CERTIFICATE OF LIABILITY INSURANCE (1038) DATE(MM/DDNYYY)
A�"® CERTIFICATE OF LIABILITY INSURANCE
09/08/2020
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 Amanda Yoder
NAME:
CGB Insurance, LLC A CONE,N Ext): (813)749-7948 A C,No): (813)200-2120
2531 Green Forest Lane E-MAIL amanda@cgbinsurance.com
ADDRESS:
#101 INSURER(S)AFFORDING COVERAGE NAIC#
Lutz FL 33558 INSURERA: Main StreetAmerica Protection Ins Cc 13026
INSURED INSURER B: Old Dominion Ins Cc 40231
Florida Gas&Plumbing,Inc INSURER C: Lloyds of London
5680 66th St N INSURER D:
INSURER E:
St Petersburg FL 33709 INSURER F:
COVERAGES CERTIFICATE NUMBER: 2020-2021 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DDNYYY MM/DDNYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
DAMAGE TO
CLAIMS-MADE ❑OCCUR _PREMISES
Ea oRENTED
""ence $ 100,000
MED EXP(Any one person) $ 5,000
A Y MPP3887X 09/08/2020 09/08/2021 PERSONAL&ADV INJURY $ 1'000'000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED Y B1 P38888X 09/08/2020 09/08/2021 BODILY INJURY(Pe r accide nt) $
AUTOS ONLY AUTOS
HIRED NON-OWNEDPROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1'000'000
BEXCESS LIAB CLAIMS-MADE 4669262-01 09/08/2020 09/08/2021 AGGREGATE $ 1'000'000
DED RETENTION $ 10'000 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVEF-1N IA 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 $
Professional Liability
C SCP2019002157 11/25/2019 11/25/2020 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I 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
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