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CERTIFICATE OF LIABILITY INSURANCE (9) DATE(MM/DD/YYYY) �`�" CERTIFICATE OF LIABILITY INSURANCE 09/27/2013 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 1-727-797-4190 CONTACT y Burgess Am p gur NAME: g Arthur J. Gallagher Risk Management Services, Inc. P HONE FAX A/C No Ext: 727-796-6264 A/C No: 727-791-1613 4904 Eisenhower Blvd., Ste 250 E-MAIL y P burgess@ajg.com bur com ADDRESS: g 7 Tampa, FL 33634 INSURER(S)AFFORDING COVERAGE NAIC# Scott Holden INSURERA: FIRST NONPROFIT INS CO 10859 INSURED INSURER B Boys and Girls Clubs of the Suncoast, Inc. INSURER C7 2300 Tall Pines Drive INSURER D7 Suite 150 Largo, FL 33771 INSURER E7 INSURER F: COVERAGES CERTIFICATE NUMBER: 36023415 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 EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY • GENERAL LIABILITY NPP450030 10/16/1 12/01/14 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,000 • Sexual Abuse Liability 1,000,000 PERSONAL&ADV INJURY $ • Professional Liability GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ included X POLICY PE LOC $ • AUTOMOBILE LIABILITY NCA449572 10/16/13 12 01 14 Ee accident)SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident • X UMBRELLA LIAB X OCCUR NMB462999 10/16/1 12/01/14 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$10,000 $ WORKERS COMPENSATION WC STATU- 70TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is included as Additional Insured on the General Liability policy, as per endorsement #PL1113 edition 06/06. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Parks and Recreation Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater, FL 33756 Scott Holden USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD amy.burgess 36023415