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CERTIFICATE OF LIABILITY INSURANCE (959) AC40R" CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 6/13/2019 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(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 Maryann Fekete NAME: Lancaster Insurance Inc PHONE (727)461-3704 FAX AIC No (727)441-3299 510 Druid Rd Suite C Maryann@lancins.com ADDRESS: y P O BOX 2856 INSURERS AFFORDING COVERAGE NAIC# Clearwater FL 33757 INSURER A:Owners Insurance 32700 INSURED INSURER B:Southern-Owners Insurance 10190 Jim Kenney Electric Inc INSURERC: James Robert Kenney Lic#EC0003101 INSURER D: 12800 Sophia Circle INSURER E: Largo FL 33774-2428 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL134304647 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE rx_� OCCUR 20514046 /12/2019 /12/2020 MED EXP(Any one person) $ 5,000 0514046 /12/2018 /12/2019 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY EOMaBINEDtSINGLE LIMIT S 1,000,000 X ANYAUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED 95433339800 1/21/2016 1/21/2019 AUTOS AUTOS BODILY INJURY(Per accident) 5 X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident 5 S UMBRELLALIABOCCUREACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION$ $ B WORKERS COMPENSATIONX WC STAT U- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE0331705 /1/2019 /1/2020 OFFICERWEMBER EXCLUDED? In I NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) 0331705 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION eryn.berg@clearwatergas.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Clearwater Gas System ACCORDANCE WITH THE POLICY PROVISIONS. 711 Maple Street Clearwater, FL 33755 AUTHORIZED REPRESENTATIVE I Maryann Fekete/MAF .Gr ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD