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CERTIFICATE OF LIABILITY INSURANCE (858)
A/'��® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/30/2017 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 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 Audra Browder NAME: CGB Insurance, LLC A/C NNo Ext: (813)749-7948 p/C No: (813)200-2120 2531 Green Forest Lane ADDRlESS:audra @cgbinsurance.com #101 INSURER(S)AFFORDING COVERAGE NAIC# Lutz FL 33558 INSURERA:Ohio Security Insurance Company 24082 INSURED INSURERB:Ohio Casualt y 24074 Florida Gas & Plumbing, Inc INSURER C:Technology Insurance 42376 5680 66th St N INSURER D: INSURER E: St Petersburg FL 33709 INSURER F: COVERAGES CERTIFICATE NUMBER:2017-2018 Master 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 1X OCCUR PREMISES(E.occurrDence) $ 300,000 BKS56241692 9/8/2017 9/8/2018 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: Property damage-single limit $ AUTOMOBILE LIABILITY (CEO OMa BINED ident SINGLE LIMIT $ 1,000,000 cc ANY AUTO BODILY INJURY(Per person) $ p' ALL OWNED SCHEDULED AUTOS X AUTOS BAS54246855 9/8/2017 9/8/2018 BODILY INJURY(Per accident) $ NON-OWNED Per accident) PROPERTY DAMAGE HIRED AUTOS AUTOS X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 US054246855 9/8/2017 9/8/2018 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? FN] N/A C (Mandatory in NH) TWC3600764 12/31/2016 12/31/2017 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Clearwater Gas is listed as additional insured for general liability purposes only CERTIFICATE HOLDER CANCELLATION eryn.berg @clearwatergas.co SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Clearwater Gas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bruce Griffin ACCORDANCE WITH THE POLICY PROVISIONS. 400 N Myrtle Ave Clearwater, FL 33755 AUTHORIZED REPRESENTATIVE Kraig Blancher/AMANDA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)