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CERTIFICATE OF LIABILITY INSURANCE (1123) A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/01/2023 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 CONTACT Sue Russell,CIC NAME: Stahl&Associates Insurance,Inc. AIC NN. Ext): (727)391-9791 /X No: (727)393-5623 110 Carillon Parkway E-MAIL certificatesstpete@stahlinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# St.Petersburg FL 33716 INSURERA: James River Insurance Co 12203 INSURED INSURER B: FCCI Insurance Company 10178 Bates Electric Inc. INSURER C: Zurich American Insurance Co 16535 7901 Hopi Place INSURER D: INSURER E: Tampa FL 33634 INSURER F: COVERAGES CERTIFICATE NUMBER: CL236166225 REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 TYPE OF INSURANCE ADSL UBR POLICY NUMBER MM/DD YYYYMLICY EFF O DD YYYY LIMITS ICY EXP LTR INSD WVD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE_7CLAIMS-MADE �OCCUR PREM SESOEa occu«Dence $ 300,000 X $5,000 Per Occurrence Deductible MED EXP(Any one person) $ 10,000 A Y 001443720 05/31/2023 05/31/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $PRO 2,000,000 OTHER: Per ProjectAgg Max $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y CA100085117 05/31/2023 05/31/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Personal Injury Prot $ 10,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE 001443760 05/31/2023 05/31/2024 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? F NIA WC100085116 05/31/2023 05/31/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Leased/Rented Equipment L/R Equipment Limit $100,000 C Installation Floater CPP872268203 06/01/2023 06/01/2024 Installation Limit $200,000 Deductibles $5,000/2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured with respect to general liability and auto liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Clearwater Gas System City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 400 North Myrtle Avenue AUTHORIZED REPRESENTATIVE J Clearwater FL 33755 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD