CERTIFICATE OF LIABILITY INSURANCE (4)A�� "® CERTIFICATE OF LIABILITY INSURANCE
ATE
D08/25/2021DIYYYv)
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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(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:
Marsh USA, Inc.
PHO1301
5th Avenue, Suite 1900
A/C, (FAX,
Ext): A/C No),
E-MAIL
Seattle, WA 98101
Attn: Seattle.CertRequest@marsh.com / FAX 212-948-4326
ADDRESS:
$ 2,000,000
CLAIMS -MADE � OCCUR
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Travelers Property Casualty Company Of America
25674
CN102835048-stn4-GAWUE-21-22
INSURED Itron, Inc.
INSURER B : The Travelers Indemnity Company
25658
INSURER C : XL Sperialty SpecialtyInsurance Company
37885
Attn: Yvonne Tanak
INSURER D : National Union Fire Insurance Company of Pittsburgh,
2111 N. Molter Road
Liberty Lake, WA 99019-9469
INSURER E,
PERSONAL & ADV INJURY
INSURER F:
COVERAGES CERTIFICATE NUMBER: SEA -003585595-13 REVISION NUMBER: 16
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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
HC2J-GLSA-9F337679-21
08/31/2021
08/31/2022
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE � OCCUR
DAMAGE TO
PREMISES (Ea occurrence)
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 2,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
GEN'L
X
POLICY❑ PRO- [:]LOC
JECT
PRODUCTS - COMP/OP AGG
$ 4,000,000
DEDUCTIBLE
$ 250,000
OTHER:
B
AUTOMOBILE
LIABILITY
CAP-lJ668762-21
08/31/2021
08/31/2022
COEaMBINED accident SINGLE LIMIT
$ 2,000,000
BODILY INJURY (Per person)
$
X
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
X
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
L
I Comp/Coll Deductible
$ 2,500
X
UMBRELLA LIAB
X
OCCUR
US00086273LI21A
08/31/2021
08/31/2022
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10,000,000
EXCESS LIAB
CLAIMS -MADE
DED X RETENTION $ 10,000
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
NIA
UB-8N023175(AOS)
UB-SN033212 (WI,MA,NE)
10/01/2021
10/0112021
10/01/2022
10/01/2022
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
D
Errors & Omissions
01-571-50-48
08/31/2021
08/31/2022
Limit:
2,000,000
SIR: $1,000,000
2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Employee Dishonesty coverage is included in the Crime coverage. Errors and Omissions coverage includes Cyber coverage.
City of Clearwater, Florida is included as additional insured where required by written contract with respect to General Liability and Auto Liability.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater, Florida
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
100 S Myrtle Avenue
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater, FL 33756
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
'_4 49",
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD