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CERTIFICATE OF LIABILITY INSURANCE (9)• .,. HeHLM: L UfJ -- - -- - A CORDTM ERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE 727 447 -6481 FAX No , 727 449 -1267 E-MAIL ADDRESS: cicerts@bouchardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER D : $1,000,000 $ 100,000 INSURER E : MED EXP (Any one person) INSURER F : REVISION NUMBER: v 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 INSR 'AND POLICY NUMBER (MM/DDY�) (MM/DD ) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CP0278060510 05/31 /2014 05/31 /2015 EACH OCCURRENCE $1,000,000 $ 100,000 DAMAGE TO occurrence) MED EXP (Any one person) $10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 X BI GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 GEN'L AGGREGATE ^I POLICY LIMIT APPLIES PRO- ECT PER: LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NN -0WNED OS AUOT Y Y CP0278060510 05/31/2014 05/31/2015 C O aBINEDj INGLE LIMIT $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY (Per ac dentDAMAGE $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 $10,000,000 AGGREGATE $ DED X RETENT ON $0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A 052046229 01/01/2015 01/01/2016 X TORYLI IT TORY LIMITS OTH• 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 Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER A MUNICIPAL CORPORATION PO 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) 1 of 2 #S64295/M64267 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALEMA —,- 411=11%/T. LLV / a ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE o, Ext): 727 447 -6481 NC, No): 727 449 -1267 EADDRE-MAIL SS: cicerts bouchardinsurance.COm INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER D : $1,000,000 $100,000 INSURER E : MED EXP (Any one person) INSURER F : • REVISION NUMBER: v 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER /DDY/YEYYY) (MM/LOD�) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y -JMM CP0278060510 05/31/2014 05/31/2015 EACH OCCURRENCE $1,000,000 $100,000 PR PREMISES TO RENTED ) ER occurrence) MED EXP (Any one person) $10,000 CLAIMS -MADE X OCCUR PERSONAL 8 ADV INJURY $ 1,000,000 X BI GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE ^I POLICY LIMIT APPLIES PEO PER: LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y Y CP0278060510 05/31/2014 - 05/31/2015 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 $ $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ (ROPERTY DAMAGE Per accident $ $ B x UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 $10,000,000 AGGREGATE $ DED X RETENTION $0 _ WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A 052046229 01/01/2015 01/01/2016 X TORY LIMITS TORY LI IT OTH- ER C E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER PO 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) 1 of 2 #S64290/M64267 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALEMA Client #: 22073 RUTHECKE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE FAX (A/C, No Eat): 727 447 -6481 (A/C, No): 727 449 -1267 ESS: cicerts @bouchardinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC Il INSURER A : Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER D $1,000,000 INSURER E : $100,000 $ 10,000 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. LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF JMM /DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CP0278060510 05/31/2014 05/31/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 $ 10,000 MED EXP (Any one person) CLAIMS -MADE X OCCUR PERSONAL 8 ADV INJURY $ 1,000,000 X BI GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PRO- n LOC JECT $ A AUTOMOBILE _ X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS AONO WNED Y Y CP0278060510 05/31/2014 05/31/2015 Ea acccident) INGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE (Per accident) $ $ B x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 $10,000,000 AGGREGATE $ DED X RETENTION $0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I N N N / A 052046229 01/01/2015 01/01/2016 X ITORY LI IT I iOTH- TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) CANCELLATION I 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 ACORD 25 (2010/05) 1 of 2 #S64288/M64267 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALEMA IIIIIIIIIIt1�IA n to • RUTHECKE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE 727 447 -6481 FAX 727 449 -1267 (A/C, No, Ext): (A/C, No): E-MAIL RESS: cicerts@bouchardinsurance.com AD INSURER(S) AFFORDING COVERAGE NAIC S INSURER A Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER D : $1,000,000 INSURER E : $100,000 $10,000 INSURER F : ERTIFICATE 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 INSR WVD POLICY NUMBER (MM/LDDIYYYYY) (MM /DDS) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CP0278060510 05/31/2014 05/31/2015 