CERTIFICATE OF LIABILITY INSURANCE•
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/VYYY)
12/15/2021
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
McGriff Insurance Services
200 Broad Street (30501)
PO Box 1357 ph -770-536-3311
Gainesville, GA 30503
CONTACT A CERT TEAM
NAME:
PHONE 770 536-3311 Fax 866 925-7124
(A/C, No, Ext): (A/C, No):
E-MAILSS: certificatesGA@mcgriff.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Hartford Underwriters Insurance Company
30104
INSURED
Fusus LLCEvanston
5550 Triangle Parkway
Suite 100
Peachtree Corners, GA 30092
INSURER e: Hartford Fire Insurance Company
19682
Insurance Company
INSURER C : P y
35378
Lloyds
INSURER D: y
$1,000,000
INSURER E :
$1,000,000
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
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.
ITS
TYPE OF INSURANCE
ADDLSUBR
IN
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYYL
—POLICY EXPSR
(MM/DD/YYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
X
X
20SBAAM5FXN
08/02/2021
08/02/2022,
EACH OCCURRENCE
$1,000,000
��7pp
PREMISES(EaEoccccurrenee)
$1,000,000
CLAIMS -MADE
OCCUR
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L
AGGREGATE
POLICY
OTHER:
LIMIT APPLIES PER:
PRO -PRODUCTS
JECT I LOC
- COMP/OP AGG
$2 r000 r000
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
20SBAAM5FXN
08/02/2021
08/02/2022
(EeacccdentSINGLELIMIT
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED RETENT ON $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N
N / A
X
20WECAM5G2R
08/02/2021
08/02/2022
X STATt1TE FORH
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
C
D
Professinal Liab.
Cyber Liability
_
CMLIJ3BFIB21
ESK0032682481
08/02/2021
08/02/2021
08/02/2022
08/02/2022
2,000,000
2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required)
Certificate Holder includes Clearwater Policy Department and City of Clearwater FL.
CERTIFICATE HOLDER
CANCELLATION
Clearwater Police Department
645 Pierce St
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
aeya_ -towel,.
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