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CERTIFICATE OF LIABILITY INSURANCE (6) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/19/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND C CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND O BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONT REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, bject to the terms and conditions of the policy, certain policies may reqconfer rights to the certificate holder in lieu of such endorsement(s). CONTACT 1-727-797-4190 PRODUCER Michele Richmond NAME: Arthur J. Gallagher Risk Management Services, Inc. FAX PHONE 727-796-6246 (A/C, No): (A/C, No, Ext): E-MAIL 4904 Eisenhower Blvd., Ste 250 michele_richmond@ajg.com ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Tampa, FL 33634 FIRST NONPROFIT INS CO10859 INSURER A : INSURED INSURER B : Boys and Girls Clubs of INSURER C : the Suncoast, Inc. 2300 Tall Pines Drive INSURER D : Suite 150 INSURER E : Largo, FL 33771 INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:25233354 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION O CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAV ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSRWVD ATMP0919962-1110/16/12 10/16/11 1,000,000 GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED X 100,000 COMMERCIAL GENERAL LIABILITY$ PREMISES (Ea occurrence) X 5,000 CLAIMS-MADEOCCURMED EXP (Any one person)$ Sexual Abuse Liability X 1,000,000 PERSONAL & ADV INJURY$ XProfessional Liability 3,000,000 GENERAL AGGREGATE$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ X PRO- $ POLICYLOC JECT 10/16/1110/16/12 TAP0907869-11 A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 (Ea accident)$ X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNEDPROPERTY DAMAGE X X $ HIRED AUTOS (Per accident) AUTOS $ X AXUXL0908097-1110/16/12 UMBRELLA LIAB 2,000,000 10/16/11 EACH OCCURRENCE$ OCCUR EXCESS LIAB 2,000,000 CLAIMS-MADEAGGREGATE$ X 10,000 $ DEDRETENTION$ WC STATU-OTH- WORKERS COMPENSATION TORY LIMITSER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. Parks and Recreation Department 100 S. Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater, FL 33756 USA © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD suzibaker 25233354