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CERTIFICATE OF LIABILITY INSURANCE (2)a A ? HIrVin?. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/17/2011 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 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 CO NAME: Alley, Rehbaum & Capes Assurance, Inc. A",."N Ext): 727. 797.5193 A/c Na. 727.725.5773 2433 Gulf to Bay Blvd. E-MAIL SS: P.O. BOX 4620 PRODUCER C MERID* Clearwater, FL 33758 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: First Natl Ins Co of America 24724 Life Force Cultural Arts Academy, Inc. INSURER B: 1606 N. Highland Ave INSURER C : Clearwater, FL 33755 INSURER D: INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 11-12 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. INS LTR TYPE OF INSURANCE A L INSR SU R WVD POLICY NUMBER POLICY EFF MM/DD POLICY P MM/DDN-YYY LIMITS GENERAL LIABILITY 0101316012 01/11/2011 01111/2012 EACHOCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED ES Ea occurrence $ 19000,000 CLAIMS-MADE [K] OCCUR MED EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 r OOO 0O X POLICY PRO- LOG N E S AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S ANY AUTO JUN 0 0 011 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULEDAUTOS HIRED AUTOS g.d . ICIA`1L RECCR US AND PROPERTY DAMAGE (Per accident) $ NON-OWNED AUTOS LEGISLATIVE SM ICS DEPT $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR H CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ N AN D COMPENSATION D EMPLOYERS' LIABILITY WC STATU- 011-1- OT ?, TQRY LIMITS ER Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE? E.L. EACH ACCIDENT $ OFPICER/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE S If yyes, describe under 1) SCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Certificate Holder is Additional Insurance ocation: 1751 Kings Highway, Clearwater, FL 33755 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater AUTHORIZED REPRESENTATIVE r? 4'-.'µ?-.• A su 100 S. Myrtle Avenue ?. C1 arwater, FL 33756 James Parenti NCH ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD ?.. ?Q-' % J Q"