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CERTIFICATE OF LIABILITY INSURANCE (1097) DATE(MUMONYYY) AC DP CERT"IFICAT"E OF LIABILITY INSURANCE 111242020 THISCERTIFICA"rE 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 p�olicy(pes) must have ADDITIONAL. INSURED provisions ar a endorsed. If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain policies may require n endorsement. A statement can this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), CONTACT PRODUCER NAM r:. Jo, hn A+ Schcralz .... .......... PHONE F.4X 813-749-0227_... Schmalz Insurance Agency _(Alt Na,Exl7� 81 -— f6 E-MAIL 3594 Tampa Road,Suite B ADQR9A&— .. Oldsmar, FE 3'4577 I,NSgRERA nottsdale Insurance CQm as NAI C# INSEJRE R,(S,�APrf,)f L7ENO COVER _ ... ........— panY .._. .,__4.1.297 11..._ INSURED IN§URERB_ PrkgressiveExpress Ins._.Company ........ ... ... ........_ .-...1019.3,....-._...-. Florida Graphic Services, Inc. INSURw'R C: The Hartford Casualty Insurance Co. 14393. _ 1351 N. Arcturas Ave,#B INSURER D: Mesa Underwriters_SpecialitY 36838 Clearwater, FI_33765-1903 ANSURC FL 33765-1903 1 INSURER F: COVERAGES CERTIFICATE NUMBER, REVISION NUMBER; �........ TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD--°THIS IS TO CERI IFY THAT"'TETE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED ORM SUCH PCTI�AIN, LIMITS SHOWN INSURANCE AFFORDED BY THE POLICIES S DESCRIBED 1SHEREIN Ir SUBJECT TO ALL THE TERMS, EXCLUSIONS,AND CONDITIONS ..,. POLICY EFi= POLICY EXP (.- Af3LILSUCiR.. .. _..,_ _ LIMITS INS R I TYPE OF INSURANCE �Q l�� POLICY hdUhM1�ER �M4NfD 1]IYYYYI „�MMII?[7FYYYY�„„„„ COMMERCIAL.GENERAL LIABILITY � EACH OCCURRE -I �.... .. ,,0010,'000..,. I7AMAaE°Ta REN EES 1100 ®I)0 CB AIWIFI- 0AC]&; I (YGC:L9R -PREMISE � 10/2712020 10/2712021 PFRSONALAny 11 E7u.s 1 ..._ 5,000 s ADV IN,7l Ry t __.._1,a0 ,00 A CP'S33t15638 _. ... . L IMI9'APPL6E';i EER. GENERAL AGGREGATE E L,F"N'9.rAGGP.L4.3Ak1'� rr PRO PRaDLIcrs hl Col7dlaErAGS ... _— _.. ,ttb0Ig6 POI BCY If JEC1 LOG _. _._ O I IER COMBINED SINGLE LIMN t SOO,OOQ_ AUTOMOBIL.E.LIABILITY (Ea ac idenq BpDVI„.Y INJURY IPer(rarsorct) $ rSSCHE�UL ED 1 1111.412020 11114/2021 PEe�ai�EI� ! DhMBODILY NJURY(FGtaccl entJl � OV Ni:1) B' AUT05ONLY� 06319363.3 IANVFLDaC / Ekli�E Gf U »-AILI OS ONLY d4R9TCaaa ONLY .. .,_.. LUMaRELLALIAB C'C'U, EAC%EiOCCURRENCE. 5- .. ._.. _- U ...._ ----. ,. EXCESS LIAB �...,. C{AItlWS•MADE. AGGrtEC�ATL _.,..'�._ .. .., C7F:D �.RE $ PB'R GTH WORKERS COMPENSATION /"`� s,rnT,UfF _"_...... FR... .,.,.---- . __. .., _._..-....,,I.FI.17f�tly-rDS,s CERzM7uIPf'ELTOIOYNE.kCmTS6 fCSrRY1EXECl�11WF�Y r N ....... � F- L EACI-I ACCIDENT ._.... _1--,.O, O.O1 91-0,00© CGE 1,000,000c : �XYL12126/2019 12126/2020 h £ (MandatoryIn Nh1 scribe uncer E DISEASE SL PciirY .lM� 1 00 PLRArI4NSWc� D llGK Legal Liability Y MP0009003008712 2122/2020 212712021 GK LegalLIab 100,000 Garage Liability Garage Liab 1,000,000 nvnw DESCRIPTION OF OPE=RATIONS d LOCATIONS d VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached IEI"re space Y:s required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE:ABOVE DE=SCRIBED POLICIES BE CANCEL.LE D BEFORE Clearwater Gas System THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DEET.IVERED IN ACCORDANCE WITH THE POLICY PROVISIONS., 777 Maple Street Clearwater, R 33755 AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPOR ION. All ri; hts reserved. ACORD 25(2016/03) The ACORD name and toga are registered marks of ACORD