EACH OCCURRENCE $1,000,000 PREMISES (EaE�ur ence) $100,000 $10,000 MED EXP (Any one person) CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 X BI GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 GEN'L AGGREGATE ^I POLICY LIMIT APPLIES PRO- JECT PER: LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS ANON-OWNED Y Y CP0278060510 05/31/2014 05/31/2015 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 �, $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ (Per accident) AMAGE $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 $10,000,000 AGGREGATE $ DED X RETENTION $0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I N N N 1 A 052046229 01/01/2015 01/0112016 X I TORY LIMITS I 1 0TH- E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) 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 ACORD 25 (2010/05) 1 of 2 #S64306/M64267 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALEMA fit#: 22073 RUTHECKE ACORDrM RTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE FAX (A/C, No, Ext): 727 447 -6481 (ac, No): 727 449 -1267 E-MAIL cicerts@bouchardinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER o $ 1,000,000 INSURER E : $100,000 INSURER F : $ 10,000 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CP0278060510 05/31/2014 05/31/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO nce) $100,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 X BI GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS AUTO-0WNED Y Y CP0278060510 05/31/2014 05/31/2015 ( Ea accid u acrid en n t) sINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per a e accident) DAMAGE $ B x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 $10,000,000 AGGREGATE $ DED X RETENT ON $O 052046229 01/01/2015 01/01/2016 X TO Y LIMIT TORY LIMITS 10TH- ER C WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N I A E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER PO 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) 1 of 2 #S64291/M64267 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALEMA Client #: 22073 RUTHECKE ,..-. ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, es 33765 727 447 -6481 CONTACT NAME: PHONE FAX (A/C, Ext): 727 447 -6481 (p /C, No): 727 449 -1267 Lo, ADDRESS: cicerts @bouchardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A : Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER D $1,000,000 INSURER E : $100,000 INSURER F : $10,000 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 LTR OF INSURANCE ADDL ADDL INSR SUBR W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CP0278060510 05/31/2014 05/31/2015 EACH OCCURRENCE $1,000,000 PREMISES Ea RENTED $100,000 MED EXP (Any one person) $10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 X BI GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE —X-1 POLICY LIMIT APPLIES PRO- JECT PER: LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y Y CP0278060510 05/31/2014 05/31/2015 COMBIaccideNED nt) SI LIMIT (Ea 1,000,000 $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B x UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 $10,000,000 AGGREGATE $ DED X RETENT ON $0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A 052046229 01/01/2015 01101/2016 X 1V- TORY LIMITS 10TH - I ER E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER A MUNICIPAL CORPORATION PO 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) 1 of 2 #S64293/M64267 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALEMA Client#: 22073 RUTHECKE ACORDru CERTIFICATE OF LIABILITY INSURANCE DATE (M YYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE /CC , Ext): 727 447 -6481 FAX No): 727 449 -1267 E-MAIL cicerts@bouchardinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER D : $1,000,000 INSURER E : $100,000 $ 10,000 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CP0278060510 05/31/2014 05/31/2015 EACH OCCURRENCE OCC URRENCE $1,000,000 PRMSES (?Ea ou ence) $100,000 $ 10,000 MED EXP (Any one person) CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 X BI GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 GEN'L X AGGREGATE POLICY LIMIT APPLIES JECT PRO- PER: LOC $ A AUTOMOBILE X _ X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON-OWNED AUTOS Y Y CP0278060510 05/31/2014 05/31/2015 COMBIaccident) NED SINGLE LIMIT (Ea $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ( DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 $ DED X RETENTION$O WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED'? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A 052046229 01/01/2015 01/01/2016 X TORY LIMITS ER TORY LIMI I I&H- C E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER A MUNICIPAL CORP PO 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S64292/M64267 ALEMA Client #: 22073 RUTHECKE ACORDn. