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CERTIFICATE OF LIABILITY INSURANCE (967) DATE(MMIDDI(YYY) ,� Ro CERTIFICATE OF LIABILITY INSURANCE 11121/2419 THIS CERTIFICATE 15 ISSUED ASA MATTER OF INFORMATION ONLY ANI].CONFERS.NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT.BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,ANP THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies).musthave ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION..IS WAIVED,subject to the terms and conditions of the policy,certain policies may require amendorsement,.A statement on this certificate does.not co nfe r.rig h Is to tIte.certificate holder in lieu of such endorsement{5}. PRODUCER CONTACT Certificates Department NAME: Single:Source;Insurance PHONE (727)298=0302 AX. No• (727)298-9029 A!CNo Ext 2189 Cleveland Street E-MAIL Certificates@singlesourceins.com ADDRESS: Unit 235 iNSURER(S)AFFORDING COVERAGE NAIL it. Clearwater FL 33765 INSURERR: Regent Insurance Company 24449 INSURED .INSURER B; General Casualty Company of Wisconsin 22414 Tampa Bay Plumbing,LLC INSURFR C. Technology Insurance Cc 42376 613 S Missouri Ave, INSURER D: Lloyd's.of London INSURER E; Clearwater FL 33756 INSURER F COVERAGES CERTIFICATE NUMBER: 01_191112009981 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INS URED.NAM EDA13OVE 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 I NSU RAN C F AFFOR D E D BY THE POLICIES DESCRIBED HEREIN IS.SUBJECT 7O ALL.THE TERMS, EXCLUS(ON SAND CONDITIONS OF SUCH POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID.CLAI.MS. INSR1 AUPLUUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD yWVD POLICY NUMBER MMIDUNYYY. .(MMIDDNYYY Llmrrs X COMMERCIAL GENERAL IJABILITY EACH OCCURRENCE $ 1,400,404 N 54,000. CLAIMS=MADE �OCCUR PREMISES Ea occurrence S'. MED.EXP.{Any.one person :S 10.000. A Y Y CGA1.304260 47/19/2419 071.1912020 PERSONAL&A09 INJURY $ 1,000,000 G EN'L AGG REGATE LIM IT APPLI ES.PER-. :GENERAL AGGREGATE $ 2,000,000 PRO• ❑LOC PRODUCE'S-COMPIOPAGG $: 2,040,000 POLICY ]ECT � OTHER: $ AUTOmomi-E.LUIBILM CEa OMaBINED SINGLE LIMIT $ 50D,000 ccident .57< ANY.AUTO abbILYItd owPi Por person.) $ B OWNED ,SCHE ULED: Y Y CBA1344260 '4711$12019 07/19/2024 60DILYINJURY(Per accident). $ AUTOS ONLY AUTOS: HIRED NON-OWNEDPROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist $ 540,400 UMBRELLA LOB OCCuA EACH.OGCURRENCE $ 2,000,040 B EXCESS LIAR HCLAIMS-MADE Y Y. CLU1304260 47/19/2019 47/19/2020AGGREGATE $ '2;040,040. DED RETENTION.$ $ WORKERS COMPENSATION ER OTH- ANDEMPLOYERS'LSA81L1T'!� Y:1 STATUTE ER N .1,000,404. ANYPROPRIETORIPARTNEPjF_XECUTIVEE.L.EACH ACCIDENT 5 C OFFIC E RIM EMBER EXCLUDED? NIA Y TWC3812045 07/19/2019 07/99/2420 (Mandatoryto NHY E.L.0 I EASE-EA EMPLOYEE $ 1'000•004 If yes,descdW under 1,000,040 DESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT $ Scheduled Equipment $42,158 B (B)Inland Marine, CIMI1 04260181180D180876 0111912619 47/1912026 Misceilaneous.Tools $.1.12,000 (D)Commercial Properly TIV-Special Form Wolb00 DESCRIPTION.OF OPERATIC)NS I LOCATIONS 1 VEHICLES[ACORD 101,Additional Remarks.Schedule,may baattached If more space is.required) Coverages continued:(D)Insurer;Lloyd's of London-Policy#ANE433301711 E.f-Exp:11120/2.019-1112012020 Professional Liability:Each Claim$1,040,404 Total Policy Aggregale S1,000,000 Certificate Holder included as:Additional Insured by written ccrtfractWith regards to General Liability(Form CG2010&CG2437)&Automobile Liability. Primary&Non-Contributory Wording IPcfuded.Certificate Holder ITstedin favor of Waiver..0 Subrogation by written contractwith regards to Gene rei Liability Autornobiie Liability&Workers:Compensatio..n.Umbrella is follow form,Thirty(3 0)days.writtennotice:inthe event of cancel tat]on. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of.CIsaiwater,Florida DIB1A Clearwater Gas Systems,Inc. ACCORDANCE WrrH THE POLICY PROVISIONS, 400 North Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater FL 33755 n 1988.2415 ACORD CORPORATION..All rights reserved. ACORD 25(2016103) The ACORD name and.Iogoare registered marks of ACORD COMMERCIAL GENERALGG 2 1 p a f 13 HE P01-#CY. PLEASE READ 1T rAREFVL'Ly- TH15 ENOORSEMENT CHANGES T OWNERS . LESSEES OR ADDITIONAL INSURED - . -DULED PERSON OR CONTF ACTORS ORGANIZATION dr�rserrierit snodi#ies insurance provided under the following: This en . ..COMMERCIAL GENERAL LIAR UTY GOVti=Rp,GE.PART ScHEOULE Name Of Oddi gapersan(s}nization(s} Locatian(s :Of Coverad Q eratians PER U 40-1 information re ulred to.complete this Schedule,it not shown above,will be shown in the Geclaiatiorts• 2- if coveragoprovided to the addiala oaelment. is is amended to required y a contract or gre. . insured Wh❑ is An Insured ersau(s} or. au are Section:l{ — only insurance a#forded to. sun that rN gre y the Scfleclule, 17 ro..eY rr�iil not be Broader than innlude as a s ashownains tl Insured d the l i' required by tihe contract or agreement to organixat'On( ) . "bodily injury , R P . uch additional