CERTIFICATE OF LIABILITY INSURANCE (952) DATE IMMIDDIYYYYI
CERTIFICATE OF LIABILITY INSURANCE 2r18r2019
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 he endorsed. If SUBROGATION IS WAIVED,subject to
the teens and conditions of the policy,certain policies may require an endorsement. A statement on this certiflcate does not confer rights to the
coMficats holder In lieu of such endorsement(s)..
PRODUCER. CONTACT NAME: Maryann Fekete
Lancaster Insurance Inc PHONE {727)461®.3704 FAx 1727a441-3290
A1C NZ_E AdX,Nv;
510 Druid Rd Suite C lm-RAIESS:Maryann.fekete@ lancasterin:sur.rain
ADDR
P O Box 2.856 INSURERS AFFORDING COVERAGE NAIC#
Clearwater FL 3.37.57 INSURERA:Owners Insurance 32700
INSURED INSURERS!Southern—Owners Insurance 101,90
Jim Kenney Electric 'Inc INSURER c:
James Robert Kenney Lic#EG`0003101 INSURER D:
12800 Sophia Circle INSURER E;
Largo FL 33774-242£3 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL134304647 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURER 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 ADDL.SUBR POLICY EFF POLICY EDLP
LTR TYPE OF INSURANCE VWD.._. POLICY NUM13ER JMMMDNYYYI immIgorrYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
I rmTU RM IED 50,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence
A CLAIMS-MADE i ' 1 OCCUR X 0514046 /12/2018 /12/2019 MED EXP(Any one Person) $ 5,000
PERSONAL&ADV INJURY S _. 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEsNLAGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOPAGG S 2,000,000
1 .7 POLICY 0
PRO- LOC BED $
It
,Ai AUTOMOBILE LIABILITY F�a.kdenl SINGLE_.LS I $ 1,000,000
x ANY AUTO BODILY INJURY(Per person) $
ALL OWNEDSCHEDULED X ! 5433339500 1/21/2016 11/21./2019 BODILY INJURY(Per accadem) $
AUTOS AUTOS
H€RED AUTOS NON-OVMEO PROPERTY DAMAGE 3
AUTOS Pier accident
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE. AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION � TWC.STATU- OTRH_..
FFICE NEMBlHl EXCLUDEAN Y PROPRIETORIPAR TN D/ clsTlvE YIN 33s ds 11t2nn13 /112 ss E.L DISEASE E.L.EACH ACCIDENT 500,000
AND EMPLOYERS'LIABILITY
ry In
C9FFICERrMEtrI6ER E](CLLII]EQ� Il NIA
-EA EMPLOYEE. $ 500,000
If Yes.desWb0 under
DESCRIPTION OF OPERATIONS wtow E,I.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(Attach ACDRD 101,Additional Remarks Schedule,if more sparse is required)
e-mail Robert.Morig@mycl-aarwater.com
CERTIFICATE HOLDER CANCELLATION
RECEIVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
E EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE MTH THE POLICY PROVISIONS.
7111 Maple Street F --R 2 2 2°,01
Clearwater, FL 33755 AUTHDR72£DFtEP ATIVE
470
GAS ADM
ACORD 25(2010105) C3Q 1988-2010 ACORD CORPORATION. All rights reserved.
INS025(2orrnD pi The ACORD name and logo are registered marks of ACORD