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 12/17/2014 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: (NC, No, Ext): 727 447 -6481 FAX No): 727 449 -1267 E-MAIL cicerts@bouchardinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Co 16535 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Rd Clearwater, FL 33759 INSURER B : American Guarantee & Liability 26247 INSURER C : RetailFirst Insurance Company 10700 INSURER D : $1,000,000 INSURER E : $ 100,000 $10,000 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 SR TYPE OF INSURANCE ADDL INSR SUBR W VD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CP0278060510 05/31/2014 05/31/2015 EACH OCCURRENCE $1,000,000 PREMISES EaEocccu RENTED $ 100,000 $10,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) X BI PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y Y CP0278060510 05/31/2014 05/31/2015 COMaccidBINED ent) SI LIMIT (Ea 1,000,000 $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294106 05/31/2014 05/31/2015 EACH OCCURRENCE $10,000,000 $10,000,000 $ AGGREGATE DED X RETENTON$0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I N N N I A 052046229 01/01/2015 01/01/2016 X _ TORY LI IT TORY LIMITS OTH- 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 Professional GLC017156900 05/31/2014 05/31/2015 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION I CITY OF CLEARWATER A MUNICIPAL CORPORATION PO 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 ce © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S64294/M64267 ALEMA 14795 A� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYV) 5/31/2013 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 pollcy(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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 NAME: CONTACT Kris Thompson PHONE 813.639.3058 I FAX mic, Nol: (A/C. No. Ext1: 813.639.7192 E-MAIL kris.thompson @wellsfargo.com INSURER(S) AFFORDING COVERAGE Corn NAIC 4 26247 INSURER A: American Guarantee and Liability Insurance INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 —.._ INSURER B : FHM Insurance Company 10699 INSURER C : EACH OCCURRENCE INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) INSURER F : ..r.,.........rr...e�e. .__ �_,_... GUVtKA49t5 a+crciit- .4.krcrsumor.. — •••--- -- - -- 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 IMM!DDMfYYI POLICY EXP (MM!DD/YYYY) LIMITS LTR A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CP0278060508 05/31/2013 05/31/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE Lx I OCCUR PERSONAL d ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GE 'L AGGREGATE POLICY LIMIT APPLIES PER: JJ COT X LOC $ A AUTOMOBILE X _ X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS x SCHEDULED AUTOS NON -OWNED AUTOS CP0278060508 05/31/2013 05/31/2014 COMBINED SINGLE LIMIT (Ea accident) idea ) 1,000,000 E BODILY INJURY Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ S A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294105 05/31/2013 05/31/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED X RETENTIONS 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below YIN N / A WC30600207982012 1/1/2013 1/1/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space is required) CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF RUTH ECKERED HALL. CITY OF CLEARWATER JUN 07 2013 RISK MANAGEMENT 9173 GERI II'IGAI t HULUtK CITY OF CLEARWATER ATTN: LEetertRADER, RISK MGMT P O BOX 4748 CLEARWATER FL 33758 -4748 ct-�, CLEAK i CA-�K5 1 P� i `• ^ ""'-�"" ""' 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 _ ___ .:...... ..w... 29 n ^nn nnoonoATlfkl All rinhta ralearved- 000912 ACORD 25 (2010/05) The ACORD name and logo are registered marks a ■ i11eiiYmun11111orr'om011u 'CYBo1A31/000471 /02/02/0/ON/' 14705 ---"."—,' CERTIFICATE OF LIABILITY INSURANCE A 0 DATE(MM,DD/YWV) 5/31/2013 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 pollcy(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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 NA Kris Thompson PHONE 813.639.3058 FAX No); 813.639.7192 INC. No Est): E DARESS: kris.thompson©wellsfargo.Com INSURER(S) AFFORDING COVERAGE NAIC Is INSURER A : American Guarantee and Liability Insurance Corn 26247 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 INSURER B : FHM Insurance Company 10699 INSURER C : 05/31/2014 INSURER D : $ 1,000.000 INSURER E : $ 100,000 INSURER F : $ 10,000 • ION NUMBER: See below vv•LrUIrvLV VL1.1II IW.-.II....,....••_... - - 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 INSR INSR SUER WVD POLICY NUMBER (MMIDDY/YYYY) (MMIDDIYYYY) LIMITS A GENERAL X LIABI COMMERCIAL GENERAL LIABILITY UrY CP0278060508 05/31/2013 05/31/2014 EACH OCCURRENCE $ 1,000.000 PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 CLAIMS - MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: POLICY PRO X LOC JFCT $ A AUTOMOBILE X — X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED NON -OWNED AUTOS CP0278060508 05/31/2013 05/31/2014 NED (Ea aCOMBIccident) SINGLE LIMIT ___$___ 1,000,000 $ BODILY INJUR -Y (Par person) BODILY INJURY (Per accident) $ PROrPERTY accident) $ $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294105 05/31/2013 05/31/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED X RETENTION $ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below YIN N / A WC30600207982012 1/1/2013 1/1/2014 x WC STATU- TORY LIMITS OTH- ER EACH ACCIDENT E.L. EA ACCIDENT $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule H more space Is required) for your information only VLIl I Mr IVAI L ■ IVL.vLf City of Clearwater P 0 Box 4748 Clearwater FL 33756 1 ■.... -,---- __ ____ 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 9(.4.4 000992 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD i - . . 'CYaolA31l00047ej02A2/010l01e- 14795 AR D CERTIFICATE OF LIABILITY INSURANCE DATE (MM/2 1YYYY) 5/31/2013 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(les) 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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 CONTACT Kris Thompson NAM PHONE 813.639.3058 FAX (AIC. No. Estt: (A/C, No): 813.639.7192 E -MAIL kris.thom son wellsfar 9 o.com ADDRESS: p INSURER(S) AFFORDING COVERAGE NAIC If INSURER A: American Guarantee and Liability Insurance Corn 26247 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 INSURER B : FHM Insurance Company 10699 INSURER C $ 1,000,000 INSURER D : COMMERCIAL GENERAL LIABILITY INSURER E : $ 100,000 INSURER F : • 6117818 REVISION NUMBER: See below 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 SUBR WVD POLICY NUMBER POLICY EFF (MMIDDYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL LIABILITY CP0278060508 05/31/2013 05/31/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10.000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000.000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY JFCT X LOC $ A AUTOMOBILE LIABIUTY CP0278060508 05/31/2013 05/31/2014 COMBINED SINGLE LIMIT (Ea accidenll 1,000,000 3 $ - X — X ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ Perr accident) DAMAGE ( $ $ A UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE AUC967294105 05/31/2013 05/31/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED X RETENTION $ 0 $ B AND WC30600207982012 1/1/2013 1/1/2014 X TORY LIMITS ER $ 1,000,000 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Y / N N / A E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 1.000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule H more space is required) Event: Friends of Music . RECEIVED Date: Sunday April 1st, 2012 CITY OF CLEARWATER JUN 07 2013 Rule MANAGEMENT CANCELLATION City of Clearwater P 0 Box 4748 Clearwater, FL 33758 I 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 9L 001001 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. I 111W III 1101111ff 11111 ff11111111111110 OM 1W 11111111 11ff 1111111 ff11 lilt -CY BO1 A31 /0004ae/OZN2pIW010- 14795 '''''--, • '` AW v CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/31/2013 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 poilcy(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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 CONTE: ACT Kris Thompson NAM PHONE 813.639.3058 FAX (A/C. No Extl: (A/C, No): 813.639.7192 E-MAIL SS: kris.thompson @wellsfargo.com INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: Burlington Insurance Company 23620 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 INSURER B : 09/28/2012 INSURER C : EACH OCCURRENCE INSURER D : AMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) INSURER F : 6117821 REVISION NUMBER: See below 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 INSR W D POLICY NUMBER (MMIDDY/YYYY) (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 1648053802 09/28/2012 09/28/2013 EACH OCCURRENCE $ 1,000,000 AMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS - MADE x OCCUR PERSONAL & ADV INJURY $ 1,000,000 X Special Events GENERAL AGGREGATE $ 2.000.000 PRODUCTS - COMP/OP AGG $ Included GE 'L AGGREGATE LIMIT APPLIES PER: POLICY JFCOT- X LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS ' SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) ___$_ $ BODILY INJURY (Per parson) . BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I N N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule N more space Is required) RECEIVED CITY OF CLEARWA1 E l' City of Clearwater is named as additional insured. Clearwater Downtown Events, Inc. is named as additional insured with respects to liquor liability. Liquor Liability $1,000,000. Founders Insurance Company. 'JUN 07 2013 04 -27 -2012 Blast Friday RISK MAN AGEMtiv . 