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CERTIFICATE OF LIABILITY INSURANCE (891) DATE(MM/DD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE oz/1z/zo18 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 have ADDITIONAL INSURED provisions or 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 Commercial Lines Division NAME: Jack Rice Insurance PHONE o (727)530-0684 FAX N Ext: C,No (727)532-9602 A/C A/ 13080 S Belcher Rd E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Largo FL 33773 INSURERA: Southern-Owners Ins.Co. 10190 INSURED INSURER B: Auto-Owners Insurance Co. 18988 Scotto Plumbing Service Inc. INSURER C: PO Box 1632 INSURER D INSURER E: Clearwater FL 33757-1632 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1821254629 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 DAMAG CLAIMS-MADE FX OCCUR PREM SES Ea oNcurDrence $ 50,000 X Physcial Damage Ded$10,000 MED EXP(Any one person) $ 5,000 A 20479726 02/18/2018 02/18/2019 PERSONAL&ADVINJURY $ 1'000'000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ 1'000'000 X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,000 JECT OTHER: Voluntary Property $ 5,000 AUTOMOBILE LIABILITY C3=M SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 4347972600 02/18/2018 02/18/2019 BODILY INJURY(Pe r accide nt) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2'000'000 A EXCESS LAB CLAIMS-MADE 4753990301 02/18/2018 02/18/2019 AGGREGATE $ 2'000'000 DED I X1 RETENTION $ 51000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE El N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Rented Equipment A 20479726 02/18/2018 02/18/2019 LIMIT: 22,000 DEDUCTIBLE: 500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Clearwater Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. 100 S.Myrtle Ave AUTHORIZED REPRESENTATIVE Clearwater FL 33756 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS GENERAL LIABILITY: Automatic Additional Insureds when required by Written Contract with Products/Completed Operations per form 55373 01/07. Scheduled Additional Insureds for Lessors (equipment) operations only per form 55183 12/04. Primary & Non-Contributory Coverage for Additional Insureds on an Automatic Basis when required by Written Contract per form 55373 01/07. Waiver of Subrogation for Additional Insureds on a Scheduled Basis per form CG2404 10/93 . AUTOMOBILE LIABILITY: Automatic Designated Insureds when required by Written Contract for Contractors per form 89304 07/10. Waiver of Subrogation for Additional Insureds on a Scheduled Basis per form 69122 05/12 . Scheduled Loss Payees per Policy. Hired Auto Physical Damage Included with $50,000 Limit Comp/Coll Deductibles: $100/$250 INLAND MARINE: Scheduled Loss Payees per Policy. UNDERLYING POLICIES: General and Auto Liabilty OFREMARK COPYRIGHT 2000, AMS SERVICES INC.