Insured. .1th respect to.liability for advertising .lnjuf , orovide far s... e„ or. "personal and additional damag art,by: g With respect.to the :In"T n f.,,.wing ed to. these caused,In whole or In p additional insureds,. the t. your acts or omissions;or on your exclusions apply' -,b dil injury ar 2: T#tie.acts or auyfsslons of those acting after: This insurance does not apply to behalf', „property damage„ occurring arts ar our ongoin hoperatians for Including materials., P in the perfotoarsce af.y. s at lacatlon(s} All work, insured( ] equipment furitlshed in Cather ttthari withservice, the additionsuch al the project ( erforrned by or deSignated.agove. work, an airs} to. be.p However:: afforded to such additional rnaintenarzce.or repaj at. the insurance extent permitted by ton o flan of ththe overed operations. has been ins applies to the ext p lacatf le . insured only pp completed;or law; and Page'i of 2 p Insurance Services office,Inc.,211.12: C.G 10 o4 13 2:. That portion of "your work" out of which the Z. Available under the applicable Limits of injury or damage arises has :been put to Its insurance shown in the Declarations;. intended use. by any person.or .organization other than another contractor or subcontractor whichever Is less. engaged in performing operations .for a This endorsement steal[ not increase the. principal as a part of the same project. applicable Limits of Insurance shown in the C. .Wlth. respect to the. insurance afforded to these. Declarations. additlonal insureds, the following Is added to Section IIl —Limits Of Insurance: If coverage provided to .the additional insured Is required by a contract or agreement; the most we will pay on behalf of the additional insured is the amount of insurance: 9. Required by the contract or.agreernent;or Page 2.of 2 ©Insurance Services.Office, Inc.,2012 GG 20 10 04 13 C:GA1304260 COMMERCIAL GENERAL LIABILITY CG 20370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAR IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -- COMPLETED OPERATIONS This endorsement modifies insurance provided.under the.follow Ing: COMMERCIAL GENERAL.LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured.Person(s) Or Organ Ization(s) Location And Description Of Completed Operations PER G 40-I Information requited to complete this Schedule,if not.shown above, will.be shown.in the Declarations. A. Section II —Who Is An Insured Is amended to S. With respect to the insurance afforded to these include as.an additional insured the person(s) or additional insureds; the following is added to organization(s) shown In the Schedule,.but only Section 111- Limits Of Insurance: With respect to liability far "bodily injury" or If coverage provided to the additional insured Is "property damage caused,.In whole or in part, by required by a .contract or agreement, the most we 'your work'" at the location designated and. will pay on behalf of the additional insured is the described in the Schedule of this endorsement ahzount of Insurance: performed for that additional insured and included in the ''products-completed operations 1. .Required by the.contract or agreement; or hazard". 2. Availableunder the applicable Limits of However: Insurance shown in the Declarations, 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted by this endorsement shall not Increase the applica hie law; and Limits of Insurance shown in the Declarations, .2. If coverage provided to the additional insured is required by a contract or agreement, the insurance:afforded to such additional insured will not be broader than that.which you are required by the contract or agreement to provide for such additional insured: CG 20 37 0413 ©Insurance Services Office, Ine.,.2012:. Page.1 of 1 CC.U13.04 2.60 COMMERCIAL LIABILITY UMBRELLA CU 24..36 12 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRODUCTS-Ca.MPLETED' OPERA.TIGNS AGGREGATE LIMIT OF INSURANCE This endorsement modifies insuranceprovided under the following: COMMERCIAL LIABILITYUM13RELL9 COVERAGE PART SCHEDULE. Products-Completed Operations Aggregate 2_Q00,000 Limit bf Insurance: Information required to complete this.Schedule,if not shown-above,will be shown in the Declarations. Section III — Limits Of Insurance is replaced by.the 4. Subject to: Paragraph 2. or 3. above; whichever following: applies,the Each Occurrence Limit.Is.the most we 1. The Limits Of Insurance shown in the Declarations will pay for the sum of all "ultimate net loss:'under anis the Schedule. of this :endorsement, and the Coverage A because of all "bodily Injury" and fallowing rules fix the most we will pay regardless of "property damage" arising out of any one "occur the.number of: rence". a: Insureds; 5. Subject to Paragraph 2. above, :the personal and. Advertising Injury.Limit lathe most we will pay un- b. Claims made, "suits" brought; or number of der Coverage B for the sura of all "ultimate not vehicles involved;or loss" because of all "personal and .advertisingin- c. Persons .or organizations making claims or jury"sustained by any one person or organization, bringing"suits". The Aggregate Limits, as described In Paragraphs 2. 