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CERTIFICATE OF LIABILITY INSURANCE (456)A� �® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 11/1/2013 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 Jack Rice Insurance 13080 S Belcher Rd Largo FL 33773 CONTACT Select Business Division NAME: FAX raHC.NNo.Ext): (727)530 -0684 I A/C.Not:(727)532 -9602 ADDRESS :cwebster @jackriceinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Southern- Owners Ins. Co. 10190 INSURED Veterans Alliance Helping Veterans, Inc. DBA Tampa Bay Veterans Alliance PO Box 1078 Clearwater FL 33757 INSURER B 2032718713 (' a. , ; ,.`_ _ JJJ INSURERC: /2014 INSURERD: $ 1,000,000 INSURER E : $ 50,000 INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBER:CL1311132046 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 INSR S1/BR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 2032718713 (' a. , ; ,.`_ _ JJJ 10/22/201310/22 I' 1 F• ., . -. /2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (a occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: )-7-1 POLICY n PFCOT- n LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS ,,., c „ . .- -. COMBINED SINGLE LIMIT (Ea accident) J BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accidert ) $ $ _ UMBRELLA LIAB EXCESS LIAB _OCCUR CLAIMS -MADE '';� ( �•?� L. " `'✓ if EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ WORKERS COMPENSATION AND D EMPLOYERS' LIABILITY Y / N ANY PROPRETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I (Mandatory In NH) If yes, describe under DESCRPTION OF OPERATIONS below N / A I WC S ATU- OTH- I TORY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Clearwater is Additional Insured with respects to General Liability per form 55181 12/04. CERTIFICATE HOLDER CANCELLATION City of Clearwater PO Box 4748 Clearwater, FL 33758 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 Cynthia Webster /MMR `_,,, %Y) C.t.,P ACORD 25 (2010/05) INS025 (201005)01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMENTS /REMARKS GENERAL LIABILITY Scheduled Additional Insured For Designated Person or Organization per form 55181 12/04. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.