CERTIFICATE OF LIABILITY INSURANCE (616)-��.,,,.� ;;;�=..
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CERTIFICATE OF LIABILITY INSURANCE I� DCT�^MM/�DD/YYYY)
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 dces not confer rights to the
certificate holder in lieu of such endorsement s.
PRODUCER
NAME:
�ylant Group Inc-Indianapolis PHONE _ 7_ .� ac No: - 7-
301 Pennsylvania Parkway, #201 E-MAIL
ndianapolis IN 46280 ADDRESS: .� iff
INSURED KI WAN03
Kiwanis Intemational, All Clubs and Their Members
3636 Woodview Trace
Indianapolis IN 46265
COVERAGES
CERTIFICATE NUMBER: 1854�53151
INSURER A
INSURER D :
INSURER E :
INSURER F :
AFFORDING COVERAGE
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
LTR INSR WVD POLICY NUMBER MM/DD MM/DDM'YY LIMITS
A GENERALLInBILITV Y 013136005 11/1/2014 1/1/2015 EqCHOCCURRENCE $2,000,000
X COMMERCIAL GENERAL LIABILIN DAMAGE T RENTED
PREMISES Ea occurrence 5500,000
CLAIMS-MADE � OCCUR MED EXP (Any one person) $5,000
� PERSONAL & ADV INJURY $2,000,000
%� Liquor Liability GENERAL AGGREGATE $2,000,000
� GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY PR� LOC Liquor Liability $1,000,000
A AUTOMOBI�EUABILI7Y 013136005 11/1/2014 1/1/2015 Eaaccident 1,000,000
ANY AUTO . BODILY INJURY (Per person) $
� ALL OWNED SCHEDULED BODILY INJURY Per accident $
AUTOS AUTOS � �
NON-0WNED Pe�r a ciUentDAMAGE $
X HIRED AUTOS X AUTOS
Aggregate Yii,000,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION � WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? � N � A E.L. EACH ACCIDENT $
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.l. DISEASE - POLICY LIMIT $
A Self-Insured Retention 013136005 11/1/2014 1/1/2015 All Claims $75,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltional Remarks Schedule, If more space is required)
Certificate Holder is named as Additional Insured as respects to General Liability only regarding the following Kiwanis event (setup, take
down & rain date(s) during the policy term are included):
03-28-15 or any future date(s) during the policy term. Springtime City will paint a residence home in the City of Clearwater's (Paint Your
Heart Out Clearwater) @ 2402 Shelley St, Clearwater, FL 33765 (Springtime City Kiwanis Club)
CERTIFICATE FiOLDER
CITY OF CLEARWATER
ATTN: NANCY LAMONGA
100 S. MYRTLE AVE
CLEARWATER, FL 33756
ACORD 25 (2010/05)
TION
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
' �,� � 4
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