CERTIFICATE OF LIABILITY INSURANCE (13)Page l of 2
i 0
AC"R" CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
10/2712021
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
Willis Towers Watson Northeast, Snc.
c/o 26 Century Blvd
P.O. Box 305191
CONTACT Willis Towers Watson Certificate Center
NAME:
PHONE t, 1-877-945-7378 A/C N67-2378
ADDRESS: certificates@wrillis.coin
INSURER(S) AFFORDING COVERAGE i NAIC #
Nashville, TN 372305191 USA
INSURERA: ACE American Insurance Company j 22'.667
I MED EXP (Any one person) $
INSURERS: Great American Insurance Company 1 16,691
INSURED
KUBRA Data Transfer Ltd.
3
30 Knox Drive
INSURERC:
_ INSURE_R 0 .. _.__.. _ __ ._. ......_..._.... _ __....
Piscataway, NJ 08854
POLICY I JE O GEi— LOC !
INSURER E:
INSURER F:
OTHER:
COVERAGES CERTIFICATE NUMBER: W22632167 REVISION NUMBER:
THIS IS TO CERTIFY7H-AT THE POLICIES OF INSURANCE -LISTED BELOW -HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEfORTHE-POLiOY 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.
INSFl _..:_,._._.,.,..._..._.......,.._,.___n_...�...,._..,.._......_.m..._._._ A�DCS�CiBR.__._.._._..,_,_._...__._.,...._�,._........�.______�..,.,. POLICY EFP T•POLICY EXP
LTR 1 TYPE OFINSURANCE POLICY NUMBER MM1DD/YYY i MM/DD/VYYY LIMITS
COMMERCIAL GENERAL LIABILITY 1,
EACH OCCURRENCE j
E CLAIMS
ItU
i Eat�occurrencejT,,_�4
-MADE OCCUR
PREMISES (i
I MED EXP (Any one person) $
PERSONAL & ADV INJURY 1 $
GEN'L AGGREGATE LIMIT APPLIES PER:
f NERAL AGGREGATE $_
POLICY I JE O GEi— LOC !
! 1 PRODUCTS . COMP/OP AGG E $
OTHER:
F
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
_CE a accieentL
° ANY AUTO
BODILY INJURY (Per person) $
OWNEDSCHEDULED
AUTOS ONLY AUTOS
I HIRED NON -OWNED
BODILY INJURY (Per accident) � $
PROPERTY DAMAGE
� AUTOS ONLY ONLY
AUTOS
AUTOS
II
$
[Ppr cc dent $
,_ _
I UMBRELLA UAB OCCUR
EACHOCCURRENCE is
3 EXCESS UAB CLAIMS•MADE
AGGREGATE $
DED I CR ETENTION $ i
i $
WORKERS COMPENSATION
PER I I O H-
AND EMPLOYERS' LIABILITY y / N i
STATUTE ER
ANYPROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED7 NIA
E.L. EACH ACCIDENT $
_.....,.,. __.
(Mandatory In NH)
;r E.L. DISEASE - EA EMPLOYEE $
D as, dascribe under
DESCRIPTION OF OPERATIONS heave
I E.L. DISEASE •POLICY LIMIT I $
A._i#nd3afGyber/TectrE&D.
_ ..r-._—.---•.>�0N--6236692.98-010-.-.., t. i.1101.C2,021J.1.X01/�n?s.,.T;im�.t_._.�..___
e)
' 59._R.DO.Od.Q_.
Per Policy
i
{Retention
(Provisions
DESCRIPTION OF OPERATIONS i LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
SEE ATTACHED
City of Clearwater
Attn: Gail Rini Customer Service
100 S Myrtle Ave
Clearwater, FL 33756
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
114
41588-2016 ACORD CORPORATION. All rights
ACOHD 25 (2016103) The ACORD name and logo are registered marks of ACORD
s1k ID; 21759052 SATM: 2287497
2 of 2 2571
AGENCY CUSTOMER ID:
Loc #:
Page 2 of 2
AGENCY
Willis Towers Watson Northeast, Inc.
NAMED INSURED
MMRA Data Transfer Ltd.
30 Knox Drive
Piscataway, NJ 08854
POLICY NUMBER
See Page 1
CARRIER
NAIL CODE
EFFECTIVE DATE: See Page I
See Page 1
See Page 1
AQUI I IUNAL titIVIAKltS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: certificate of Liability Insurance
INSURER AFFORDING COVERAGE: Great American Insurance Company NAIC#: 16691
POLICY NUMBER: SAA 479-90-07-07-00 EFF DATE: 11/01/2021 EXP DATE: 11/01/2022
TYPE OF INSURANCE:
Crime
ACORD 101 (2008101)
LIMIT DESCRIPTION: LIMIT AMOUNT:
Limit $2,000,000
Retention $500,000
The ACORD name and logo are registered marks of ACORD
SR ID: 21759052 BATCH: 2297497 CERT: W22632167