CERTIFICATE OF LIABILITY INSURANCE (1116) CERTIFICATE OF LIABILITY INSURANCE DATE Ri4ts?DD7KY.YY!
THIS CERTIFICATE iS ISSUED AS A NATTER OF INF0RmATION ONLY AND CONFERS NO RIGHTS UPON THE CERTWICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS cERT"IFI.CATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE.1SSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCED,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 conifer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT }teri
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Se INSURER a;ACE.rae Underwfite,,s.I;-Suri elce Comynny . 20702
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COVERAGES CERTIFICATE NUMC3ER:3GE.O.)Tn113 REVISION NUMBER-.
THIS IS TO CER11FY THAT T HE FSO IJCIES CES fN}SLJFANCE LISTED BEL0VV HAVE BEEN ISSUED TO THE INSUREf3 I�tAt ED ABOVE FOR THL POLICY PERIOD
INDIC-Rf";rD- NOTWITHST:ANI7INO ANY REOt!R.E..IsENT, TERM OR CONDITION OF ANY C.OP?TRACT OR OTHER COCUNIEN'T WITH RESPECT TO WHICH I H• S
ERTIFICATE MAY BE ISSIJED OR k1AY PE'RTAINi.THE INSURANCE:AFFORDED BY THE POLi(aiC-_'S DE5G4�1BED HEREIN 1S.S1,j EEC7" 1-O ALL THE 7'ERtos.
I~'XCL0S[ON SAN D C0NDITION S Cdr StsCH POLICIES.L 11,1rl's SHDV;'.N MAY HAVE SEES,RE.DEJCED BY PAID CLA€"JS•
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LTR TYPE OF INSURANCE � N POLICY NDMBER � MA11AI7IYYY�Y 'FrrSrdMWYYYY ! LIMITS:
A }� COMMCRCIAL GE.NE RAL LIABILITY :HD0:C473ri09!5 a 1107:.7023 09,0:?2.[12•+ GJ'1Clf Y7C.C€JRHERC i= r.C1o1i3O:111
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A WORKERS COMPENSATION WC {5057a2?7 I(kA'.0I1,WA CilG1.•"1 323 0,1.,10 Ii202$ P.E7 f,Ti
B ANO r-MPLOYE k{S L.l A61 LiTY 9CF�. nC3784£3T r-,AWI—XI 1TA:i0k':. .. FR...
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DEScRWTO N:0F OPE RAM NS i LOC ATI ON51VEHICLt.S (AC ORD 101,Acltlitiorlal Remarks Sthrdule.,may 4e areacherl EE more spa"Is required)
Any F'ruv'S ICI ns refer-em:ed on tt?is C;e rtl fi.8ie of Iml-w 3fkc af,P!y on]y as Fequ St!d.try BVI it IF?n contt act-Irl Tho event 0 cant• -_l[atinli i y.the€n:;uraFlce unnpany fjE5j Ilse G'enr ral
L-ia:t,'l5iy,WorkcrS Comper15atiGn,a31d Autorr7Doile LIabili€Y pcalIcy(fOSI haVP Lb Ven e,fidOMF-d f6 PC09i e'10 days`N0tk:&of.Cancellatlbn iP the certfficate holder Sl1t7V:n t!P_f!];^l,
RE;C&A Dated Feb.2020
Cli,arvratcr Gas is sr,cluded a s 8n Ad.000-1al Irisurr;N br..the Genera!Liability putcy;bol[Irby for an occurrenze rati:lr g from 1he services provided by tile rained bnsured afid
f+)r w[Iir,h the narnetl ifisufed ttas 40ree sf Ib prwi_1e.Add Oonal 1nsu(el status,
Brartr,I;Dapt;'021
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS_
CIoar�4 iter Gay AUTHORIZED RFPRGSENTATWC f
777 t0apie Sm,.Pt
Cleatwafer.FL;33755
Paan 1 of? 01988-2015 ACORD CORPORATION. All rights reserved.
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