CERTIFICATE OF LIABILITY INSURANCE (1061) 'a / 2 NrIAC CERTIFICATEILI ILITY I DATE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S 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(les)rmlust be endorsed, If SUBROGATION IS WAIVED,subject to
the terms arld conditions of the pol'Icy,certalrl poll cles may requlto amt endorsement. A statement on this certificate dues not c onto r ri ghts to the
certifiicate holder Orn Ileta of swch endorserrment(s).
PRODUCER MtDNTcr Mary,.. Fe.kete
Lancaster Insurance Trac PHONEe : (727)461-3704I` 401: I727)441-n29e
510 Druid Rd Suite C 6DDRES•S,Maryarra@ lamins.corms
In G Box 2556 INSURER(S) AFFORDING COVERAGE NAMC 0
Clearwater FL 33757 INSamRERA:Owners Insurance 32700
INSURED INSURER B:SoutS;earrn-ClwnersInsurance 101.90
I Jim Kenney Electric Inc INSURER C
James Robert Kenney Lic EC0003101 INSURER D
128300 Sophia Circle INSMaRERIE:
Largo FL, 33774-2421' INSURER F:
COVERAGES CERTIFICATE NUMBER:C'L1S4304647 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIESOF INSURANCE LISTED BELOWHAVE BEEN ISSWDI I?7C THI INSURED NAIuIEI}AI3DVE FOR THE POLICY PERIOD
INDICATED. NOTWT'HSTANDINGANY REQUIREMENT;,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN',THE INSURANCE AFFORDED RIYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITION OF SUCH POL.ICOE'S,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL4iMS"
MNSR TYPE OF INSURANCE POLICYN'UMMMBER MAMWDOPf MNMOR DON LIMITS
YEXP
LTR
GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,000
X. CChMM1MAERCMA.GENERAL LIABILITY PREMISES iEamuccuMnrvenoe $ 50,000
..
CLAWS-MADE [i]CYCCUIR 1. 0514046'. 6/12,/2020 6/12/2021 MED EXP(Any one person) $ 5,000
0514045 6/12/2019 6/12/2020 PERSONAL &ADV INJURY $ 1,000,000
IM51.4oae /12/2018 6/12/2019 GENERAL AGGREGATE $ 2,000,000
GEN!'LAGGREGATE LIM ITA'PPUESPER; PRC'DOCT,S-CO1wP)OPAG(p $ 2,000,000
.POLICYEl M El LOC
AIJTOMIOBILELIABILITY
C,0M1lNr1.1,,SlNGL5 7m-7—
$
X AN'YAUTO BODILY INJURY(Perperson) $
ALLOWNED SCHEDULED 5433.33!9900 1/21/2020 .1./21./2.0,21. BODILY INJURY(Per accidentW $
AU"rOS AUTOS
HIFtEDAJTQS
NON-OWNED PROPERTY DAMAGE $
AUTOS Per accwen
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAO CLAIMS-MADE AGGREGATE.
DED RETENTION$ $
B WORKERS COMB PENSATMON x, 'VYt"GTATI,I- CYVI°d-
AND EMdflPLOYER•5"LIABML"Y" YIN
ANY PROPRIETOWPARTNEME)FCUTUVE 20331705 /1/2021 /1/2022 CL EACH ACCIDENT $ 500,000
OFFICER/MFM
BER FXCLUDED7 N 1A..
IMMan%datory In NH) 0331705 /1/2020 /1./2021 1.L.DISEASE•EA EMPLOYEE I$ 500 000
II yes,describe under 0331705 ./1/2.019 ./:1/2'020
DESCRIPTION OF OPERATIONS belowE.L.DISEASE•POLICY L1y! $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES(Attach ACORD 901,Additional Remarks Schedule,.I9 range apace Is rarpulredl
The, City of Clearwater and Clearwater Gas is listed as additional insured with respect to the general
liability and ccatlrMercia auto. liability insurance.
e-mail Torry-aagganas@clearwaterga,s.com
CERTIFICATE HOLDER CANCELLATION
Eryn.Berg@MyClearwater.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
"( ACCORDANCE WITH THE POLICY PROVISIONS'.
City c� Clearwater Gas Department
4000 N Myrtle Aare
AUTHORIZED RREPRESENTATIVEClearwater, FL 33755 MAR' 11If a"(""""N mm
I1
a.r°y.n Fekete/r aF
ACORD 25(2010105) 0 1988-2010 ACORD CORPORATION, All rights reserved.
INS025(2101005I.01 The ACORD name and,logo are registered marks of ACORD