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CERTIFICATE OF LIABILITY INSURANCE (1119)AC RO EP CERTIFICATE OF LIABILITY INSURANCE DATErr) 02/23/2023 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 McGriff Insurance Services, LLC 10100 Katy Freeway, #400 Houston, TX 77043 CONTACT Rachel Manis-Hyatt NAME: PHONE 713-877-8975 FAX 713-877-8974 (A/C. No. Ext): (A/C, No): E-MAIL rmanis-h attm riff.com ADDRESS: y INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Hartford Accident and Indemnity Company 22357 INSURED Primoris Distribution Services, Inc. including Florida Gas Contractors, Inc. and FGE Engineering, Inc. 10518City, FL 33US Highway 33525 52 301 DadeINSURER INSURER B :Twin City Fire Insurance Company 29459 INSURER C :Hartford Fire Insurance Company 19682 D Axis Surplus Insurance Company 26620 INSURER E :Gotham Insurance Company 25569 INSURER F :Oxford Insurance Company TN LLC 17142 COVERAGES CERTIFICATE NUMBER:B25ULSA6 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 INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY 61CSEQU3414 02/28/2023 02/28/2024 EACH OCCURRENCE $ 2,000,000 PREMISES (EaENTEoccu DAMAGE TO ence) $ 2,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE RPOLICY OTHER: X LIMIT APPLIES PER: JEQ LOC PRODUCTS - COMP/OP AGG $ 4,000,000 $ C AUTOMOBILE X — LIABILITY ANY AUTO OWNED AUTOS ONLY_ HIRED AUTOS ONLY — SCHEDULED AUTOS NON -OWNED AUTOS ONLY 61CSEQU3415 02/28/2023 02/28/2024 COMBINED SINGLE LIMIT (Ea accident) 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Physical Damage Ded. $ 250,000 D F X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE P-001-000806562-02 1001-23-1 02/28/2023 02/28/2024 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED X RETENTION $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below �, / N N N / A 61WNQU3411 61WBRQU3412 $500,000 Ded/SIR applies to all 02/28/2023 02/28/2024 X PER STATUTE 0TH - ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Automobile Excess Liability EX202300003084 02/28/2023 02/28/2024 Each Loss Aggregate $ 3,000,000 $ 3,000,000 $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is included as Additional Insured as respects the General Liability policy as required by written contract and subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, FL 34618-4748 RELtivcu MAR 0 223 CITY CLERK DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE g4.44414r , ACORD 25 (2016/03) Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD