CERTIFICATE OF LIABILITY INSURANCE (1102) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYY)
r...�-• 0612712022
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($),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL(INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an en'dorsem'ent. A statement on
this certificate does not confer rights to the certificate holder in lieu of such andorsement(s),
PRODUCER CONTACT Amy O'Neal
tronwvood,a Marsh,&McLennan Agency,LLC Co tP �sa._ED tl, b � I nx 1404)503-9101
4404 503-9100 AaC Ne c
4401 Northside ParkwayNW E-MAIL
ADDRESS: aDneal{QPIr4nwwDDdlrnS.C(DrrN
Suite 800 INSURER(S)AFFORDING COVERAC'E MAIC a
AVanta GA 30327 INSURER A: Charter Oak Fire Insurance Company 25545
INSURED INSURER B: The Phoenix.Insurance Company 25523
Control Southern Inc. INSURER C. Travelers Property Casualty Company of America 25674
3850 Lak'efeld Drive INSURER D: Travelers Indemnity Company 25658
INSURER.E
Suwvanee GA 30024-0241 INSURER F:
COVERAGES CERTIFICATE NUMBER, CL2262739920 REVISION NUMBER:,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 7O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSR
INSR. .... ADDLSUBW ....
LTR TYPE OF INSURANCE AR21 EFF P REXP .... ."""'". `......
'(NSD WW'JD .,,. POLICY tMMPDDdYY'YY' MMII.9R D1rYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ,$, 1,000,000
CLIMS•MADE P (SEs Ea wcre,ce $ 300,000 ExI
MED EXP(Anyone person) $. 10.000
A Y630IG27602000F22 07/01/2022 0710112023 PERSl7NAL:8ADV dNUUItY 1,000,000
�GEN'LAG5''CR'ECATE I.IMITAPPLIES PER: GENERAL AGGRFR'.,A:rE $ 2,000.000'
/'e,. POLICY ..v JE� LOC PRODUCTS COMP(OPAG'G 2,OOQ,4�04
OTHER: Employee Benefits s 1 MI$2M
AUTOMOBILE LIABILITY COMBINED SINGLE L19IT $ 1,000,000
Ea accident
ANYAUTO BOMLY INJURY Mer Person) $ ._
B AU OS AUTOSaDLED 8402N4305932214G 0710112022 07/011207.3 BODILY'INJURY Meraocaderno S
AU OS
SCHEDULED
S
PRCOPERTY(DAMAGE ,_ .......
HIRED NOOS NY Para2cccsna
AUTOS ONLY AIDT{DS ONLY
UMBRELLA LIAB X OCCUR. EACH OCCURRENCE $ 20 000,000
C EcXCESS LIAR CLAIMS-MADE CUP7,16453782214 07/0412022 071011202.3 AGGREGATE $ 20,000,000
DED 1XI RETEN71ON$ 10,000 ._
_..... ...
$
WORKERS COMPENSATION 'QRTRI-
AND EMPLOYERS'LIABILITY YIN
D ANY PROPRIETOR/PARTNERtEXE'Cfl11&'VE 1,000,000
OFFICERWMEMBER EXCLUIDEY � NIA UB'IK4264652214G 07/0112022 0710412023 E I• EACH,ACCIDENT
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1„004„44Cb
E4 yes,dklSCPltle under'
DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 1,000,000
......
DESCRIPTION CIF OPERATIONS/LOCATIONS I VEHICLES tACORD 187,Additional Rorararks Schedule,may be attactned it morespace is required)
CERTIFICATE HOLDER CANCELLATION
R (., I V E E°) SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE(DELIVERED IN
Clearwater Gas ACCORDANCE WITH THE POLICY PROVISIONS,
400 N MyyrUe Avenue
AUTHORIZED REPR.ESENTAT'I'W"E
Clearwater GAS ADMI FL 33755
D 1888-2415 ACORD CORPORATION.. All rights reserved.
ACORD 25(2416103) The ACCORD name and logo are registered marks of ACORD
Additional Named Insureds
Other Named Insureds
-4 gh~ r ranE:- , L.�c _., UW %, .ab; i cy Company, Adu;t:—Ona; Named ;nzu-Ed
;dustry l7-ism Prnpe+4_ I. .. T. mated I,.-ak='_._ty r'019 a:y; Addit.:Qsn . Named _rissired
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