2. The Aggregate Limit Is themost we will pay for the and 3. above, apply separately to each consecutive sum of all"ultimate net loss"under: annual period and to any remaining period.of less than a: Coverage A, except"ultimate.net loss" because 12 months, starting .with the beginning of the policy of"bodily injury"or"property damage": period.shown In file Declarations, unless the policy period Is extended after issuance for an additional (1) Arising out of the ownership,maintenance or period of.less than 12 months.: In#hatcase; the addi- use of a"covered auto;or tional period will be deemed part of the last preceding (2) Included In the"products-completed operas period for purposes of determining the Limits of lnsur- tions hazard';and ance; b. Coverage B: 3. The Products-Completed Operations. Aggregate Limit shown in the Schedule of this endorsement Is the most we will pay for the:sum of all "ultimate net loss" under Coverage A for.damages because-of "bodily injury" and "property damage" included:In the"products-completed operations hazard".. CU 24 36 12 05 Q.180 Properties,:Inc.,2005 Page 1 of.1 .CB A 13.0.6.2.6 0 COMMERCIAL AUTO CA o4 44 0310 THIS ENDORSEMENT CHANGES"THE POLICY: PLEASE READ IT CAREFULLY.. WAIVER OF TRANSFER .OF RIGHTS OF RECOVERY AGAINST OTHERS TO U5 (WAIVER OF SUBROGATION) This endorsement modi€les insurance provided.under the.following: BUSINESS.AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL.DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR.CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement; the provisions of the Coverage Form apply unless mod!_. fled:by the endorsement. This endorsement changesthe policy effective on the inception date of the policy unless another4ate is indicated below. Named Insured: Endorsement Effective.Date: .SCHEDULE Name(s)Of Persons) Or Organization(s): ANY PERSON OR ORGANIZATION WHOM YOU ARE TO WAIVE RIGHTS Or RECOVERY AOA.INST UNDER A CONTRACT OR WRITTEN AGREEMENT IN EFFECT: PRIOR TO ANY L05S OR: DAMAGF, BUT ONLY TO THE EXTENT REQUIRED IN. THE WRITTEN CONTRACT OR AGREEMENT. Infnrmation.required to complete this.Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers.To Us Condition does not apply.to the person(s) or organization(s) shown In the Schedule, but only to the extent that subrogation Is walved pr.!or to the "aa. cident' or the "foss" under a contract with that person or organization.. CA.04 44.03 10 ©Insurance Services Office.,Inc.,2009 Page 1 of 1 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 07/17/2019 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 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 CONTACT Certificates Department NAME: Single Source Insurance a/CNN. Ext): (727)298-0302 A/c,No): (727)298-0029 2189 Cleveland Street E-MAIL Certificates@singlesourceins.com ADDRESS: Unit 235 INSURER(S)AFFORDING COVERAGE NAIC# Clearwater FL 33765 INSURERA: Regent Insurance Company 24449 INSURED INSURER B: General Casualty Company of Wisconsin 24414 Tampa Bay Plumbing,Inc INSURER C: Technoloy Insurance Company 42376 613 S Missouri Ave. INSURER D: Lloyd's of London INSURER E: Clearwater FL 33756 INSURER F COVERAGES CERTIFICATE NUMBER: CL1971709306 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 INSURANCEAUULbUbK POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 50,000 MED EXP(Any one person) $ 10,000 A Y Y CGA 1304260 07/19/2019 07/19/2020 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y CBA 1304260 07/19/2019 07/19/2020 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident Uninsured Motorist CSL $ 500,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2'000'000 B EXCESS LAB CLAIMS-MADE CLU 1304260 07/19/2019 07/19/2020 AGGREGATE $ 2'000'000 DED I I RETENTION $ $ WORKERS COMPENSATION X1 SPTER EORH AND EMPLOYERS'LIABI LI TY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? N/A Y TWC3812045 07/19/2019 07/19/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Scheduled Equipment $42,158 B/D (B)Inland Marine(D)Commercial Property CIM1304260/81180D180870 07/19/2019 07/19/2020 Miscellaneous Tools $112,000 TIV-Special Form $300,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder included as Additional Insured by written contract with regards to General Liability(Form CG2010&CG2037)&Automobile Liability. Primary&Non-Contributory Wording Included.Certificate Holder listed in favor of Waiver of Subrogation by written contract with regards to General Liability, Automobile Liability&Workers Compensation.Thirty(30)days written notice in the event of cancellation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Clearwater,Florida D/B/A Clearwater Gas Systems,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 400 North Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater FL 33755 '�)C _l @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD