CERTIFICATE OF LIABILITY INSURANCE (1059) ffE(MM/DD/YYYY)
ACOR"
28/2021
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 NAME CT John A. Schmalz
Schmalz Insurance Agency A//°NN Ext): 813-855-6639 A/c No: 813-749-0227
3894 Tampa Road, Suite ADDRIESS:
Oldsmar, FL 34677 INSURER(S)AFFORDING COVERAGE NAIC a
INSURERA: Scottsdale Insurance Company 41297
INSURED INSURER B: Progressive Express Ins.Company 10193
Florida Graphic Services, Inc. INSURERC: The Hartford Casualty Insurance Co. 14397
1351 N.Arcturas Ave,#B INSURER D: Mesa Underwriters Speciality 36838
Clearwater, FL 33765-1903 INSURER E:
FL 33765-1903 INSURER F:
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
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE � OCCUR PRTE
EM SESDAMAGE OEa oecur ence $ 100,000
MED EXP(Any one person) $ 5,000
A CPS7266270 10/27/2020 10/27/2021 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑ PRO-
JECT ElLOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY EO agc,deDtSINGLE LIMIT $ 500,000
ANY AUTO BODILY INJURY(Per person) $
OWNED
B AUTOS ONLY AUTOSULED 06319363-3 11/14/2020 11/14/2021 BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY STAT
Y/N UTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
C OFFICER/MEMBER EXCLUDED? ® N/A 21CAO9 12/26/2020 12/26/2021
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
G Legal Liability G Legal Liab 100,000
D P0009003008712 2/27/2020 2/27/2021 g
Garage Liability Garage Liab 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Clearwater Gas System THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
777 Maple Street ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, Fl. 33755 AUTHORIZED REPRESENTATIVE
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