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CERTIFICATE OF LIABILITY INSURANCE (840) DATE(MMIDLNYYYY) a ° CERTIFICATE OF LIABILITY INSURANCE 3/22/2017 THIS CERTIFICATE 1S 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 poiicy(les) 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 HAMEACT Maryann Fekete Lancaster Insurance Inc PHONE (727)461-3704 AIC . (127)441-3296 fAfC No 1210 S. Myrtle Ave. RECEIVED ADDRESS'Maryann.fekete @lancasterinsur.com P O Box 2855 INSURERS I A FFO R DING COVERAGE NAIC9 Clearwater FL 33757 MAR 21 Z017 INSURERA:OWnerS Insurance 32700 INSURED INSURIERS:FL United Business Assoc FUBA 913782 Jim Tenney Electric Inc INSURER C: James Robert Kenney Lic#ECO003101 �� INSURER D: 12800 Sophia Circle INSURER E: Largo FL 33774-2428 INSURER F! COVERAGES CERTIFICATE I'UMBER: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. IN SRI O L SV13R POLICY EFF POLICY EXP LIMITS LTR TYPE OF tNSURANCE POLICY NUMBER M3491t7171'1 Y MIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES rEa o ourrencel 50,000 A CLAIMS-MADE F7X OCCUR X 20514046 /12/2016 6/12/2617 MED EXP(Arty one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER- PRODUCTS-COMPIOPAGG $ 2,000,ooO }C POLICY PRO LOC S A AUTOMORII.E LIABILITY EaaaccudentSENGLELIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per persnnr S ALL OWNED x SCHEDULED X 543339860 1/21/2016 I/21/2017 BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S RED I I RETENTIONS $ B WORKERS COMPENSATION R WC LIMIT- O13 AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEHECUTIVE NIA El EACNACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? 0631251 4/1/2017 4/1/2018 (Mandatory in NH) El DISEASE-EA EMPLOYEE $ 500,000 IF yos.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIM1T $ 500,000 DESCRIPTION OF OPERATIC NSI LOCAT10NSI VE141CLES (Attach ACORD 101,Additional Remarks Schedule,if more spa co is roquired) The City of Clearwater and Clearwater Gas is Listed as additional insured with respect to the general liability and commercia auto. liability insurance. CERTIFICATE HOLDER CANCELLATION rosie.westerfield@ clearwat 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: Rosze AUTHORIZED REPRESENTATrVE 400 N Myrtle Ave t Clearwater, FL 33755 '� � � ACORD 25(2410105) ©1888-2090 ACORD CORPORATION. All rights reserved. INS025(201005).67 The ACORD name and logo are registered marks of ACORD