CERTIFICATE OF LIABILITY INSURANCE (1047) ® DATE(MMIDDMYYY)
D CERTIFICATE OF LIABILITY INSURANCE 10/0612020
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 endorsements).
PRODUCER CONTACT Gwen ❑I!✓anti
A. Kilbride Insurance,. Inc. PHONEE, 813-995-7457 _FAX C,Ne).813-949-1324
E-MAIL --
243$ Land 0 Lakes Blvd ADDRESS:certificate akilfJride.com ----
Land
-_Land a Lakes, FI. 34639 _ INSURE R(S)AFFORDINGCOVE RAGS _- NAIC#
INSURERA:Western World Insurance. Compan_y
rvsuRED INsuRERB:Granada Insurance Comp 15879
CSP Plumbing Services Inc INSURERO: _.
12511 Choctaw Trail INSURER D.
Hudson, FL 34569 ENSURER£:
�i
INSURER F.-
COVERAGES
:COVERAGES CERTIFICATE NUMBER: 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
iNbICATEb, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH 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 -- ADDL SUBR i AOLICY EFFmPOLICY EXPT-
LTR TYPECFINSURANCE 1.1NSQ WVQ POLICY NUMBER : MMIDDIYYYY) tMM)DDrffYYI LIMITS
!COMMERCIAL GENERAL.LIABILITY I 3 i EACH OCCURRENCE s S. I iG00.000
DAA E-FO�'iENT _.' "I QQ,QQfl
�� PREMISES(Ea occurrence} I S
j 3 �CLAIMS-MADE tI � OCCUR ' � „,.-. ..-._.
� � I ME�AMy fine person} i 5 _�,QQfl.
iI� .........-.�.._..,_
x x NpP8533178 10/25/79: 7Qj25./2Q.1 PERSO NAL&ADV INJURY S I,OQQ;000.
GENT AGGREGATE LIMITAPPLIES PER; ;GEN£RALAGGREGATE S 2,000;.0.00.
f POLICY JEC I� f LOC I I PRODUCTS-COM PIOPAGG 5 2,000I000
OTHER:
COMBINED SINGLE LIMIT
AUTOIkOBILELIAR ILrrY 5_-...__._ 100,000
El ANY AUTO BODILY INJURY(Per person) is
OWNED I SCHEDULED x OIIOFLOOD43685Q7/27/20. 07/2721,1 BOD ILYINJURY(Per acciderit)I S
AUTOS
_ AUTOS Os T
'}TIRED r-�. NON-OWNED PRaP)"RTY DAMAGE
AUTOS:ONLY AUTOS ONLY Per
NLY
Pergonal Inju �g�--- '10,000
-1 UMBRELLA LIAB. I
OCCUR l +EACH OCCURRENCE $.
l E%CESS LIAB ��tpfMS=MADE# k AG�GREG�ATE 5
I QED RETENTIONS' i S
i WORKERS COMPENSATION PER OTHN
AND EMPLOYERS`LIABILFTY STATUTE ER
ANY PROP RIET04iPARTNERJEY I NkECUT1V.E ❑i N IA- i E.L.EACH ACCIDENT _ �S
OFF I CE RIM 1111 E R E%CLUI]ED?
(Mandatory in NH) I ? I E.L.DISEASE-EA EMPLOYEE:S
If yes,describe under 1
DESCRIPTION OF OPERATIONS below I E.L.DISEASE.-POLICY LIMIT $
i I
{
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(AC 6RDA 61Aildillonal Remarks Schedtirie,piay.he attached If mora space is required)
Certificate holder is also an additional insured.under General liability and. Auto coverage, as per written
contract. Waiver of subrogation also included .under General liability coverage, as per written contract.
Certified Plumbing Contractor#CFC1426960
License Qualifier: Craig E. Isabella
CERTIFICATE HOLDER CANCELLATION
Clearwater Gas System
SH011LD ANY flF"THE ABOVE DESCRIBED POLIC1ESt3E CANCELLED BEFORE
45.5 North Myrtle Ave: THE EXPIRATION DATE THEREOP, NOTICE WILL 13E DELIVERED IN
Clearwater FL 33755 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
JEG.
O 1988-2075 ACORD CORPORATION. All rights reserved:
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