CERTIFICATE OF LIABILITY INSURANCE (991) AC40REO� CERTIFICATE OF LIABILITY INSURANCE DATE IM NYYY)
10125/2019
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, EXTENT] 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
NAME: Vickie Porter GIC
MacLennan& Bain Insurance PHONETFAX
214 Aberdeen Drive _lAtC Np-F-At 219-253=0743 —___ [ r+,j_219.464-9826
Valparaiso IN 46385 E-MAIL
p ADDRESS: vickie@ql@dennanbain.com _
......__INSURRR�R(S AFFORLtING COVERAGE,_..-._._. -.. - NAIC Ir
— ....._—_ INSURERA:Twin City Fire Insurances Co pan r� 29459
- — —.
-CL
INSURED SENSTECINSURER a:Travelers Property CaSUaIt�InSlJranCC Company � 36161
Sensit Technologies LLC _ --- ---
8a1 Transport Drive INSURER C_—___
Valparaiso IN 46383 INSURER D
INSURER E;
INSURER F:
COVERAGES CERTIFICATE NUMBER:867774195 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.
- .._
ADOL SUBR .-..--- ---- "..
T _ TYPE OF INSURANCE ---- P4i,f�Y EFF -. f�+DLICY�EXP ......_......_ ._ ,....-----
vwvn: POLICYNUMBER.. M -MMD LIMITS
A X COMMERCIALCaENERALLIABILITY 83CESOF7774 111112019 111112020
EACH OCCURRENCE 51,000,000
r-
I ...�CLAIMS-MADE I OCCUR � PREMISES
REM 7�RENTE6 �- „_ ._._..._._
' �ME13 EXP¢Aaaora}person)�� $300,000
rson) $10,000
L PERSONAL&ADV INJURY $1 000,000
i GEN`L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE 52000,000
PRD. ( _ ..._
—1 POLICY C _JECT -_�LOC PRODUCTS-COMP!'OP AGG $2 000,000 ""--
OTHER' I ..- .-..— — _..-_.._
S
B AUTOMOBILE LIABILITY -'. BA-DL519496 1111/2019 1 111112020 COMBINED SINGLE LtlMITI$7,000,000
_..- (Eaaccdenl t-_.....
X I ANY AUTO I BODILY INJURY(Par person) S
OWNED sCHE171ILED
_._ AUTOS ONLY ' �AUTOS I BODILY INJURY[Peraen,denl) S
){ I HIRED ;� NON-OWNED PROPERTYDAMAOE--
—_ .... -
I..... AUTOS ONLY _ AUTOS ONLY I far az dentl .—._ ;S
A X UMBRELLA LU1B x OCCUR ( 83XSQN 1720 1 111112019 i 11 tV2020 EACH OCCURRENCE $7,#300,000
{EXCESS LIAR t-- CH OC _.------- --000
_ .. .._i'CLAIMS=k>IADE AGGREGATE 57.000,{700
DEC RET,
NFiON$ %. �- ....._- ._-.--
g7 WORKERSCOMPENSATION 1 $..
AND EMPLOYERS'LIABILITY Y 7 N UB-7.7439915-13 11/112#719 11/112920 'X TAT,UTE EOTRH- _
ANYPROPRIETORiPARTNER XE:CIJ7IVE I"",N i �E L EACH ACCIDENT ($1 000 0017 ., ..
"OFFICERIMEMBEf2ExCLUDE.D'? L: '"N/A' ( _ t .._ ,._.. ...._
(Mandatory In Nw) ( L DISEASE-EA EMPLOYEE,S 1,000.000
!If yes,descrube under ----...-_ -..�_....___._._.._—,_,
DESCRIPTION OF OPERATIONS below j j E.L-DISEASE-POLICY LIMIT�51,000,000
I
DESCRIPTION OF OPERATIONS/LOCATIONS I VE LES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) #.17, i of FI j.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION [TATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Clearwater Clearwater Gas System ACCORDANCE WITH THE POLICY PROVISIONS.
Attu: Bruce Griffin
400 North Myrtle Avenue AUTHORIZED REPRESENTATIVE
Clearwater FL 33755
USA �
031988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(21116/03) The ACORD name and logo are registered marks of ACORD