CERTIFICATE OF LIABILITY INSURANCE (1058) DATE(NW DDIYY M
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THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION.ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR ALTER THE-COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES HOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSLIRER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER;AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pvlicy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS.WAIVE0j subject to the terms and conditions of the.pollC.y,Certain policies may require an endorsement. A staterrient'on
this.certifcate does.not confer rights to the certificate holder.In.lieu of Such endorsement(s).
PRODUCER :GONT4CT
,AMEAmanda Yoder
:
CG5 insurance,LLC PHHONNu Ext- (813)749-7948- Fvc,o: (873}200-2120
253.1 Green.Fore st.Lane ADDRESS : amarida®cgbins1lrance.com
#10'1 INSURER(S)AFFORDING COVERAGE NAtC0
Lutz FL 33559 INSURERA: Main StreetArnerica pr6teetion los Co 13026
INSURE[) ENSURER B.: OW Dominion IRS CO 40231
Florida Gas&Plumbing,.Inc INSURERRC: Lloyds of London
5680 66th St N INSURER D:
INSURER E':
St Petersburg FL 33709 INSURERF:
COVERAGES CERTIFICATE-NUMBER: 2020-2021 Master REVISION NUMBER-
THIS 13 TO CERTIFYTHAT THE.PCLIC IES OF INSURANCE LISTED:BELOW HAVE BEEN ISSUED TO:THE INSURED NAMED ABOVE F.ORTHE POLICY PERICD
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 IN.SURAN CEAIF FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THI-TERM S,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS.SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR POLICY EFF' POLICY EXPLTR TYPE OF INSURANCE INSR Vy11p POLICY HUMBER. MMIOD MAIIDDIYYYY. LIMITS
X COMMERCIAL GENERALLIABILITY EACROCCURRENCE. S1:000.000
:CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 1{30'000.
MED EXP(Any.oi a person) ..$ 5,000
A MPP3887x 0910812WO 09/0812021 PERSONAL&AOV.INJURY g 1,1100,000
GEN-LAGGREGATELIMITAPPLIES PER: GENERALAGGREGATE $..21OOO+D00
POLICY E:1 PRO0. D LOC. PRODUCTS-COMPlOP.AGG :1$ 2'000,000
OTHER: JECT $
AUTOMOBILE UABILm COM131NED SINGLELIMCr g 1,000.000
Ea accident
ANY AUTO BOOILY.INJURY�Perparson). $
B OWNED. SCHEDULED B:IP3888OX 0910812020 09/08/2021 BODILY INJURY(per aMwent) I
AUTOS-ONLY
AUTOS
HIRED ANON-OWNED PROPERTY DAMAGE .S
AUTOS ONLY AUTOS ONLY Aeraccidenl
3
UMBRELLAWAB OCCUR EACH OCCURRENCE .:5. 1,000,000
e EXCESS LIAR CLAIM"ADF CUP36876 09/08/2021) 09/08/2021 AGGREGATE $ 1,000,000.
PEA I X RETENTIONS 0'000 $'
WORKERS COMPENSATION PER.. OTH_
AND EMPLOYERS'LIABILITY .Y1 N. STATUTE. ER'
ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ .NIA E,L EACH ACCIDENT `5
OFFICERIMEMSER EXCLUDED?
(Mandatory in NH) E,L.DISEASE=EA EMPLOYEE $
1[.yes,describe under
DESCRIPTION OFOPERATIONS below E.LDISEASE-POLICYJMrr $
Professional Liability
C SCP2019002157 1/125/2026 1.112512021 1,000,000
DESCRIPTION OP.OPERATtONS!LOCATIONS 1 VEHICLES.tACORv..101;Addiflonal Remarks Schedute,may be attached i(more space is required)
CERTIFICATE HOLDER CANCELLATION
SH OULD.ANY OF THE ABOVE DESCRIB ED POLICIES BE CANCELLED S€Fd RE
THE EXPIRATION DATE THE RED F,NOTICE WILL BE;DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
100 S Myrtle Ave
AUTHORIZE[)REPRESENTA7IVE
Clearwater FL 33756
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