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CERTIFICATE OF LIABILITY INSURANCE (4) AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �._. 10/17/2022 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 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 Insurance Inc PHIAJCN o E t: (727)461-3704 FAX A/C No: (127)441-32ee 510 Druid Rd Suite C ADDRESS:Maryann@lancins.com P 0 BOX 2856 INSURERS AFFORDING COVERAGE NAIC# Clearwater FL 33757 INSURER A:Owners Insurance 32700 INSURED INSURER B:Southern-Owners Insurance 10190 Jim Kenney Electric Inc INSURERC: James Robert Kenney Lic#EC0003101 INSURER D: 12800 Sophia Circle INSURER E: Largo FL 33774-2428 INSURER F: COVERAGES CERTIFICATE NUMBER: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 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 CLAIMS. INSR FF POLICY EXP LTR TYPE OF INSURANCE A OL BR POLICY NUMBER MMIDD/YPOLICY EYYY MM DDfYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITYAMA E TO R PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE FOOCCUR 20514046 /12/2022 /12/2023 MED EXP(Any one person) $ 5,000 0514046 /12/2021 /12/2022 PERSONAL &ADV INJURY $ 1,000,000 0514046 /12/2020 /12/2021 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY Ee aB tlenINEDtSINGLE LIMIT $ 11000,000 X ANYAUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED 5433339800 1/21/2021 1/21/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $_ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION S $ B WORKERS COMPENSATION X WC STATU- GTH- AND EMPLOYERS'LIABILITY YIN — ANY PROPRIETOR/PARTNER/EXECUTIVE 0331705 /1/2022 /1/2023 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? � N I A (Mandatory in NH) 0331705 /1/2021 /1/2022 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION tony.magganas@myclearweater.c 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 Fekete/MAF I ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn95 roninng)ni 'rL. Ar^MM .-.,.. - --A 1— -s A—MM