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CERTIFICATE OF LIABILITY INSURANCE (844) DATE(MMIDDIYYYY) ACOWLIF CERTIFICATE OF LIABILITY INSURANCE 07/25/2018 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 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 Linda Fontenot NAME: Insgroup,Inc. PHONE.,Ext): (713)541-7272 talc,No): (713)772-5224 5151 San Felipe,24th Floor E-MAIL ADDRESS: Ifontenot(d)insorouD.net INSURER(S)AFFORDING COVERAGE NAIC# Houston TX 77056 INSURER A: Starr Indemnity&Liability Company 38318 INSURED INSURER B: Indian Harbor Insurance Company 36940 Heath Consultants Inc. INSURER C: 9030 Monroe Road INSURER D: INSURER E: Houston TX 77061 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1872390521 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE F_x]OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person) $ 10,000 A 1000090437181 07/30/2018 07/30/2019 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY F PRO ❑LOC PRODUCTS-COMP/OPAGG $ 4,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 1000198851181 07/30/2018 07/30/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY IX AUTOS ONLY Per accident UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 10,000,000 A X EXCESS LIAB CLAIMS-MADE 1000095274181 07/30/2018 07/30/2019 AGGREGATE $ 10,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA 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 $ Pollution Liability Aggregate/Each Claim $10,000,000 B Professional Liability US00085663LI 1 8A 07/30/2018 07/30/2019 Aggregate/Each Claim $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The General Liability policy includes a blanket additional insured endorsement OG184 0412 and waiver of subrogation endorsement CG2404 0509 policy contains a special endorsement with the primary and non-contributory wording per endorsement CG2001 0413 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.Contractual Liability coverage provided by the policy is standard and may not cover all liabilities assumed by the named insured under the contract with the certificate holder endorsement CG0001 0413.Policy include a blanket 30 day notice of cancellation endorsement SIIL 100 1014 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. 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 Attn.:Clearwater Gas Systems ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS The Auto Liability policy provide a blanket additional insured endorsement SICA1016 0414 waiver of subrogation endorsement CA0444 1013 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. Policy include a blanket 30 day notice of cancellation endorsement SICA1028 1115 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The Umbrella Liability Policy provides follow form excess limits over General Liability (including Products and Completed Operations) , Auto Liability and Employers Liability Insurance (with respect to Professional Employer Organization (PEO) SOI/Heath Consultants INC client #7913 only) . The policy includes Additional Insured status and waiver of subrogation regarding form number XS100 1008, to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.