CERTIFICATE OF LIABILITY INSURANCE (962) 0 DI
DATE IMMIDYYYYI
A�V CERTIFICATE OF LIABILITY INSURANCE
41/24/2019
THIS CERTIFICATE IS ISSUED AS A FATTER 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($),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 CONTACT Glebble Greissinger
NAME2
Ironwood Insurance Services,LLC IH17NE (404}503-9100 FFA
No): (404)503-9101
4401 Northside Parkway E' L ADDRESS; 9 dgreissin er Ironwood ns.com
Suite 800 INSURE. S)AFFORDING COVERAGE NAIL#
Atlanta GA 30327 INSURER A, Cherter Oak Fire Insurance Company 25615
INSUREDINSURER B. Travelers indemnity Company 25658
Control Southern Inc. INSURER C: Travelers Property Casualty Ccmpany of America 25674
Shining Light Properties,LLC INSURER D: Travelers Casualty Ins Cc ofAmerica 19046
3850 Lakefield Drive INSURER E.
Suwanee GA 30024-0241 INSURER F:
COVERAGES CERTIFICATE NUMBER; CLI962424704 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..
TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS
ILTR INSD WVD POLICY NUMBER MWDDfYYYY MMIDDIYYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A 100,000
CLAIMS-MADE OCCUR PREMISE'S(Fa oi=rrimce
MED EXP(Any one person) s 5,0[}0
A 630113276020 0710112019 0710112020 PERSONAL&AOV'INJURY $ 1,000,000
GE N'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
POLICY1:1,IECTT Il LOC PRODUCTS-COM PIOPAGG $ 2,000,040
OTHER: Employee Benefits $ 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,400',0140
Ea amiden4
ANY AUTO BODILY INJURY(Par person) S
B OVVNED SCHEDULED 8102N430593 0710112019 0710112020 BODILY INJURY(Par accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE S
AUTOS ONLY AUTOS ONLY Per accident
X UMBRELLA Lill AB I X1 OCCUR EACH OCCURRENCE S 20,040 000
C EXCESS LIAR Ll CLAIMS-MADE CUP7J645378 0710112019 07101/2020 AGGREGATE S 20,000 000
DED I X RETENTION$ 10,000 $
WORKERS COMPENSATIONX 7,gTLITE. OTH.
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L EACH ACCIDENT $ 1,000,000
D OFFICERIMEMBEREXCLUDED? N NIA UB7IC426465 07/01/2019 0710112020
(Mandatary in NH) E L DISEASE EA EMPLOYEE $ 1 000;0011
If Yes,describe under 1,040,000'
DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACO RD 101,Additional Remarks Schedule,may be attached If more space Is required)
3;)VF9,)
CERTIFICATE HOLDER CANCELLATION
,L,'A S i m SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Clearwater Gas ACCORDANCE WITH THE POLICY PROVISIONS.
400 N Myrtle Avenue
AUTHORIZED REPRESENTATIVE
Clearwater FL 33755
Q 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 2 (2016103) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
LOC#:
AC"R" ADDITIONAL REMARKS SCHEDULE Page of
AGENCY NAMED INSURED
Ironwood insurance Services,LLC Control Southern Inc.
POLICY NUMBER
CARRIER NAiC CODE
EFFECTIVE DAM-
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM 15 A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Nates
Additional Named Insureds
Shining Light Properties,LLC
Ry -1 'Y .
G'r SDM
A 'I
ACCORD 101 (2008101) Q 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD