CERTIFICATE OF LIABILITY INSURANCE (1065)/
A� " CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
03/23/2021
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
CONTACT Sue Russell, CIC
NAME:
Stahl &Associates Insurance, Inc.
pnHiC Ext): (727) 391-9791 ac, No): (727) 393-5623
E-MAIL certificatesstpete@stahlinsurance.com
ADDRESS:
110 Carillon Parkway
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA: Zurich American Insurance Cc 16535
St. Petersburg FL 33716
INSURED
INSURER B: American Guarantee & Liability Ins Co 26247
INSURER C :
Bates Electric Inc.
INSURER D:
7901 Hopi Place
INSURER E:
INSURER F:
Tampa FL 33634
COVERAGES CERTIFICATE NUMBER: CL2132355778 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
LTR
TYPE OF INSURANCEADDLSUBR
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 2,000,000
_7CLAIMS-MADE FX OCCUR
DAMAGE TO
PREM SES Ea oNcRETE ante $ 100,000
MED EXP (Any one person) $ 10,000
X Contractual Liability
PERSONAL&ADV INJURY $ 2,000,000
A
Y
GL0079886501
04/01/2021
04/01/2022
LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $4,000,000
POLICY PRO ❑ LOC
JECT:
MOTHER
PRODUCTS-COMP/OP AGG $ 4,000,000
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
BODILY INJURY (Per person) $
X
ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
Y
BAP079886601
04/01/2021
04/01/2022
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
HIRED HNON-OWNED
AUTOS ONLY AUTOS ONLY
PIP -Basic $ 10,000
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE $ 5,000,000
AGGREGATE $ 5,000,000
B
EXCESS LABCLAIMS-MADE
AUC690698400
04/01/2021
04/01/2022
DED I X1 RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? Y
(Mandatory in NH)
N/A
WC870268400
01/01/2021
01/01/2022
PER X STATUTE ETH
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000,000
Limit $100,000
A
Leased/Rented Equipment
Installation Floater
CPP872268201
04/01/2021
04/01/2022
Limit $200,000
Deductible $2,500
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
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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 33755eC�7
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD