CERTIFICATE OF LIABILITY INSURANCE (1036) A� - R" TIFI ATE F LI BILI IN A C oATE(IH&1fCO1rYYYYJ
892712020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEN. 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 INSURERjS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT- If the certificate holder is an ADDITIONAL INSURED,the policy(les)Dust 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($),
PRONCER AC.
MorrisReynolds Inc. N ME r
14€121 South Dixie Nigh ay LA1cA ,t
ie _W �ci���:3015-25559543
Miami FL 36176 -Aij,
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_w INSURERA:mUnited States Fire Insurance _ 21113
INSURED KRUTSER-01 ..B iusuRetai F ret insurance 147010
Krutsin er Services, Inc. INSURER .
4511 North 56'Street
Tampa FL 33610-7109 INSURER o
INSURERE: �..,,�.---....... .�.._ .,.....__,.._.,,_ ....,,_.._ �,._.—.�,_.,...�.�,.......�......�....��..
INSURERF7
COVERAGES CERTIFICATE E NUMBER:1706420331 REVISION UMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED.] BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUER OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY LAIC}CLAIMS.
INSR — -- A:ooL SUBR . ,�,,,_....,_.... I�{9l.I
LTR TYPE�OfINSURANCE 'POLICY NUMBER MMICFCWPV'Y'YY. IMMIDDIYYYYI LIMITS
A X COMMERCIAL GENERAL LIABILITY i Y 506-848752-4 312412420 1 3/24#2021 I EA OCCURRENCE S 1,000,000
_.,®. �..
�— IA �C�d
CLAIMS-MAGE OCCUR g3tlQ;f?iR17
.. y ..PREMIses(E o currgncsJ� ,�,..m..�
I _ iv ED EXP(Ansy cne peragnl S 5 000 n
p PERSONAL&AOV INJURY [S`1000,000
ICEN'LAGGREGATELIMIT APPLIES PERt I � } IrGENERALAGGREGATE: IS 000000 -. _..
+x+ 'POLICY I I PRO- LOC' I ' PROOUI�YS OOMPIOP AO: S 2[7L3O 0013
�._..—,r_Or
OrtVlaR:
i$
A I AUTOMOSILFLIAOILITY Y r 1506-8987524 3/2412020 3f2412021 COMBINE®SINGLE LIMIT $1.000,000
Ea accident)
?:1 ANY AUTO 11,
C)OILY IN URY(Per person) S
I_ OWNED ( SCHEDULED 1 ( BODILY INJURY(Por accident) �5--- �c
AUTOS ONLY I AUTOS 1
{
HIRED i 4 NO hi-OWNeD �Pt�OPEf2rY�6�7h9,�C,�F.
X y
AUTOS ONLY I� AUTOS ONLY (. I [P�ancideestd -- --J,5
UMBRELLALIAB OCCUR I _ EACH OCCURRENCE
EXCESS LIAO �.._ CLAWS-MADE
DED �reNTION$ I � +$�w,�..�....m._...�...,m
6 IWORKERS COMPENSATION - 1 52040787 1 J18J2'OF ri 91812021 X PER a CSTI-M �
!
AND EMPLOYERS'L"ILITYYIN I STATUTE I I ER _
ANYPROPRIE70Pi'PARTNFR+EXECUTrVEE1.
�.. g EACNACC.IgENT $500,OIT0
sOFRCERIMEMBEREXCLUDED? I lA999 '�, � — - -
7r(disrnFatoryinNH) �"'-` +: � E DISEASE-EA EMPLOYEE 5`500,000
II yes,.desuibe under §{ 1 � --------.---
DESCRIPTION OF OPERATIONS be ow # 1 E:L,DISEASE-POLICY_I.R41T $500,000
A Oaragekeepers Legal L:abcllly 506-8987524 312412020 312412021 Complccrilisan 15300
DESCRIPTION OF OPERATIONS 1LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may Iso attached it more specs is required)
Sale of new trucks,parts and lepairltestin (tune ups,warramty work,etc)as related to energy industry trucks.
Clearwater Gas Systems and The City of leaRvater are inclu(ed as additional insureds as required by written contract regarding to the General Liability and
Auto Liability coverages.
CERTIFICATE HOLDER CANCELLATION
RECEIVED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF„ NOTICE WILL BE DELIVERED IN
City of Clearwater Gas System ACCORDANCE WITH THE POLICY PROVISION&
4170 N myrtle Avenue
Clearwater FL 33755 AUTHORIZED REPRESENTATIVE
USA
I
GAS ADMIN �-
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