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CERTIFICATE OF LIABILITY INSURANCE (4)
--� DRMARTI-01 TGODFREY ACORO" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/15/2015 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 License#L087115 CONTACT NAME: Hub International Southeast PHONE (727)797-0441 FAX NI I: (727)669-0673 Suite 600 600 Cleveland Street .a/c No Ext E-MAIL ADDRESS: Clearwater,FL 33755 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURERB:Viking Insurance Company of Wisconsin 13137 Dr Martin Luther King Jr INSURER C: Neighborhood Family Center Inc 900 N.Dr.MLK Ave INSURER D Clearwater,FL 33755 INSURER E INSURER F; COVERAGES CAT PER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE rAY OF CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTANDI QU TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION S SHq0JMAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE U NUMBER MMIDDY� MM DDYlYYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENT n CLAIMS-MADE OCCUR X 311. 01101/2015 01/01/2016 PREMISES Ea occurrence $ 300,00 X Soc service ext MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 POLICY PRO- JECT ❑LOC PRODUCTS-COMPIOPAGG $ 3,000,00 OTHER: .,.;•. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 Ea accident A X ANY AUTO PHPK1253 01/01/201$ 1/01/2016 BODILY INJURY(Per person) $ ALL OWNED jC rH BODILY INJURY(Per accident) $ AUTOS PRO PERTY DAMAGE $ HIRED AUTOS Per accident Az, ;' $ X UMBRELLA LIAB CCUR '. - OCCURRENCE $ 1,000 00 A EXCESS LIAB ..IMS-MADE Ai=79481 479481 - /01/201;'ltl/20111LEGATE $ DED X RETENTION$ G_ A, gate $ 1,000,00 WORKERS COMPENSATION R I OTH- AND EMPLOYERS'LIABILITY ` TATUT ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC610317 01/0 015 01/, EAC f� T $ 100,00 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) E.L.Djjffl�OYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below A6 EAAWE-POL iJ $ 500,00 f.. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional^ - edule, twuned if more space is requi RE:Certificate Holder is named as Additional Insured. ei CERTIFICATE HOLDER C., CATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater Parks&Recreation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 Clearwater,FL 34618 AUTHORIZED REPRESENTATIVE s � u ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD