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CERTIFICATE OF LIABILITY INSURANCE (752) ` p DATE(MM/DD/Y A — L � CERTIFICATE ' ' 7/2812016 6 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). CONTA PRODUCER NAME:CT Sherry Wilt Lancaster Insurance Inc PHONE (727)461-3704 A/C No): (727)441-3296 1210 S. Myrtle Ave. E"MAIL .Sherry.Wilt@ lancasterinsur.com P 0 BOX 2856 INSURERS AFFORDING COVERAGE NAIC# Clearwater FL 33757 INSURERA:Owners Insurance 32700 INSURED INSURERB:FL United Business Assoc FUBA 913782 Jim Kenney Electric Inc INSURERC: James Robert Kenney Lic#EC0003101 INSURER D: 12800 Sophia Circle INSURER E: ,Largo FL 33774-2428 INSURER F: COVERAGES CERTIFICATE NUMBER:CL134304647 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 I ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE FxI OCCUR 20514046 6/12/2016 6/12/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 11 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X I POLICY PRO LOC $ A AUTOMOBILE LIABILITY Ea a.,oeritSINGLE LIMIT 300,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 9543339800 11/21/2015 11/21/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ _ 500,000 OFFICER/MEMBER EXCLUDED? n N/A 0631251 4/1/2016 /1/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION rosiewesternfield@ learwate SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater Gas Department Attn: Rosie AUTHORIZED REPRESENTATIVE 400 N Myrtle Ave Clearwater, FL 33755 w / ............ L404& ACORD 25(2010105) ©1988-2010 ACO D CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD