CERTIFICATE OF LIABILITY INSURANCE (954) KRUTSER-01 KLEE
DATE(MMiDDNYYY)
CERTIFICATE OF LIABILITY INSURANCE 312112019
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 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).
PR CER I CONTACT
Morris&Reynolds Inc. � PHONE
14821 South(Dixie Highway (A+c,No,Ext).(305)238-1000 �Iauc Nnl(305)255-9643
Miami,FL 33176 E-MAIL
.._._-.._.__�NSURER(SIAFFOROING COVERAGE - NAIC I
-----___- -_--..�
INSURER_A_Un€ted States Fire Insurance2111
INSURED IN SURER a.RetallFirst Insurance Co. 10700
Krutsinger Services,Inc. INSURER D
Mir.Steven Krutsinger
4511 North 66 Street zNSURER D: _-- L
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 BEEN REDUCED BY PAID CLAIMS.
MSR ADD SUBR --— POLICY EFF POLICY E7iP`I -UNFITS
__ TYPE OF INSURANCE POLICY NUMBERII
A LIABILITY EACH C]GGIJRRENCE S 1,000,000
COMMERCIAL GENERAL _. __
I�CLAIMS•MADE I�_� ii
OCCUR �( 506896126-2 312412018 312412020 DAMAGE TIS RENTI=I 10(1,000
P EMI E;�(Ea gr'tLgMogp) k -.
5,000
_IvtED EXP(An_y orae peqOn 5,---.- _'-m.•.
9 ' PERSONAL$;ADV INJURY $ 1,000,004
,PEN'L AGGREGATE LIMIT APPLIES PER: - _...-. 2,000,000
GENERALAGGREGATE s_._
POUCY I�j LOG ( r 2,000,000
�.
�r'(tCl[3FlCT5-.CQMP7Q�,4GG �$ '
OTHER: ;
--
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
e acadenta.-- —
ANY AUTO X 506-896126-2 3/2412018 1312412020 INJURY
SCgPerpersony _
f- OWNED SCHEDULED _._D]LY -
HU ONLY AUTO I'RdJPE �L1FiY( r ac
Psc�dea���$
AUTOSONLY AO
ADDW INJ
..._ � DAMAGE
I I$
UMBRELLA LIAa
(7C7GUR ! EACH CGURRENCE_.__
._._..- EXCESS LIAR CLAIMS-MADE AGGREC,-A-T
DED RETEN7€ON$ $ ---
B iHORKERS COMPENSATION - -. PER GTH-
AND EMPLOYERS"UABIUTY I -- ,T&T.U]', _ Eft
ANY PaoPR€ETCSRdPARTNERIEXECUTIVE Y r N Is204078-. 91812018 91812019 F EACH_AC�IDENT $ 500 000
qqrF€ ERfM HiER EXCLUDED? N r A —.. ...__.. --
llMe cry n l
El DISEASE_EA5MPLOYEE S_- 600,000
II ese descralge under Ds RIFT CDN a OPERATIONS hoe€ow I ( ' -- -- 500,000
A jGarage Liability I I E.L.DI EASE-POLICY LIMIT 5 —
till' � ( s06 8961262 � 312412019 312412020 150,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES(ACORD 101,Addhional Remarks Schedule,may Iw'as
If macre apace is r"ulred)
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.
CER IFICATE H LDERR EIVED CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater Gas System , ('. 5 2-01 OS ACCORDANCE WITH THE POLICY PROVISIONS.NOTICE WILL BE DELIVERED 1N
400 N.Myrtle Avenue
Clearwater,FL 33755
AUTHORIZED REPRESENTATIVE
GAS ADMIN
ACORD 26(2018103) @ 1988-2016 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD