CERTIFICATE OF LIABILITY INSURANCE (1073)AC40RIDF CERTIFICATE OF LIABILITY INSURANCEDATE(MWDVYYW)
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,
F5/5/2021
THIS CERTIFICATE IS ISSUED ASA 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 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
CON TAQ I
rY
NAME: Maryann Fekete
Lancaster Insurance Inc
510 Druit! Rd Suite C
HONE I . (727)461-3704 FRlC. NoI; 1-12-1; 441-3298
1 AIC,
ADDRESS: Maryann@lancins. com
P ❑ Box 2856
Clearwater FL 33757
INSURER(S) AFFORDING COVERAGE NAIC P
INSURERA:Owners Insurance 32700
INSURED
INSURER B : Soutlhern--Owners Insurance 10190
Jim Kenney Electric Inc
INSURERC:
James Robert Kenney Lic#ECO003101
INSURER D:
12800 Sophia Circle
INSURERE:
Largo FL 33774-2428
INSURER F:
COVERAGES CERTIFICATE NUM13ER:CL134304647 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,
nOL�i.�i:ONS AND CONDI T IViti�S OF 3L;C:I POLIO! Z3- �.iPAN l 3 yl:0Vv'4 IVIIi, � WE SEEN FREDUCED 11Y F;A;D CLF5flV13,
'n
INSR
LTR
TYPE OF IN
L
UBR
POLICYNUM13ER
POLICY EFF
JMMjL/'fML.MEMDffYYYL
POLICY EXP
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE 5 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISE a trance S 50,000
.p1
CLAIMS -MADE OCCUR
x
0514046
/12/2021
/12/2022
MED EXP lAny one mon) S 5,000
0514045
/12/2020
/12/2021
PERSONAL & ADV INJURY $ 1,000,000
GENERALAGGREGATE $ 2,000,000
0514046
/12/2019
/12/2020
GEN'LAGGREGATE LIMITAPPLIES PER
PRODUCTS - COM PIOPAGG $ 2 r 000.000
lc POLICY PRO- LDC
$
A
AUTOMOBILE LIABILITYOMB
ED SINGLE LIM
(Eacl 5 1,000,000
BODILY INJURY (Per person) $
x ANYAUTO
ALL AUTOS AOESULED
5439334600
1/21/2020
1/21/2021BODILY
INJURY (Per acaoern) $
NCH
NON -OWNED
HIREDAUTOSAUTOS
PROPERTY DAMAGE $
Per a0dent
S
UMBRELLA LIAO
OCCUR
EACH OCCURRENCE S
EXCESS LIAR
CLAIMS -MADE
AGGREGATE 5
DED I I RETENTION $
S
B
WORKERS COMPENSATFON
lNC STATU• DTH -
AND EMPLOYERS' LIABILITY Y 1 N
X
E . EACH ACCIDENT $ 500,000
ANY PROPRIETORIPARTNERIEXECUTIVE
OFF ICERIMEMBEREXCLUDED?
NIA
R0331705
1112021
1312022
E.L.DESEASE - EA EMPLOYEE a 500 ,000
(Mandatory in NH)
0331705
11/2020
1112021
Dyes, describe under
DESCR lPTIDN OF OPERATIONS below
0331705
/1/2019
13/2020
EL DISEASE-POUCYLIMIT S 500 ,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The City of Clearwater and Clearwater Gas is listed as additional insured with respect to theneral
qpe
liability and liability
commercia auto. insurance. f EGEIVED
e-mail Tonymagganas@clearwatergas.com
MAY 10 2021
hAC� Ar-%RAIINI
CERTIFICATE HOLDER
Eryn.Berg@MyClearwater.com
City of Clearwater Gas Department
400 N Myrtle Ave
Clearwater, FL 33755
CANCELLATION
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
Fekete/MAF 44'1 rz&
INZiUZ5 (201ODS).01 The ACORD name and logo are registered marks of ACORD