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CERTIFICATE OF LIABILITY INSURANCE (1069)
,a�oRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/01/2021 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 Aon Risk Services Central, Inc. St. Louis MO Office CONTACT NAME: (A/CONNo. Ext): (866) 283-7122 (FAA/XC. No.): (800) 363-0105 E-MAIL 4220 Duncan Avenue suite 401 ADDRESS: MWZY30160721 St Louis MO 63110 USA 06/01/2022 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Old Republic insurance Company 24147 Pulte Group, affiliates and subsidiaries 2662 S. Falkenburg Rd. INSURER B: INSURER C: Riverview FL 33578 USA INSURER D: DAMAGE TO RENTED $5,000,000 INSURER E: CLAIMS -MADE X OCCUR L� INSURER F: COVERAGES CERTIFICATE NUMBER: 570086770039 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. Limits shown are as requested INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY Clearwater FL 33755 USA MWZY30160721 04/01/2021 06/01/2022 EACHOCCURRENCE 5,000,000 SIR applies per policy terns condi ions DAMAGE TO RENTED $5,000,000 CLAIMS -MADE X OCCUR L� PREMISES Ea occurrence MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $5,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $5,000,000 X POLICY I—JI PRO- JECT LOC PRODUCTS - COMP/OP AGG $5,000,000 OTHER: A AUTOMOBILE LIABILITY MWTB 314605-21 04/01/2021 06/01/2022 COMBINED SINGLE LIMIT $2,000,000 Ea accident BODILY INJURY( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED Per accident ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LAB CLAIMS -MADE DED RETENTION A WORKERS COM PENSATIONAND MWC31460421 04/01/2021 06/01/2021 X I PER STATUTE OTH A EMPLOYERS' LIABILITY Y/N MWC31612921 06/01/2021 06/01/2022 E.L. EACH ACCIDENT $2,000,000 ANY PROPRIETOR/ PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $2,000,000 If yes, describe under D DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater Gas AUTHORIZED REPRESENTATIVE 400 N. Myrtle Ave. Clearwater FL 33755 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD