CERTIFICATE OF LIABILITY INSURANCE (921) KRUTSER-til ES
CERTIFICATE OF LIABILITY INSURANCE L30910712018YI
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($),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorser!.
if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer ri hts to the certificate holder in lieu of such endorsement(s).
_.
CONTACT
PRODUCER F-N MEz.
Morris 8r Reynolds Inc. i J,wc"N ,exi8:1(306)23$-1000 (,vc,No).( i7S)255«9643
14821 South Dixie Highway Ey1 AIL
Miami,FL 33176 ADDRESS:
INSURERS)AFFORDING COVERAGE NAIL#
INSURER AUnited States Eire Insurance X21113
=
INSURED INSURERS.RetailFirst Insurance Co. 10700
Knitsinger Services,Inc. INSURER c _--
Mr.Steven Krutsinger
4511 North 56 Street „_INSURER .,._--_ ...m. —.m� - -- _I ...._
Tampa,FL 33610-7109 INSURER E.
INSURER F
COVERAGES CERTIFICATE NUMBER: 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 SEEN REDUCED BY PAID}CLAIMS.
.._.. -.N ERCH CrCCURRFNG
INT R ...fv.ADOL SUBl2 POLICY EFF POLICY EXP LIMITS
'TYPE OF INSURANCE � POLICY NUMBER
A X COIfIMfrRc1ALGENERAL LIABILITY F 1,000,000
DAMAGE TO RENTED 100,000....
CLAIMS-MADE X OCCUR X 15068933038 0312412018 0312412019 PREMISES(Ea occuffence) $
MED EXP(Any.one person) !s 5,000
PERSONAL&ADV INJURY S 11000,000,
GEN"L AGGREGATE.LIMIT APPLIES PER _G�IERAL_AGGREGA"I`yE i_$__-- ..0.._2,000,000
POLICY..' .y p LOC 'i :PRODUCTS-COMPIOPAGG $ 21000,000
OTHER �. �.
A AUTOMOBILE LaAeILITY COMBINED SINGLE LIMIT s 1,400,000'
(Ea acojenl)
X ANY AUTO X 15068933038 0312412018 0312412019'BODILY INJURY(Per person) s
OWNED SCHEDULED BC)DLYINJURY(Per accident)'$
AUTOS ONLY AUTOS
_--.... PERT
A ONLY NOry_.[�yy pp - P Gecooe [3,4MACrE .
—,AUTOS f (Ir ace cenlL-
UMBRELLA LIAR OCCUR EACH OCCURRENCE I$
I
t EXCESS L.IAS CLAIMS-MADE :AGGREGATE 5
DED I RETENTIONPRS
B WORKERS COMPENSATION ( �S7A:TUTE � ERH
ANY ANY ROPRIEERs'uASIUTY Y d N N t A -- --- --5#0,000:
If es bescartv EXCLUDE ECUTIVE X2044787 091tI812018 t391t1872t119 Et EASE EAE t LOYE {J00'
ASCRIPTION OF OPERATI(}NS below IW m. E.L.DISEASE-PCLICY LIMIT $
A Garage Keepers Llals 6068933038 4312412.018 0312412018 150,0dtI
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 401,Additional Remarks Schedule,may be attached If more space.Is required)
Clearwater Gas Systems and The City of Clearwater are included as additional insureds as required by written contract regarding to the General Liability and
Auto Liability coverages..
RECEIVED
CERTIFICATE HOLDER _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cit of C[sarater Gas System
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City y ACCORDANCE WITH THE POLICY PROVISIONS.
400 N.Myrtle Avenue tG'A S Af)N!IN
Clearwater,FL 33755
AUTHORIZED REPRESENTATIVE
ACORD 25(2016103) @ 1988-2015 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD