CERTIFICATE OF LIABILITY INSURANCE (1045) A CERTIFICATE F LIABILITY INSURANCE DATE(MdAD1YYYY)
411612020
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 CONTRACTBETWEEN 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 corder rights to the certificate holder In lied of such endorsement(s).
PRODUCER -NAME- THERESA JENKYNS I
Morrow Insurance Group PHONE
16036 NORTH DALE MARRY { tN, Et1 X13�fi3 1089 -- �w� wqL81393'1-3743
E-MAIL
— --
LUTZ FL 33 548 ADDRESS: cerlrllcates@morrowinsurance nel
INSURERgS1 AFFORDING COVERAGE � NAIC#
INSURERA,FCC!INSURANCE COMPANY I 10178
INSURED PREC107 __.
NSURER
PRECISION (`DETER REPAIR, INC
4410 AIRPORT RD INSURER C:
PLANT CITY FL 33563 INSURER 9:
INSURER-,E,,—,--
INSURER F;
COVERAGES CERTIFICATE NUMBER:854286620 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, TERN!OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT-To WHICH THIS
CERT rICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER%1S,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS'
YNSFR ._._......__... .m....-.....- ._-AE5r3 G' R........ .....__...--....._ 515LICY AFF PC -Y EXP
LTR TYPE OF INSURANCE .O'.._Vp•. POLICY NUM BE hMM1DDTYYYY MMfDDNYYYl LIMITS
A X COMMEPIC IALGENERAL LIABILITY GLIG0044434 51712020 51712021
EACH OCCURRENCE $'I 000 00€7
CLAIMS-MADE X+ OCCUR I � I`CTAP�,�tAC�@*T'O'h'�E`N7"In�A._.
PREMISES(Eaoc1currencel_ $000000
...- ( ..... j MED EXP(Anyone person) ($15,000
PERSONAL 5 ADV IN jyRY D,OOO,OOLI
GEN'L.AGGREGATE'LIMIT APPLIES PER: GENERAL AGG.REGATE �$_2,000,000_—
_X .POLICY JEOT �LOC PRODUCTS-COMPLOP AGCy....j$2,000,000 4
OTHER:
A AUTOMOSILE LIABILITYCOMBINED SINGLE LIMIT CA!00044437 A1201202C? 412012021 i'$1 000,000
jEa acdentl
Xi ANY AUTO _ Ir BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLYI AU1"O5 r BODILY INiuRY(Peracadent) $
-_..
X HIRED 1 X NON-OWNED e PROPERTY DAMAOE -
,—._ AUTOS ONLY !AUTOS ONLY
Xi FL STATUTORY PIP $10,000
A X UMBRELLA LIAR I X OCCUR UMB10005290700 i 111512019 1115Q020 I EACH OCCURRENCE 5,000,000
EXCESS LIAR- CLAIMS-MADE; AGGREGATE $$5,000,000. ..
DEO RETENTIONS _.
A WORKERS COMPENSATION 001-WC19A-78645 813112019 1 0/3112020 XPER OTH-
ANO EMPLOYER'S'LIABILITY _LSTATUTE ;_EER
ANYPROPREETORIPARTNERiEk.ECtITIVE YIN I r _...._ _......
OFFICEPJMEh4aERE?[CLUDED"1 NIAIEl
F
E.
EACH ACr'POEN1 .- $1 000„OOfI
lMandatsry I n NHp E,L.DISEASE-EA EMPLOYEE'$1 000,000
If yes desCrib�pander _
DESCRIPTION OF 0PERATIONS below _ E.L-DISEASE-POLICY LIMIT $1,00x0 000
I � I
!'DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES IACORO 101,Addltlonai Remarks Schedule,may be attached it//sate space is required)
GAS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION MATE THEREOF, NOTICE WILL BE' DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CLEARWATER GAS SYSTEMS
100 S MYRTLE AVE
CLEARWATER FL 33756 AUTI1oRlZEOREP RES ENTATIVE
1988-2015 ACORN CORPORATION. All rights reserved.
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