9173 City of Clearwater P 0 Box 4748 Clearwater, FL 33758 1 at -4,1 0_LoRA-, ev3< -5,(2__ 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 001014 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1988 -2010 ACORD CORPORATION. All rights reserved. I full III fill III 1111111111111111111111ff 11111 11W 11111 U lW III! 111111111 'CYBotA31 /000187/02Al2N/olOaY �.■� 11V"', 14795 AR v CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 9/20/2012 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 pollcy(les) 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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 CONTACT Kris Thompson NAME: P PHONE 813.639.3058 (AIC, No, Ext): E-MAIL .m son wellsfar ADDDREDRE kristho o.com SS: P @ g FAX 813.639.7192 (NC, No): INSURER(S) AFFORDING COVERAGE INSURER A: Burlington Insurance Company INSURER B : Mount Vernon Fire Insurance Co INSURER C : INSURER D INSURER E : INSURER F : NAIC # 23620 26522 COVERAGES CERTIFICATE NUMBER: 4879245 • 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 SUER INSR_ WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X Special Events OCCUR _ 1648053802 09/28/2012 09/28/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE S RENTED SES (Ea a occurrence) PREMISES ( $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY ( -I PRO JECT X PER: LOC PRODUCTS - COMP /OP AGG $ Included $ AUTOMOBILE __ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) 1; BODILY INJURY (Per person) $ BODILY INJURY Peraccident ( accident) $ PROPERTY DAMAGE (Per accidenT1 $ UMBRELLA LIAB 4 EXCESS LIAB -I OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N / A WC STATU- I TORY LIMITS OTH- ER $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B CL26293445 Liquor Liability 9/28/2012 6/02/2013 $1,000,000 Each Occurrence $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) RECEIVED Certificate holder is named additional per written contract for Blast Friday 09 -28 -2012. CfTY OF CLEARwATER SEP272012 RISK MANAGEMENT 9173 CERTIFICATE HOLDER CANCELLATION City of Clearwater P 0 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 002937 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. i1111111d11111111111ma1u1111111111a11111uu111110111uuti •C Y 801 A20/001220/02/02/O/O/oro' Aco v� RTIFICATE OF LIABILITY INSURANCE THIS TIFICATE 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 pollcy(les) 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). 14R)n DATE (MM/DDIYYYV) 5/31/2013 PRODUCER Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 CONTACT NAME: Kris Thompson PHONE 813.639.3058 (A/C. No. Est); E-MAIL kris.thompson @wellsfargo.com ADDRESS: INSURER A : FAX 813.639.7192 (A/C, No): INSURER(S) AFFORDING COVERAGE Burlington Insurance Company NAIC H 23620 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : R: See below COVERAGES CERTINUAI t IVUMlstic: s, • • , �« • °- --- - -- - -- 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. POLICY EFF POLICY EXP (MMIDDIYYYY) INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER (MMIDD/YYYY) UNITS LTR A 164B053802 09/28/2012 09/28/2013 EACH OCCURRENCE $ 1,000,000 GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 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 X Special Events GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ Included GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X LOC POLICY J COMBINED SINGLE LIMIT (Ea accident) $ AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ S RETENTION $ DED COMPENSATION T WC STATU• ORY LIMITS OTH- T ER WORKERS AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION DESCRIPTION Certificate $1,000,000/$2,000,000 OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule H more space Is required) RECEIVED holder is named as additional insured per written contract for Blast Friday 09 -28 -2012. Liquor Liability CITY OF CLEARWATER Mt. Vernon Fire Insurance Company Policy Number CL 2629864. JUN 017 2013 RISK MANAGEMENT 917 CERTIFICATE HOLDER City of Clearwater P 0 Box 4748 Clearwater, FL 33758 CANCELLATION 001016 ACORD 25 (2010/05) 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 The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. 11111111 1111111 11111 aertaer11 nre�e 'CYaot A3t /0004aUN2/021ololoa' ACORD ' CERTIFICATE OF LIABILITY INSURANCE THIS TIFICATE 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 pollcy(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). DATE (MM?DDNVYY) 5/31/2013 PRODUCER Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road CONTACT Kris Thompson NAME: PHONE 813.639.3058 (NC. No. Exti: E-MAIL ADDRESS: FAX (AIC, No): 813 639.7192_ -- --- __ -- kris.thompson @wellsfargo.com INSURER(S) AFFORDING COVERAGE INSURER A : INSURER B : INSURER C : Burlington Insurance Company INSURER D : NAICS _ 23620 INSURER E : Clearwater, FL 33759 INSURER F : COVERAGES CERTIFICATE NUMBER: 6117825 REVISION NUMBER: See below 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. - - - -- POLICY EFF POLICY EXP MMIDDIYYYY MMIDDIYYYY INSR LTR TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER 