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CERTIFICATE OF LIABILITY INSURANCE (918)A� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/29/2018 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 po icy, 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Katie Torres-Mihokovich NAME: (A/C. No , Ext):(727)391-9791 FAX X No): (727)393-5623 E-MAIL katie.torres@stahlinsurance.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A: West American Insurance Company 44393 INSURED Interprint Inc 12350 US Highway 19 N Clearwater FL 33764 INSURER B : The Ohio Casualty Insurance Company 24074 INSURER C : FFVA Mutual Insurance Co 07/01/2019 INSURER D : 000 $ 1,000,DAMAGE INSURER E : INSURER F: X COVERAGES CERTIFICATE NUMBER: CL1862942971 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LABILITYEACH Y BKW58651211 07/01/2018 07/01/2019 OCCURRENCE 000 $ 1,000,DAMAGE CLAIMS -MADE X OCCUR TO R PREMISES (EaENTED occurrence) $ 1 ,000,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PRO -LOC PER: GENERAL AGGREGATE $ 2'000'000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY Y BAW58651211 07/01/2018 07/01/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Uninsured motorist $ 500,000 B X UMBRELLA UAB EXCESS LIAB - OCCUR CLAIMS-MADEUS058651211 07/01/2018 07/01/2019 """""" ""'y" "' EACH OCCURRENCE 1,000,000 $ AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A WC84000183292018A 01/01/2018 01/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1000000 $ ,, E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1, 000, 000 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Clearwater and Clearwater Gas are included as additional insured with respects to General Liability and Auto liability as required by written contract. CANCELLATION 1 City of Clearwater PO Box 4748 Clearwater FL 33758 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chi! X Pi _ D ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD