insgroup.net INSURERS AFFORDING COVERAGE NAIC# Houston TX 77027 INSURER A:Liberty Mutual Fire Ins. Co. 23035 INSURED INSURERB:Steadfast Insurance Company 26387 Heath Consultants Inc. INSURER C; 9030 Monroe Road INSURER D: INSURER E. Houston TX 77061 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1672280483 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 1MTH 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFtNSURANCE ADDLSUER POLICYNUMBER MPMfDDY r MMIDUY�P LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 RENTED DA" ETO A CLAIMS-MADE ® OCCUR PREM SES Eaooaxrence S 1,000,000 TB2Z91452436036 7/30/2016 7/30/2017 ACED EXP(Any one person) $ 1(),000 PERSONAL S.ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY[X] jEO ❑LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY EOhfB1,NEDD SINGLE LIMIT $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED A,g2Z91452436026 7/30/2016 7/30/2017 BODILY INJURY(Perecadent) $ AUTOS AUTOS NON-OMED PROPERTY DAMAGE $ X HIRED AUTOS Ix AUTOS Per accident X UMBRELLA LIA13 X OCCUR EACH OCCURRENCE S 10,000,000 A EXCESS LIAB CLAIMSWADE AGGREGATE $ 10,000,000 OED I X I RETENTION$ 10,000 TH7Z91452436066 7/30/2016 7/30/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOWPARTNERIEXECUTIVE ❑ NIA E.L EACH ACCIDENT $ OFFICER/A(EMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS be?av E.L DISEASE-POLICY LIMIT I$ B Professional Liability E00593231603 7/30/2016 7/30/2017 AgTegats $10,000,000 Each Claim $10,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS[VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) The General Liability policy includes a blanket additional insured and waiver of subrogation endorsement LC0443 0512 policy contains a special endorsement with the primary and non-contributory wording per endorsement LC2402 0213 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. Contractual Liability coverage provided by the policy is standard and may not cover all liabilities assumed by the named insured under the contract with the certificate holder endorsement CGO001 0413. Policy include a blanket 30 day notice of cancellation endorsement LIM9901 0511 to the certificate holder only when there is a written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater; THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn. : Clearwater Gas Systems ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE Henry Hochman/LFF ©9986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2o1401) COMMENTSIREMARKS between the named insured and the certificate holder that requires such status. The Auto Liability policy provide a blanket additional insured endorsement CA2048 1013 waiver of subrogation endorsement CA0444 1310 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. Policy include a blanket 30 day notice of cancellation endorsement LIM9901 0511 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. Umbrella Liability policy provide Auto Liability Follow Form and Contractual Liability Follow Form LCU0001 0413 applies. Additional Insured status is included regarding form number LCU0001 1101, waiver of subrogation endorsement LC2407 0807 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. Policy include a blanket 30 day notice of cancellation endorsement LIM9901 0511 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.