CERTIFICATE OF LIABILITY INSURANCE (1013) HALMAHOL2
DATE(MMPOD1YVYYP
TI I ANTE E LIABILITY I DATE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FIGHTS UPON THE CERTIFICATE FOLDER. 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
.-.
COrl7rnerOlal Lines -NAME
PHONE PAX
r c,ft a 513-B52 300 �.iaac,N®I: 513-862-6428
USI Insurance Services LLC ADDRESS: sheryl.stewartusi,eorn
312 Elm Street,23rd Floor INS URER(S)AFFORDING COVERAGE � NAIC
Cincinnati,OH 45202 INSURER A: ACE American insurance Company 22657
INSUREDINSURER B Federal a
Insurance Com n 20281
Senslt Technologies LLC —.� � .`y
INSURER Chubb National Insurance Company 10052
881 Transport Drive _ ®....
INSURER o
INSURER E
Valparaiso,IN 46383 INSURER F.
COVERAGES CERTIFICATE NUMBER., 14929873 REVISION NUMBER: See below
THIS IS TO CERTIFY IFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUER 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.
IpISRB 'A r S313R POLICY EFF POLICY EXP
LTR N TYPE OF INSURANCE I - POLICY NUMBER: lmmippryyyyl Im UrYYYYl LIMITS
X COMMERCIAL GENERAL,LIABILITY
A _ F-17� OGLG2773862A 0410112020 04/4112021 EACH OCCUR RENO E s t o�otr
CL - i
CI-AIMS-MADE I " OCCUR TED
PREA,IISES Ea ac6L.¢,rrerse:eJ_.eS 1900000
MED EXP(Anyone personl ' 5 5DOO
PERSONAL.&ADV INJURY S 100DOOO
GENLAGGREGATE LIMIT APPLIES PERGENERAL AGGREGATE. $ 2009O00
POLICYJECGT� LOC PRO6UCT'S Ct hPtOP AGG a" 200DOOO
OTHER:°. � S
B AUTO MOBILE LIABILITY ( 73602458 '...04101/2020 04/01/2021 Eaaac6denCSiNGLELINIfT (� 1000400
ANY AUTO BODILY INJURY IPer"rson) is
OWNED SCHAUTOSLILEl7 BODILY INJURY(Per acci€teni} $
AUTOS ONLY �AUTOS
HIRED NON OWNED PROPERTY 6.&�MAGE
AUTOS ONLY AUTOS ONLY er acclda~nl
A X UMBRELLA LIAB x OCCUR XOOG27739143 0410112020 0410112021 EACH OCCUR Rr-NCE is 4.000,000
EXCESS UAB GLA_IMS-raAr}E AGGREGATE . 4,000,000
DEC RETENTIONS ( _
WORKERS COMPENSATION 04/0112020 0410112021 x ssaRiTUTL,® . H,
C AND EMPLOYERS'LIABILITY _. 71758720
YINANYPROPRIETOR,'PARTNEMEXECUTWE. I _..1000400
OFFICER•MEMBEREXCLUDED> NPA' E-L EACH ACCIDENT -
IMandatory in NH) E.I.-DISEASE-EA EMPLOYEE S 1000000
If yes,describe sender
DESCRIPTION OF OPERATIONS below E1 ;DISEASE POLICY LIMT S 1000000
-
I
DESCRIPTION OF OPERATIONS I LOCATIONS P VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if maze space Is required)
Evidence of Coverage.
o'qy"
A
_CERTIFICATE HOLDER CANCELLATION
City of Clearwater-Clearwater Gas System SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn:Bruce Griffin ACCORDANCE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY P'ROVISION'S.
400 Forth Myrtle Avenue
Clearwater,FL 33755 AUTHORIZED REPRESENTATIVE
I
The ACORD name and logo are registered marks of ACORD Q 1988-2015 ACORD CORPORATION, ,All rights reserved.
ACORD 25(2016103) 111111111111111111111111111111111111111111 111il 111111111111111111111111111111111111111
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