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CERTIFICATE OF LIABILITY INSURANCE (919) TE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE DATE 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 Kell Meyer NAME: y y Single Source Insurance p/C NNo E#: (727)298-0302 p/C No: (727)298-0029 2189 Cleveland Street ADDRESS:commercial@singlesourceins.com Unit 201 INSURER(S)AFFORDING COVERAGE NAIC# Clearwater FL 33765 INSURERA:Re ent Insurance Company INSURED INSURERB:General Casualty Company of Tampa Bay Plumbing, LLC INSURERC:Markel Insurance Co 38970 613 S Missouri Ave. INSURER D: INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1871806541 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/YYY MM/DD/YYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE � OCCUR DAMAGE ( RENTED 50,000 PREMISES Ea occurrence $ X Y CGA 1304260 7/19/2018 7/19/2019 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO- POLICY ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS X y CBA 1304260 7/19/2018 7/19/2019 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS APer accident Uninsured motorist combined $ 300,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ CLU 1304260 7/19/2018 7/19/2019 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A C (Mandatory in NH) y MWC0114331-02 7/19/2018 7/19/2019 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Inland Marine CIM1304260 7/19/2018 7/19/2019 Scheduled Equipment $ 42,158 D Commercial Property B118OD180870/10129SP 7/19/2018 7/19/2019 TIV $ 275,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder listed as Additional Insured with regards to General Liability & Automobile Liability. Primary & Non-Contributory Wording Included. Certificate Holder listed in favor of Waiver of Subrogation with regards to General Liability, Automobile Liability & Workers Compensation. CERTIFICATE HOLDER CANCELLATION Robert.MorigQclearwatergas SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater, Florida THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN D/B/A Clearwater Gas Systems, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 400 North Myrtle Avenue Clearwater, FL 33755 AUTHORIZED REPRESENTATIVE Brooke Railey/FRONT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)