164B053802 09/28/2012 09/28/2013 LIMITS EACH OCCURRENCE AMA ET.RNE PREMISES Ea occurrence MED EXP (Any one person) COMMERCIAL GENERAL LIABILITY CLAIMS -MADE LX I OCCUR Special Events PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG $ 1,000,000 100,000 $ _ 5,000 $ 1,000,000 2.000,000 Included GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC COMBINED SINGLE LIMIT Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS UMBRELLA LIAR EXCESS LIAB RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below OCCUR CLAIMS -MADE YIN EACH OCCURRENCE AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) City of Clearwater is named additional insured per written contract. Blast Friday 11 -30 -2012. Liquor Liability $1,000,000/$2,000,000. - Policy No CL2629866, Mount Vernon Fire Insurance Company CERTIFICATE HOLDER City of Clearwater P 0 Box 4748 Clearwater, FL 33758 001022 ACORD 25 (2010105) CANCELLATION L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ RECEIVED CITY OF CLEARWAIEK JUN 0'7 2013 RISK MANAGEMENT 9173 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 The ACORD name i�u�edurior11 Bin MIN ©1988 2010 ACORD CORPORATION. All rights reserved. 'CYe91 A3 1 /000,r91102p21a/0ra0' 14795 Aco D CERTIFICATE OF LIABILITY INSURANCE THIS TIFICATE 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(les) 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). DATE (MMIDDNYYY) 5/31/2013 PRODUCER Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road CONTACT NAME: Kris Thompson PHONE 813.639.3058 (NC. No. Eat): E-MAIL ADDRESS: Clearwater, FL 33759 COVERAGES CERTIFICATE NUMBER: 6117823 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. POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) kris.thompson @wellsfargo.com INSURER(S) AFFORDING COVERAGE INSURER A: Burlington Insurance Company INSURER B : INSURER C : AIC, Not: 813.639.7192 NAIC # 23620 INSURER 0 : INSURER E : INSURER F : REVISION NUMBER: See below INSR LTR A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Special Events AWL SUER' INSR WVD POLICY NUMBER GE 'L AGGREGATE LIMIT APPLIES PER: PRO- X LOC POLICY JFCT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS 164B053802 (MMIDDIYYYY) 09/28/2012 09/28/2013 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY $ $ $ $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ Included $ SCHEDULED AUTOS NON -OWNED AUTOS 1,000,000 100,000 5,000 1,000,000 2,000,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) 3 $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident_ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE DED RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN NIA WC STATU- TORY LIMITS E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE OTH- ER E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule it more space is required) City of Clearwater is named as additional with respects to written contract. Liquor Liability 10 -26 -2012 to 10 -28 -2012, CL2629865, Mt. Memon Fire Insurance Company, $1,000,000/$2,000,000. CERTIFICATE HOLDER City of Clearwater P 0 Box 4748 Clearwater, FL 33758 CANCELLATION $ RECEIVtU CITY OF CLEARWATER JUN 07 2013 RISK MANAGEMENT 9173 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 00103 ACORD 25 (2010/05) The ACORD name i�ia�di�nuYno11111devw0110 © 1988 -2010 ACORD CORPORATION. All rights reserved. 'CY801 A311000489A2A2iOlWON- 14795 A CPRD CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 9/20/2012 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 pollcy(les) 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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 NAMEACT Kris Thompson PHONE 813.639.3058 FAX 813.639.7192 LAIC�No Ext): jA/C, No): E-MAIL kris.om son welisfar ADDRESS: o.com SS: P C 9 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Burlington Insurance Company 23620 INSURER B : Mount Vernon Fire Insurance Co 26522 INSURER C : INSURER!) : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 4879302 • 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 SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL LIABILITY 1648053802 09/28/2012 09/28/2013 EACH OCCURRENCE $ 1,000,000 X X - - -- COMMERCIAL GENERAL LIABILITY lCLAIMS -MADE [x 1 OCCUR Special Events DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 $ 5,000 MED EXP (Any one person) PERSONAL & ADV INJURY $ 1,000,000 _ -- _ —... GENERAL AGGREGATE $ 2,000,000 GE,N'L AGGREGATE LIMIT APPLIES PER: POLICY ( I PRO- I X I LOC PRODUCTS - COMP /OP AGG $ Included AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS -_ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE (Per accident) $ $ 1 UMBRELLA LIAB EXCESS LIAB } OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I 1 RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If describe Y / N N / A I WC STATU- I TORY LIMITS E.L EACH ACCIDENT OTH- ER $ E.L. DISEASE - EA EMPLOYEE $ yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Liquor Liability CL26293445 9/28/2012 6/02/2013 $1,000,000 Each Occurrence $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) Certificate holder is named as additional insured per written contract for Blast Friday 09 -28 -2012. CITY RECEIVED 7F CLEARWATER SEP272012 RI''K MANAGEMENT 9173 CERTIFICATE HOLDER CANCELLATION City of Clearwater P 0 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 9(ws 4 002945 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD I ©1988 -2010 ACORD CORPORATION. All rights reserved. 'C Y BO 1 A20/001224102/02%o/o/o/o' 14795 AR °® CERTIFICATE OF LIABILITY INSURANCE DATE YV) 6/5/2012 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 pollcy(les) 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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 NAMEACT Kris Thompson PHONE 813.639.3058 FAX (A/C. No, Ext): (A/C, No): 813.639.7192 E-MAIL SS: kris.thompson @welisfargo.com INSURER(S) AFFORDING COVERAGE GENERAL LIABILITY NAIC N 40142 INSURER A : American Zurich Insurance Company INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 INSURER B : Florida Hospitality Mutual Ins Co 10699 INSURER C : $ 1,000,000 INSURER D COMMERCIAL GENERAL LIABILITY INSURER E : $ 100,000 INSURER F ES CERTIFICATE 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 SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/Y1/YY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL LIABILITY CP0278060507 05/31/2012 05/31/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea $ 100,000 CLAIMS -MADE X OCCUR occurrence) MED EXP (Any one person) $ 10,000 PERSONAL Y ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY JECT PRO- X LOC $ A AUTOMOBILE - - - -- X X LIABILITY ANY AUTO CP0278060507 05/31/2012 05/31/2013 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ 1,000,000 $ ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS BODILY (Per ( ) $ PROPERTY DAMAGE (Per accident) $ $ A -- UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC96729441 -03 05/31/2012 05/31/2013 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED X RETENT ON $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC306- 0020798 -2012 1/1/2012 1/1/2013 X WC STATU- TORY LIMITS OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Y / N N I A E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space is required) CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF RUTH ECKERED HALL. CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER ATTN: LEO SCHRADER, RISK MGMT P 0 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 000665 ACORD 25 (2010/05) The ACORD name and logo are regis ered marks of ACORD ©1988 -2010 ACORD CORPORATION. All rights reserved. I1111111II11111tlN,11111111111111W111111 lrll *CYBO1 A 13I0002»vO2/02rororo /o• 14795 A D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/25/2012 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(les) 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 Commercial Lines - (813) 639 -3000 Wells Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 CONTACT Kris Thompson NAME: p PHONE 813.639.3058 FAX 813.639.7192 (A/C. No, Extl: (A/C, No): E-MAIL we son kris.thom llsfar o.com ADDRESS: p @ g INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Burlington Insurance Company 23620 INSURED Ruth Eckerd Hall, Inc. 1111 McMullen Booth Road Clearwater, FL 33759 INSURER B : 09/30/2011 INSURER C EACH OCCURRENCE INSURER D X INSURER E : DAMAGE O RENTED PREMISES jEa occurrence) INSURER F : COVERAGES CERTIFICATE NUMBER: 4239932 REVISION NUMBER: See below 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 SUBR MD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY 164B053322 09/30/2011 09/30/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE O RENTED PREMISES jEa occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Special Events PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ Included POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- TORY LIMITS OTH- ER ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Y / N N / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE* $ 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) RECEIVED City of Clearwater is named as additional insured. Clearwater Downtown Events, Inc. is named as additional insured with respects to liquor liability. Liquor Liability $1,000,000. Founders Insurance Company. APR 04 -27 -2012 Blast Friday !"f1 ,3 ,{I 1011 l ahV4 ,- ?eC • RISK MANAGEMENT CERTIFICATE HOLDER CANCELLATION City of Clearwater P O 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 9L 001653 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD (This certificate replaces certificate# 4239028 issuer' on 4/25/2012) ©1988 -2010 ACORD CORPORATION. All rights reserved. I1111111111III111IIIVI111IIV111111111IBAI111111111II 'CY801A25/000815/02/02/0/0/0/0'