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CERTIFICATE OF LIABILITY INSURANCE (2) DRMAR-1 OP ID: KD CERTIFICATE OF LIABILITY INSURANCE 1 DATE 01/23D/YYYY) 01/23/13 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). CONTACT PRODUCER 727-797-0441 NAME: Connelly, Carlisle, Fields& FAX Nichols 727-669-0673 PHONE I No Ext: A/C No): P.O. Box 1027 E-MAIL Clearwater, FL 33757 ADDRESS: Michael Devereux INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Philadelphia Ins.Companies 18058 INSURED Dr Martin Luther King Jr INSURER B:Guarantee Insurance Company Neighborhood Family Center Inc 900 N. Dr. M LK Ave INSURER C Clearwater, FL 33755 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 • X COMMERCIAL GENERAL LIABILITY X PHPK959928 01/01/13 01/01/14 DAMAGE TO RENTED 100,00( PREMISES Ea occurrence $ CLAIMS-MADE FxI OCCUR MED EXP(Anyone person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 X Soc service ext GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY CEO SINGLE LIMIT Ea O accident $ 1,000,00 • X ANY AUTO PHPK959928 01/01/13 01/01/14 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,00 • EXCESS LAB HCLAIMS-MADE PHUB406446 01/01/13 01/01/14 AGGREGATE $ 1,000,00 DED I X I RETENTION 10,000 $ WORKERS COMPENSATION WCSTATU- I JOTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y TBD 01/01/13 01/01/14 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is hereby named as additional insured with respect to general liability. CERTIFICATE HOLDER CANCELLATION CITYOC4 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. Economic Developement Dept AUTHORIZED REPRESENTATIVE PO Box 4748 ) Clearwater, FL 34618 `ITS �. �G✓� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD