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CERTIFICATE OF LIABILITY INSURANCEClient#: 15698 HOMELESS A CORD.. CERTIFICATE OF LIABILITY INSURANCE DATE YY) 11 /O2 /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 Bouchard Insurance 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE 727 447 -6481 FAX 727 449 -1267 (A /C, No, Eat): (A /C, No): ADDRESS: cicerts @bouchardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC C INSURER A : Evanston Insurance Company 35378 INSURED Homeless Emergency Project Inc 1120 Betty Lane N Clearwater, FL 33755 -3303 INSURER e : Bridgefield Employers Ins Co 10701 INSURER C Florida Insurance Trust CLAIMS -MADE INSURER D : OCCUR INSURER E : $ 10,000 INSURER F : VERAGES 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 GENERAL X TYPE OF INSURANCE LIABILITY COMMERCIAL GENERAL LIABILITY ADDLSUBR INSR Y WVD Y POLICY NUMBER FITGL3455520 - -- � ;{'^ q s `■ V . -- OFFICIAL s "e�:Hi %: ;AL'S i "r >•y.� FITAU3455520 €t08i0M'1 POLICY EFF (MMIDD/YYYY) 1 yg(2015 k4.:'," :i--i ,�,r , . ` � `�� 5 POLICY EXP (MMiDD/YYYY) 06/01/2016 06/01/2016 LIMITS EACH OCCURRENCE $1,000,000 A DAMAGE TO (E occurrence) $300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- JECT X PER: LOC PRODUCTS - COMP /OP AGG $ 3,000,000 EOa aBINEDt) INGLE LIMIT $ $1,000,000 C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A x UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE FITXS345552015 11/01/2015 06/01/2016 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below Y 1 N N N I A 083053302 01/01/2015 01/01/2016 X WOCRYTAMITS EORH E.L. EACH ACCIDENT $100,000 E . DISEASE - EA EMPLOYEE $100,000 E I DISEASE - POLICY LIMIT $500,000 A A Professional Liab Abuse /Molestation FITGL345552015 FITGL345552015 11/01/2015 11/01/2015 06/01/2016 06/01/2016 $1,000,000/$3,000,000 $1,000,000/$3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (AttaRger1B191z d tional Remarks Schedule, if more space is required) ��'ll.... LL'�II VYGG1lJJ ri _ .. . JAN 1 3 2016 (See Attached Descriptions) GAS ADMIN CERTIFICATE HOLDER CANCELLATION City of Clearwater Housing Division 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 #S302407/M302401 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KARGE DESCRIPTIONS (Continued from Page 1 NOTICE: Bouchard Insurance is required to comply with the licensing agreement we hold with ACORD. ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations pertaining to proper use of the Certificate of Liability Insurance form. We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of Subrogation coverage applies. According to ACORD, the Description of Operations section must be limited to describing information necessary to identify the operations, locations and vehicles for which the certificate was issued. Please note the Description of Operations section of the Certificate cannot be used to add additional information except as just described. Marking a Y next to the line of business adequately documents coverage. Equally important, it satisfies the rules and regulations governing the proper use of the Certificate of Liability Insurance form. Certificate is a reflection of the current coverages provided for the insured. Limits aryl coverages are afforded to the certificate holder only if required by written contract. 1119 Fairburn Ave, Clearwater, FL; 1101 Fairburn Ave, Clearwater, FL; 1112 Fa' urn Ave, Clearwater, FL; 1106 Fairburn Ave, Clearwater, FL. Loc# 2 - 1119 Fairburn Ave; Clearwater, FL Loc# 26 - 1101 Fairburn Ave; Clearwater, FL Loc# 28 - 1112 Fairburn Ave; Clearwater, FL Loc# 29 - 1106 Fairburn Ave; Clearwater, FL SAGITTA 25.3 (2010/05) 2 of 2 #S302407/M302401 rIin +1t• 15C,98 HOMELESS ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/Y 11/02/2015 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 Bouchard Insurance NAME: PHONE 727 447 -6481 FAX No :727 449 -1267 (A1C, No, Eat): 101 N Starcrest Dr. E-MAIL cicerts @b ouchardinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Clearwater, FL 33765 727 447 -6481 INSURER A: Evanston Insurance Company 35378 INSURED Homeless Emergency Project Inc INSURER B: Bridgefield Employers Ins Co 10701 INSURER C: Florida Insurance Trust 1120 Betty Lane N Clearwater, FL 33755 -3303 INSURER D INSURER E $ 300,000 INSURER F: CLAIMS -MADE Fx_1 OCCUR 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 ADOLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM1DD /YYYY POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY Y Y FITGL345552015 11101/2015 06101/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED $ 300,000 CLAIMS -MADE Fx_1 OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 3,000,000 $ POLICY PRO- -( LOC JECT C AUTOMOBILE LIABILITY FITAU345552015 6/01/2015 06/01/201 acccid.nIINGLE LIMIT Ee S $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X HIRED AUTOS X NON -OWNED AUTOS A X UMBRELLA LIAR X OCCUR FITXS345552015 1101/2015 06/01/201 EACH OCCURRENCE s2,000,000 AGGREGATE s2,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE YIN OFFICER /MEMBER EXCLUDED? NIA 083053302 1/01/2015 01/01/2016 X 1TWoCRSyTLATXi, I FR OTH- E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $100,000 (Mandatory in NH) E . DISEASE -POLICY LIMIT 1 $500,000 If yes describe under DESCRIPTION OF OPERATIONS below A Professional Liab FITGL345552015 11/01/2015 06/01/2016 $1,000,00043,000,000 A Abuse /Molestation FITGL345552015 11/01/2015 06/0112016 $1,000,0001$3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) CiTY (See Attached Descriptions) J CERTIFICATE HOLDER CANCELLATION City of Clearwater Housing ti g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD #S302407/M302401 KARGE DESCRIPTIONS (Continued from Page 1) NOTICE: Bouchard Insurance is required to comply with the licensing agreement we hold with ACORD. ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations pertaining to proper use of the Certificate of Liability Insurance form. We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of Subrogation coverage applies. According to ACORD, the Description of Operations section must be limited to describing information necessary to identify the operations, locations and vehicles for which the certificate was issued. Please note the Description of Operations section of the Certificate cannot be used to add additional information except as just described. Marking a Y next to the line of business adequately documents coverage. Equally important, it satisfies the rules and regulations governing the proper use of the Certificate of Liability Insurance form. Certificate is a reflection of the current coverages provided for the insured. Limits and coverages are afforded to the certificate holder only if required by written contract. 1119 Fairburn Ave, Clearwater, FL; 1101 Fairburn Ave, Clearwater, FL; 1112 Fairburn Ave, Clearwater, FL; 1106 Fairburn Ave, Clearwater, FL. Loc# 2 - 1119 Fairburn Ave; Clearwater, FL Loc# 26 - 1101 Fairburn Ave; Clearwater, FL Loc# 28 - 1112 Fairburn Ave; Clearwater, FL �- Loc# 29 - 1106 Fairburn Ave; Clearwater, FL SAGITTA 25.3 (2010105) 2 of 2 #S302407/M302401