CERTIFICATE OF LIABILITY INSURANCE (1055) A�o®
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1z/17/zozo
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 Sue Russell,CIC
NAME:
Stahl&Associates Insurance,Inc. TONE. Ext: (727)391-9791 a/c,No: (727)393-5623
110 Carillon Parkway EMAIL certificatesstpete@stahlinsurance.com
ADDRESS:
INSURER(s)AFFORDING COVERAGE NAIC#
St. Petersburg FL 33716 INSURERA: Zurich American Insurance Cc 16535
INSURED INSURER B: Travelers Property Casualty Cc ofAmerica 25674
Bates Electric Inc. INSURER C: American Guarantee&Liability Ins Cc 26247
7901 Hopi Place INSURER D:
INSURER E:
Tampa FL 33634 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL20121654668 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
DA M
CLAIMS-MADE ❑OCCUR PREM SESOEa oNcurrDence $ 300,000
MED EXP(Any one person) $ 10,000
A Y GL0079886500 04/01/2020 04/01/2021 PERSONAL&ADV INJURY $ 1'000'000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
PRO-
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED Y BAP079886600 04/01/2020 04/01/2021 BODI LY I NJ U RY(Pe r accide nt) $
AUTOS ONLY AUTOS
HIRED NON-OWNEDPROPERTYnt DAMAGE $
AUTOS ONLY AUTOS ONLY Per accide
PIP-Basic $ 10,000
TUMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5'000'000
B EXCESS LIAB 11 CLAIMS-MADE ZUP41M93350 04/01/2020 04/01/2021 AGGREGATE $ 5'000'000
DED RETENTION $ 10'000 $
WORKERS COMPENSATION PER O
EMPLOYERS'LIABILITY v/N ER
TH-
AND STATUTE
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
C OFFICER/MEMBER EXCLUDED? El
N/A WC870268400 01/01/2021 01/01/2022
(Mandatory in NH) DISEASE-EA EMPLOYEE $ 1,000,000
E.L.
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
L
Leased/Rented Equipment imit $100,000
A Installation Floater CPP872268200 04/01/2020 04/01/2021 Limit $200,000
Deductible $1,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Certificate holder is included as additional insured with respect to general liability and auto liability as required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Clearwater Gas System City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
400 North Myrtle Avenue
AUTHORIZED REPRESENTATIVE
Clearwater FL 33755
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ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD