CERTIFICATE OF LIABILITY INSURANCE (973) --w1 WORLNON-01 GIRDLERS
.44CORO' DATE IMMIDDIYYYY)
III&� CERTIFICATE OF LIABILITY INSURANCE 02112/2019
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(les)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 License#OE67768 c,RAJACT Stephen Girdler
Insurance Office of America,Inc. pa"c°N,k,E.t; 813 262-245122604 Ajc No: 813)637-8484
4915 West Cypress Street
Tampa,FL 33607 %%Jkss,.Staphon.Girdlor@loausa.com
INSURER(Si AFFORDING COVERAGE NAIC 0
INSURER A:Great American E&S Insurance Company 37532
INSURED INSURER B:Owners Insurance Company 32700
World Wide Nondestructive Testing,LLC INSURER C:Florida wo*ers Compensation Joint Underwriting Association.Inc NA
PO Box 1499 INSURERD:Admiral Insurance Company 24856
Land O'Lakes,FL 34639
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 BEEN REDUCED BY PAID CLAIMS.
INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1'000'000
CLAIMS-MADE �X OCCUR PL225833401 0211212019 02112!2020 DAMAGE T(EaO RENTED 500,000
MED EXP one Person) 20,000
PERSONAL&ADV INJURY 11000,000
GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000
POLICY[ PECT E-1 LOC PRODUCTS-COMPIOPAGG 2,000,000
OTHER: $
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000
X ANY AUTO 6216627900 0211212019 02!1212020 BODILY INJURY Per person)
OWNED
ONLY X AUUTNOOSWLryEEDp BODILY INJURY Per aoadont S
AUTOS ONLY AUTOS ONLY Pe�aExiRrlent AMAGE S
Id I S
A UMBRELLALUIB ECLLAIMS-MADE]
EACH OCCURRENCE 51000,000
rxEXCESS LIAB S225833501 0211212019 02112!2020 AGGREGATE
DEO I I RETENTION 5 5,000,000
C WORKERS COMPENSATION PERTUTE I OTH-
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN 66452881 0211312019 0211312020 E.L.EACH ACCIDENT s 1,000'000
OFFIr
51 y1lnn N1t1t)tUul "EXCLUDED? NIA
((aa�an E.L.DISEASE-EA EMPLOYEE S 1,000'000
It yes.describe wider 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
D Professional Llabili E000004270502 02112!2019 0211212020 Aggregate 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached it more space Is requlmd)
CERTIFICATE HOLDER CANCELLATION
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
Clearwater Gas System p
400 N.Myrtle Ave. hl' Ais—(!So
09arwater 33756
ACORD 26(2016103) ®1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD