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CERTIFICATE OF LIABILITY INSURANCE (1101)
Client#: 1.605825HALMAHOL2 ACORM CERTIFICATE OF LIABILITY INSURANCE DATE.(MMIODIYYYY) 4/0312022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOE&NO.T AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITIITE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED PEP13ESENTATFVEOR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:Ifthe 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 poli.cy,.certaln.policies may require an endorsement.A statement on this certificate does not Confer any rights to the certificate holder in lieu of such endorsernent[s). PRODUCER. CONTACT NAME_ Erin Shull USI Insurance Services,LLC H IC Na;AOEE513$52-6304 312.Elm St.24th Floor E-MAIL Cincinnati,OH45202-3576. DD ess: erin.shull@usi.com 8U657-3116 INSURER(S]AFFORDING COVERAGE MAIC# INSURER A:ACE.American Insurance.Company 226$7 INSURED ACE Pro Er Casual Insurance Co 20699 INSURER 8; P$�Y� Casualty Sensit Technologies LLC WSURERC.;Chubb Indemnity Insurance Company 42777 851 Transport Drive Great Northern Insurance Company 20303 Valparaiso,IN. 46.383 1NSURERD: p Y INSURER E: INSURERF, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS I$ TO. CERTIFY THAT THE POLICIES OF INSURANCE LISTED 3ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR.:CONDITION.OF ANY CONTRACT OR OTHER.DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE.AFFORDED BY THE POLICIES DESCRIBEb HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF.SUCH:POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY.PAIL] CLAIMS. IN$R ADDLSUB POLICY EFF .POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMMIDR= (MMIDDIYYYY LIMITS A x commERcIAL.GENERALLIABILITY OGLG2773862A 041.0112022 041011.20.22 EACH OCCURRENCE $1,000,000 CLAIHS.S-MADE �OCCUR.. PREM#SES EaEcwEnce $1 000 DOD X BI1PD Ded:25060 MED EXP'(Any ane person $5000 PERSONAL 8 ADV.INJURY $1000,000. GEN'L AGGREGATE LIMIT APPLIES PER:. GENERAL AGGREGATE s2,000,000 X POLICY.E JETPO- �LOC PRODUCTS-COM NOP AGG. '$2,000,000 OTHER: $ p. AUTOMOBILE LIABILITY 73602458 4/01/2022 04101/202 C.MaBINEi7SINGLEETLIM Ea ccident 1,000,000 X ANY AUTO BODILY INJ URY.(For Pei son) $ OWNED SCHEDULED: AUTOS ONLY: AUTOS SOOILY PERTY INJURY.(Per accldent) $ X HIRED NON-OWNED PRODAMAGE AUTOS ONLY X AUTC$ONLY Per accddeni $ $ 13 X UMBRELLA LIAR x OCCUR XOO.G27739143 0 410.112022 04101/2 023 EACH OCCURRENCe 14000000 EXCESS LIAR CLAIMS-MADE AGGREGATE s4,000,000 DED I X I RETENTION$10000 $ C WORKERS COMPENSATION 71755720 0410112022 04/091202 ,X s� OTH- AND EMPLOYERS'LIASILITY . ANY PROPRIETORIPARTNERIEXECUTNE OFF ICERWEMBER E:CCLUDED7 �Y 1 N NIA E_L 0 EACH ACCIDENT 54 A00,000 (Myandatory in NH) E,L.DISEgSE-EA EMPLOYEE sl 990 900 DESCRIPTIO:OFOPERAT€ONSbelow E.L.DISEASE.•POLICYLIMrr S1,000.009 DESCRIP-noN OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACaRD 101,Add€t€onaT Remaft SchodkiN,may be attached If mars Space Is oqulred) Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION City of Clearwater-Clearwater Gas 5ystenr. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Bruce Griffin ACCORDANCE WITH THE POLICY PROVISIONS. 400 North.Myrtle Avenue CLEARWATER,FL 33755 AUTHORIZED REPRESENTATIVE ©1996-2015 ACORD CORPORATION.All rights,reserved.. ACORD 25(2018103) 1 of 1 The ACORD name and logo are registered marks of ACORD. 4W55291841M35509021 SAPZR