CERTIFICATE OF LIABILITY INSURANCE (931) ' `' CERTIFICATE OF LIABILITY INSURANC 9/4/2018
THIS
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(les)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 corder rights to the
certificate holder in lieu of such endorsements .
PRODUCER CONTACT NAME: V±ck±e Porter
MacLennan & Bain Insurance PHONE (219)464-0100 FA N.J.(219)464-9826
JAIG-Ng
214 Aberdeen Drive E-MAILADDRES ,vs c3eieftaclenrtanbain.cnaP
INSURERS AFFORDING COVERAGE NAIL N
Valparaiso IN 46385 INSURERA.Twin Ci:t-y Fire Insurance Co 29459
INSURED INSURER B:Travelers Property Casualty Co 91;674
S nsit Technologies LLC INSURERC:Travelers Indemnity Co of Conn 25682
INSURER.D:
851 Transport Drive INSURER E:
Valparaiso IN 46383 INSURER F;
COVERAGES CERTIFICATE NUMBER:2018 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.
" POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER DDdYYYY MMEDDIYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITYPREINISIS F1 `
ES Eaccxurrenceencel S 300,0017'
CLAIMS-MADE 11 OCCUR 83CESOF7774 11/1/2018 11/1/2019 MED EXP(Any one person) $ - 10,000
X Contractual L±ab±llty PERSONAL&ADV INJURY $ 1,000,000
included. GENERAL AGGREGATE $ 2,000,00Q
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,000
X POLICY LIM LOC I Deductible $ $5,000
AUTOMOBILE LIABJUTY OEO am DISINGLE LIMIT 1,000,000
B X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED 3G912939 11/1/2018 11/1/2019 BODILY INJURY(Per accident $
AUTOS AUTOS �
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS Per acciderr4 $
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000
A X1 EXCESS UAB CLAMS-MADE AGGREGATE $ 7,000,000
DED I X I RETENTION$ 0 B3XSON1720 1/1/2018 1/1/2019 $
C WORKERS COMPENSATION WC STATU- OTFI-
AND EMPLOYERS'LIABILITY YIN Y T aJ
ANY PROPRiETORMARTNERIEXECUTIVE� E L.EACH ACCIDENT $ —1-A-0 00 000
OFFICER/MEMBER EXCLUDED' l_,_�i N I A
(Mandatory in NH) B-7x439915-18-14-G 1/1/2018 11/1/2019 El DISEASE-EA EMPLOYE' $ 1 000,000
0 yes,describe under
DESCRIPT;ON OF OPERATIONS below E.L.DISEASE•POLICY LiMi-r I$ 1 000 000
T_
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it mare space is required)
NOVa. �:,F
�,I r8�
GAS ADMIN
CERTIFICATE HOLDER CANCELLATION
Bruce.Griff n f myClearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater Gass System
Attn: Bruce Griffin AUrtIORtzED REPRESENTATIVE
400 North Myrtle Avenue
Clearwater, FL 33755
R MzxeLestrxan CPCUf VSP
ACORD 25(2010106) 01988-2010 ACORD CORPORATION. All rights reserved.
INS025(2moD5p.09 The ACORD name and lotto are registered marks of ACORD