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CERTIFICATE OF LIABILITY INSURANCE (1029) DATE(MM/DD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 08/27/2019 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 Alyssa Gomez NAME: CGB Insurance,LLC HCONN. Ext): (813)749-7948 a/c,No): (813)200-2120 2531 Green Forest Lane E-MAIL al ssa c binsurance.com ADDRESS: y @ g #101 INSURER(S)AFFORDING COVERAGE NAIC# Lutz FL 33558 INSURERA: Ohio Security Insurance Company 24082 INSURED INSURER B: Ohio Casualty 24074 Florida Gas&Plumbing,Inc INSURER C: Allied Insurance Co 10127 5680 66th St N INSURER D: INSURER E: St Petersburg FL 33709 INSURER F: COVERAGES CERTIFICATE NUMBER: 2019-2020 Master 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 $ 300,000 MED EXP(Any one person) $ 15,000 A Y BKS56241692 09/08/2019 09/08/2020 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 $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ C OWNED SCHEDULED Y ACP3009439354 09/08/2019 09/08/2020 BODILY INJURY(Pe r accide nt) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1'000'000 B X EXCESS LAB CLAIMS-MADE EL56241692 09/08/2019 09/08/2020 AGGREGATE $ 1'000'000 DED I X1 RETENTION $ 10'000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEElN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This policy includes an automatic additional insured endorsement that provides coverage to entities as an Additional Insured when there is a written contract in place that requires this. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Clearwater Gas ACCORDANCE WITH THE POLICY PROVISIONS. 400 N Myrtle Ave AUTHORIZED REPRESENTATIVE Clearwater FL 33755 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD