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CERTIFICATE OF LIABILITY INSURANCE (173)ECKER -2 OP ID: JJ '`�� °R °n CERTIFICATE OF LIABILITY INSURANCE DATE 07 /01/2013' 07/01/2013 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 Phone: 727- 447 -6481 Bouchard - Clearwater Fax: 727449-1267 101 Starcrest Drive P 0 Box 6090 Clearwater, FL 33758-6090 Eric Beck Adam Bouchard, AM NAME: PHONE FAX (AIC, No, Ext): (A /C, No): (MM /DD/YYYY) ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Nautilus Insurance Company 17370 INSURED Eckerd Youth Alternatives, Inc Keith Gauthier 100 N Starcrest Drive Clearwater, FL 33765 -3224 INSURER B : Everest National Insurance Co 10120 INSURER C : Charter Oak Fire Insurance Co EACH OCCURRENCE INSURER D : Travelers Indemnity Co of Amer 25666 INSURER E : MED EXP (Any one person) INSURER F : 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 LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER (MMIDDY/YYYY) (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X . - �'^-'3r"1 GFP7000173P1 y tom. i ;4_,___�-, 4 �s, ;0044313 • C._,;..." -\ -.- 07/01/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES {Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GE X GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 1,000,000 'L AGGREGATE LIMIT APPLIES POLICY n JEa PER: Loc Emp Ben. $ 1,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NONOSWNED .,.. w. CF4CA00094121 ' c ...+ :" 07/01/2013 ( 07/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CFX1000123P1 07/01/2013 07/01/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 Excess $ 4Mil of $5M DED X RETENTION $ 0 C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER /MEMBER EXCLUDED? i (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A TR0UB9527B26012 TC2KUB- 488D0278 -12 10/01/2012 10/01/2012 10/01/2013 10/01/2013 X WC STATU- TORY LIMITS 0TH - ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A A Professional Abuse /Molestation PFP1000223P1 PFP1000223P1 07/01/2013 07/01/2013 07/01/2014 07/01/2014 Limits $1MiU$3Mil Limits $1Mil /$3Mil DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) TROUB- 9527B260 -12 - WC POLICY FOR STATES: FL, OR, TN TC2KUB- 488D0278 -12 - WC POLICY FOR STATES: IA, LA, NC, NH, TX, VT & WV CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY ONLY IF REQUIRED BY WRITTEN CONTRACT, AND SUBJECT TO THE TERMS, CONDITIONS AND LIMITS AS SPECIFIED IN THE POLICY -. —......— . - ..- -.. CITYOFC CITY OF CLEARWATER P.O. BOX 4748 CLEARWATER, FL 33758 -4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ECKER -2 OP ID: BV A`CCORCPY CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/10/2013 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 Phone: 727- 447 -6481 Bouchard - Clearwater Fax: 727 -449 -1267 101 Starcrest Drive P 0 Box 6090 Clearwater, FL 33758 -6090 Eric Beck Adam Bouchard, AAI CONTACT NAME: FAX PH NNo Extl: (A X, No): POLICY EXP (MMIDD/YYYY) E -MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Nautilus Insurance Company 17370 INSURED Eckerd Youth Alternatives, Inc Keith Gauthier 100 N Starcrest Drive Clearwater, FL 33765 -3224 INSURER B : Everest National Insurance Co 10120 INSURER C : Charter Oak Fire Insurance Co $ 1,000,000 INSURER D : Travelers Indemnity Co of Amer 25666 INSURER E : $ 100,000 INSURER F : ,aa ^GO. $ 5,000 COVERAGES GtKIIFR.AItnumacrc: - -- - - -- -- - - -- 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS LTR A GENERAL LIABILITY X GFP1000173P1 j. �+ i 5 20 �3 OCj 07/01/2013 07/01/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES EMIEMI DAMAGE SES S RENTED ( (Ea occurrence) occurrrr ence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 1,000,000 GEN'L AGGREGATE � POLICY LIMIT APPLIES PER LOC EOMBBen $ 1,000,000 B JET AUTOMOBILE LIABILITY AUTOMOBILE i �1�Pp'��'� t� � CF4c 1 1 'Li 1V S ryCS LEO' ttV 601101/2013 07/01/2014 SINGLELIMIT CO BINEDt) $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE CFX1000123P1 07/01/2013 07/01/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 Excess $ 4MiI of $5M DED X RETENTION$ 0 C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN - TROUB9527B26013 TC2KUB488D027813 10/01/2013 10/01/2013 10/01/2014 10/01/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 ANY CER /MEMB PROPRIETOR/PARTNER/EXECUTIVE f OFFICER/MEMBER EXCLUDED? I N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A A Professional Abuse /Molestation PFP1000223P1 PFP1000223P1 07/01/2013 07/01/2013 07/01/2014 07/01/2014 Limits $1MiU$3Mil Limits $1Mil /$3Mi1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) TROUB9527B26013 - WC POLICY FOR STATES: FL, SD, TN TC2KUB488D027813 - WC POLICY FOR STATES: AL, IA, LA, NC, OK, SC, TX & VT CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY ONLY IF REQUIRED BY WRITTEN CONTRACT, AND SUBJECT TO THE TERMS, CONDITIONS AND LIMITS AS SPECIFIED IN THE POLICY.. CERTIFICATE HOLUEK CITY OF CLEARWATER P.O. BOX 4748 CLEARWATER, FL 33758 -4748 I CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .� ..... •.'r. rFCt1Aa ATlf kI All rinhte rnomNPr1_ ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD