CERTIFICATE OF LIABILITY INSURANCE (1097) CCORV CERTIFICATE OF LIABILITY 'INSU ANNEYyYJ
3/"7,/202'2
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
REPRE'S'ENTATIVE 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 CONTACT
NAME. Maryann Fekete
Lancaster nSlg9rnn^e IncPHONE FAX
c No Ext (727)451-3704 avc Na: tJara¢a••sxs
510 Druid Rd Suite C � MAIL
ADDRESS:Maryann@ lancs.ns.comp.
P O Box 2856
-.INSURER(S)AFFORDING COVERAGE NAIL#
Clearwater FL 33757 INSU'RERA:Owners Insurance 32700
INSURED INSURER B:Southern-Owners Insurance 10190
Jird Kenney Electric Inc
James Robert Kenney Lsc##ECO003101 INsuRERc:� " INSURER 0:
1.2800 Sophia Circle INSURER E:
Largo FL 33774-2428 INSURER F;
COVERAGES CERTIFICATE. NUMBER:CL134304- 7 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE:BEEN ISSIUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY'REQUIREMENT,TERM/OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 CLAIMIS.
/NSR PIE OF INSURANCE L 5UOR POLICY EFF PU CY EXP
LTR POLICY NUMBER JEKawyyyyMMIDDfYYYY1LIMITS
GENERALLIABILITY EACH OCCURRENCE 'S 1,000,000
COMIM9IERCIALGENERAL LIABILITY PDAMAGETO S� aNTEfrnnGe� IIS 50,000
CLAIMS-MADE OCCUR 20514.046 /12/2021 /.12/2022 MED EXP(Any one gersonS 5,000
..0514046 /12/202.0 6/12/2021 PER'SOiNAL.S ADV INJURY "a 1,000,000
0514046 /12/20151 /12/2'.020 GENERAL AGGREGATE $ 2,000,000
GEN'LAGGREGATE.LIMIT'APPLIES PER' PRODUCTS...COM4PFOpp.4".,G S. 2,000,000
S
POLICY 0 PR0- LOC
AUTOMOBILE.LIABILITY -5MBINIEeDntSIN LE LIMIIT S 1 0 .
00000
ANYALTO BODILY(INJURY(Per person) $
ALL OUWVECOCSCHEDULED
5433339•80,0 12/21/2020 7/21/2021AUTOSBODILY INJURY(Per SL
HIREICD AUTOSNON•OVWNEI7 PROPERTY DAMAGE.. AUTOS Per adClde9lu S'
S
UMBRELLALIAB OCCUR. EACH OCCURRENCES
/EXCESS LIAR CLAIIMS•MADE AGGREGATE. S
O£O RETENTION S $
WORKERS COMPENSATION rPJC STATLI- 0TH•
AND EMPLOYERS`LIABILITY YIN � I
ANY PROPRIETORIPARTNE�RP' .ECUTPME 20331705 ./1/2022 /9../2023 EL EACIhRA.CCId]�ENT $� 500,000OFFICERVMIF.M6B'IER.'EXCLUDED? FD NBA
(Mandatary In NH), 0331705 ...''/1/2..021 /1/2022 E.L.DISEASE-EA EMPLOYEE $ 5bb �IDb
If yeas,deScrilbe Urlder
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I'VEHICLES/Attach ACORD 101,Additional Remarks Schedule,It more space isrequired)
tonymagganas@myclearwater.com
CERTIFICATE HOLDER CANCELLATION
eryn.berg@clearwatergas.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Clearwater Gas System ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater
711 Maple Street AUTHORIZED REPRESENTATIVE
Clearwater, FL 33755
Maryann Fakete/MAF IT
ACORD 25(2010105) C 1988-2010 ACORD CORPORATION. All rights reserved. '
INS025(201C105).01 The ACORD name and logo are registered marks of ACORD