CERTIFICATE OF LIABILITY INSURANCE (8)ACS ®
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
06/26/2019
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 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
Aon Risk Services Northeast, Inc.
New York NY Office
One Liberty Plaza
165 Broadway, Suite 3201
New York NY 10006 USA
CONTACT
NAME:
(AH/CNNo. Ext): (866) 283-7122 FAC No ): (800) 363-0105
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
Kubra Data Transfer Ltd.
30 Knox Drive
Piscataway NJ 08854 USA
INSURER A: Travelers Property Cas CO of America
25674
INSURER B: The Charter Oak Fire Insurance company
25615
INSURER C: The Travelers Indemnity Co.
25658
INSURER D:
$1,000,000
INSURER E:
INSURER F:
CLAIMS -MADE n OCCUR
COVERAGES
CERTIFICATE NUMBER: 570077091912
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. Limits shown are as requested
INSR
LTR
TYPE OF INSURANCE
ADDL
INSD
SUER
WVD
POLICY NUMBER
POLICY EFF
(MM/DpIYYYY
POLICY EXP
f MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL UABILITY
TCZJGLSA2H53218ATIL19
07/01/2019
07/01/2020
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE n OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$1,000,000
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$1,000,000
LIMIT APPLIES PER:
GENERAL AGGREGATE
$5,000,000
--G--E��N'LAGGREGATE
A
POLICY( PRO-
JECT I (LOC
PRODUCTS - COMP/OPAGG
$2,000,000
OTHER:
A
AUTOMOBILE LIABILITY
TC2J-CAP-2H532166-TIL-19
07/01/2019
07/01/2020
COMBINED SINGLE LIMIT
(Ea accident)
$5,000,000
X
ANY AUTO
BODILY INJURY ( Per person)
-
OWNED
-
SCHEDULED
BODILY INJURY (Per accident)
_
AUTOS ONLY
HIRED AUTOS
-
AUTOS
NON -OWNED
AUTOS ONLY
PROPERTY DAMAGE
(Per accident)
-
ONLY
_
C
x
UMBRELLA LIAB
X
OCCUR
ZUP61N1520919NF
07/01/2019
07/01/2020
EACH OCCURRENCE
$3,000,000
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$3,000,000
DED X RETENTION 510 000
r B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TC20UB2370326819
07/01/2019
07/01/2020
X
PER
ETH
C
r'
ANY PROPRIETOR / PARTNER / EXECUTIVE
YIN
N
TRKUB2J70325619
TRKUB2J70327A19
07/01/2019
07/01/2019
07/01/2020
07/01/2020
E.L. EACH ACCIDENT
$1,000,000
B
OFFICER/MEMBER
(Mandatory In NH)
NIA
Tc20UB2J 70324419
07/01/2019
07/01/2020
E.L. DISEASE -EA EMPLOYEE
$1,000,000
A
If yes,describe
DESCRIPTION under
DySOPERATIONSE.L.
below
TC2JUB2J70328119
07/01/2019
07/01/2020
DISEASE -POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 01, Additional Remarks Schedule, may be attached if more space is required)
City of Clearwater is included as Additional Insured in accordance with the policy provisions of the General Liability,
Automobile Liability and Excess Liability policies. General Liability policy evidenced herein is Primary and Non -Contributory
to other insurance available to an Additional Insured, but only in accordance with the policy's provisions.
CERTIFICATE HOLDER
CANCELLATION
Holder Identifier :
Certificate No : 570077091912
City of Clearwater
100 S Myrtle Ave
Clearwater FL 33756 USA
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
cS4'ass%Z l r ee weed e/Y Dfslot,
ACORD 25 (2016/03)
191988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD