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CERTIFICATE OF LIABILITY INSURANCE (846)1— 1 0 A " ° CERTIFICATE OF LIABILITY INSURANCE DATE (MMfDDIYYYY) 3/22/2017 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 he 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 endorsementjsj. PRODUCER Lancaster insurance Inc 1210 S. Myrtle Ave. P O Box 2856 Clearwater FL 33757 CO ACT NAM E: Maryann Fekete PHONE _,j,,,, (727} 461 --3704 r F,Ax o _ (727)441- -3298 (AIC Pa aDOAILss:Maryann. fekete@ lancasterinsur . com INSURER(S)AFFORDING COVERAGE NAIC # twsuRERA:Owners Insurance 2700 INSURED LTim Kenney Electric Inc Tames Robert Kenney Lic#ECO003101 12800 Sophia Circle Lax ❑ FL 33774 --242$ INSURERB:FL United Business Assoc FUBA 913782 INSURER G: INSURER D: INSURER E: S 1,000,000 INSURER F: COMMERCIAL GENERAL LIABILITY COV9RAGES 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 RFEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A DL SUER POLICY NUMBER FIIOIO DIYYYY MMIODY EYP LIMITS Clearwater, FL 33755 GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO NT 1 PREMISES Ea occurrence S 50,000: MED EXP (Anyone person) 3 5, 000 A CLAIMS -MADE FX] OCCUR X 20514046 /12/2017 /12/2018 PERSONAL & AOV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PFR. PRODUCTS - COMPIOP AGG $ 2,000,000 § ]C POLICY PRO LOC A AUTOMOBILE LIABILITY EaM1w6dentl tE LIMIT 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY [Peraccldent} $ ALL Or ED x SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS x 9543339800 1/21/2016 1/21/2017 PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIA8 CLAIMS -MADE DED I I RETENTION S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE (Mandatory NH INCLUDED? { ry ' } MIA A 0631251 /1/2017 /1/2018 x WC STATU• OTH- I E L EACH ACCIDENT $ 500 000 E . DISEASE - EA EMPLOYE $ 500 000 E L DISEASE - POLICY LIMIT 500,000 If yes, da SCribe under DESCRIPTION OP OPERATIONS below DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES {Attach ACORD 101, Additional Remarks Schudula. if more spacc is required} The City of Clearwater and Clearwater Gas is listed as addi THnsured with respect to the general liability and commercia auto. liability insurance. R 2 N P 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: Rosie 400 N Myrtle Ave AUTHORI2EDftEPRESENTATIVE Clearwater, FL 33755 ACORD 25 (2010105) INS025 (201005y Ot ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD