CERTIFICATE OF LIABILITY INSURANCE (753) From. GF; FaW,aker To- 727-502-4902 race 212 Dare. 7/1 512010 10:35.23AIVL
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LL.-../)RD'' CERTIFICATE OF LIABILITY INSURANCE -,j15�z(,.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) trust be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and candifions of the policy,certain policies may require an endarscment. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER rONTA..T.Angela Powers
Ben Brown Insurance Agency PHONE ('341)366-9373 FAX
Ne),.{94.]365-3:43
E-MAIL
Angela @benbrownins.com
i 3731 5 Tuttle Ave APDRESS:.... .-_.-... ...__-._. ..--
INSURER(S)AFFORDING COVERAGE NAIC
Sarasota FL 34239-6410 INSURERA:Colony Insurance Co . 39993
.... . INSURERB-Ohio Security .Iris Co .... .. :2408
J Harris Piping, LLC. INSURER c:Ohia Casualty Ins Co 24074
35331 Chambers Dr. H�NB4RERO: —.. .. .-- ----------
...
INSURER E: _ ... ... ....-......._.........—.-... ..
Sephyrhills FL 33541 INSURER F:
COVERAGES CERTIFICATE NUMBER:15M, BA, Excess REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE INSURED NAMED ABOVE FOR TiIE POLICY PERIOD
INO'CATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND€TION OF ANY CONTRACT OR OTHER OOCUIQIENT WITH RESPECT TO WH!CI I 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 OFSUCH POLICIES.LIMITS SHOWN VAY HAVE BEEN REDUCEDSY PAID CLAIMS, _
1N5R .... .....Atif3L:SR _ .._T.�.-POLICY EFF .FdLECYExP
tTR TYPE OF INSURANCE 1}ggp:pyyp POLICY NUMBER WMIDWYYYY MM.MWYYYY I L1411T5
X C ?tl.MERCIAL0ENERAL LIABiLrrY EACH OCCURRENCE
`DAST7iGFtvTE� 1DO,000
A _CI.A:MS-N1ACF 'h' OCGttR PREhS SF.S_{E.p a I.rr-rJ 1 5._..........
' 103GLII00537901 11)1112015 10/1/2015 fi F.(J EXP{Dry 7r.e p°r53r1 3
PERSONAL S ACV Y_UR`? a 5,0;70,00
_. -.._.. 5,000,000
CE 1.AGGREGATE I.M T APPL'F.S PER GENERAL.AGGREGATE 5
PRO -.._ PRGCUCTS COP,Ip,OP ACG 5 5.00G,000
X Pouc- LOG ECT
OTHER
COMB NFr;S NGtF i
AUTOMOBILE LIABILITY
T
5 ],,❑DO,000
..x.. AN-AUTO
B 001 N_URv[PorP�mor
S -.. ALTO' NFC SC'iFCULEC 8;75552995A8 10/1/2015 10/1/2016 'SOC:L."NjURv(Peraxt�cn['.•3.
AUTOS `..-..-..
NCN-WVNFC PRCWFRTyCAh.1ACF S
'�{r?�r,.�rrenE'
I _....-H RED AUTOS _......AUTC75 .1—_..........—.....
_ .. . .-_._ ...._
X UMBRELLA LIAB }{ OCCUR EACH OCCURRENCE 1,OOO,000
--....._ y ...._._
L, EXCESS LIAR CAA 10 M.ACF AGGREGATE - _3.. 1�_i?00,000
DFC RFTENTONS -VO56385396 1C/E4/2015 10/24/2016: 5
PFR OTH-
WORKERS'COMPENSATIGN STATUTER y
AND EMPLOYERS'LIABILITY YIN .��_... .. .... .....-.._
E.E. EACH ACC CFNT S ._...._
AK-PROP R.ETOR:PAR-mER.EXE.^,L.T VL _.. . NIA
A. .... ..-.. ..-. ..__.-_...... ..... ....
:]FF-F R:t:k E.'BFR EXCL(A)LD': E L C.SEASF-EA EN.PI.CYEE 5
(Mandatory in NN) -
f r`?s ^es-n`i.t,r:r'r SEASE-P6L'CV LAI r S
CESCR PT ON OF QPFWT CNS E>eWr
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DESCRIPTION OF 0PERATI ON81 COCATI0 NS I VERI CLES (ACO 811101.Additional Remarks SChed Ul e,may he attached if rrara&PIC*is raga ire d)
Underground Gas Piping & mobile Welding.
CERTIFICATE HOLDER CANCELLATION
{727}562-4902
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater Administrative THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
O£Fice5 and South Area Service Canter ACCORDANCE WITH THE POLICY PROVISIONS.
400 North Myrtle Ave
Clearwater, FL 33755 ALI71iORIZEOREPRESEN7ATIVE
Cu?1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered sharks of ACORD
IN rris'ax%•ias sent,�j to 'G P'; Fax%liake`fax sever. For r:'n-P. •nfo,n"a-.on,vi t. htip:ltvv of qfI Cam
From, GR FaxMaker ta; 727,562-49C2 Page. 112 Date. "711 91201 '10,35:23 AM
FAX
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GIL�hjtcV Ceuthticate n'insurance JW Hairns
Message! Hells there,
Attached 6s the rt queste'd certificate, Neale let me know if you need, any+thun,g
adcdiltionaY. Have a Treat day!
Thairtk you, {
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Angela Powers
P
Account Manager
Ben Brown Insurance Agency, Inc,.
3731 S. Tuttte Ave,.
Sarasota, FL 34739
Phone: 941-366-9373
Direct Line: 941-487-3511
Fax: 941.365.3143
wti�clatl? r1'�arvint rrs.r;�Dar`u
COW'Il t Y NO"F the unfor rnu.ior conoined un tiills eimai r inten::ed only for vie pe^son or e ltity:o which,
it is ad,drLss.ed ranr may r.ortain cnnh hen:a6 parr:,/+or ioM,gai"ry privil,,�lgeii informauor 1f voj area not U d^signatec.
recipient,you may not rcvrewwP, copy or dlrstribute t,i9s It YOU awls rrressap e 1°i error,
please limrncrtiab: iy c'e,8ete it,de',:roy a,wy rm]e,',and notify sender. Tiainit youa..
rDISCAVWR:No cOvera9e't-an bP pain,ivound,or ritered via envail.Any and all rFaar°gews',regunsts„ aid,+or
applgcat'ionsw All be effective,only upuarr writ cn com-runicatiican frcarn na.r�jgency and/or Lnic insurance Carr'er.We
c,a;t Tot guvan ileevie,security o`'uratormat on transmitted over:'tree goterraet.
Bert Brown Insurance Agency Inc.,
3731 South Tra!kI Avenw.'snrnt,,rat.a FL 34 3F,J-5410
Tel.g41..36o 3373 Fax: 041 3155-31.43
d'�aP le'It75Wf�g.r'gti.fN;�,' 1d:+J?N'.�.t7r;nt:r[Y:"�'rllr1�grr F3ga4,.E.Pif:lr&r
7hls fax v)as sent th OR FaxMrakeT fax server. For onfnrni abon„vlsslt Conn