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CERTIFICATE OF LIABILITY INSURANCE (882) a DATE(MWDD/YWY) CERTIFICATE OF L 1/18/2018 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). CONTACT Mar ann Fekete PRODUCER NAME: y Lancaster Insurance Inc PHONE (727)461-3704 FAC No I?27)441-3298 1210 S. Myrtle Ave. EMAIL .Maryann.fekete @lancasterinsur.com P O 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 INSURER C: James Robert Kenney Lic#EC0003101 INSURER D: 12800 Sophia Circle INSURER E: Lar O 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 ADOL UBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAME E TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $_,_! A CLAIMS-MADE OCCUR X 20514046 6/12/2017 6/12/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY Ea acci 1,000,000 dent BODILY INJURY(Per person) $ X ANY AUTO ALL OWNED X SCHEDULED X 95433339800 11/21/2017 11/21/2018 BODILY INJURY(Per accident) $ — AUTOS AUTOS PROPERTY DAMAGE NON-OWNED Per accident) $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ Is DED RETENTION$ WC STATU- OTH- B WORKERS COMPENSATION X — ANDEMPLOYERS'LIABILITY YIN 4/1/2017 4/1/2018 500,000 ANY PROPRIETORIPARTNER/EXECUTIVE 10631251 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE' $ — 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of Clearwater and Clearwater Gas is listed as additional insured with respect to the general liability and commercia auto. liability insurance. Robert.Morig @myclearwater.com 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 AUTHORIZED REPRESENTATIVE Attn: Rosie 400 N Myrtle Ave Clearwater, FL 33755 kto/- ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD