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CERTIFICATE OF LIABILITY INSURANCE (3) DRMAR-1 OP ID: KD CERTIFICATE OF LIABILITY INSURANCE 7011/07/2014 M/ Y) 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 Phone:727-797-0441 NAME: HUB International Florida CCF&N Fax:727-669-0673 HONE N Ext: Fvc No): P.O. Box 1027 E-MAIL Clearwater, FL 33757 ADDRESS: Michael Devereux INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Ins.Companies 18058 INSURED Dr Martin Luther King Jr INSURERB:St.Paul/Travelers Insurance Co 25658 Neighborhood Family Center Inc 900 N. Dr. M LK Ave INSURER C Clearwater, FL 33755 INSURER D: INSURER E: INSURER F: 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 MM/POLICY EXP /LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X PHPK1098385 01/01/2014 01/01/2015 DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ CLAIMS-MADE FxI OCCUR MED EXP(Anyone person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 X Soc service ext GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 3,000,00 POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COEa MBINED ccident SINGLE LIMIT $ 1,000,000 a • X ANY AUTO PHPK1098385 01/01/2014 01/01/2015 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS P AUTOS era ccident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00 • EXCESS LIAB CLAIMS-MADE PHUB440441 01/01/2014 01/01/2015 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" 7D75027A 01/06/2014 01/06/2015 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 4748j'' Clearwater, FL 34618 `T!�.� �t. �G✓(�C.-�^�. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD