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CERTIFICATE OF LIABILITY INSURANCE (5) DATE(MM/DD/YYYY) ACCOR" CERTIFICATE OF LIABILITY INSURANCE 1311812016 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 NAMEACT COLLEEN B BURKE BURKE INSURANCE SERVICES, INC PHONE 727-441-3094 FAX No:727-449-0102 P O BOX 1134 E-MAILo Ext DUNEDIN, FL 34697 ADDRESS: COLBURKE @HOTMAIL.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ALLIANCE OF NONPROFITS FOR INSURANCE RISK RETENTION 10023 INSURED INSURER B: DR. MARTIN LUTHER KING JR NEIGHBORHOOD FAMILY CENTER, INC 900 MARTIN LUTHER KING JR AVENUE INSURER 7 CLEARWATER, FL 33755 INSURER D7 INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A X COMMERCIAL GENERAL LIABILITY X 2016-4596 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(E.oc ",.nce) $ 50,000 X PROFESSIONAL 2016-4596 01/01/2016 01/01/2017 MED EXP(Any one person) $ 20,000 X DIRECTORS&OFFICERS$1,000,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PELT [::] LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ A AUTOMOBILE LIABILITY X 2016-4596 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LAB X OCCUR 2016-4596 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE X AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ AUTO PHYSICAL DAMAGE X 2016-4596 01/01/2016 01/01/2017 $1,000 COMPREHENSIVE DEDUCTIBLE A $1,000 COLLISION DEDUCTIBLE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 2014 FORD E340 #1 FBNE3BL9EDA36810 2014 FORD E350 #1 FBNE3BLOEDA36811 Certificate Holder listed below is named as Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CLEARWATER PARKS AND RECREATION DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 S. MYRTLE AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER, FL 33756 AUTHORIZED REPRESENTATIVE COLLEEN B BURKE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DRMARTI-01 TGODFREY ACORO CERTIFICATE OF LIABILITY INSURANCE P AT 3/8/2 D/YYYY) `••---"' 3/8/2016 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). CONT PRODUCER License#L087115 NAMEACT Hub International Southeast PHONE 727 797-0441 FAX 727 669-0673 600 Cleveland Street Alc No Ext:( ) (A/C,No): ( ) Suite 600 E-MAIL ADDRESS: Clearwater,FL 33755 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Viking Insurance Company of Wisconsin 13137 INSURED INSURER B Dr Martin Lutf @r ffing Jr INSURER C: Neighborho { family Cxf�� 900 N. INSURER D D� M "Ave ;, Clearwa ;.'F�L 33758 INSURER E: INSURER F: COVERAGES " CWIFIGA( ' UMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLI URANi§TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN ENT '(t ]t1 60�,CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MfTAIN, THE (,t� UF2AJF� AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF S" LI ES.LIMI `SHOWN fy/Y HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE -�,'ADDL$,I,J$R "- POLICY EFF POLICY EXP LIMITS LTR 'r INSD OLIC�G,-` ABER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR "`_ PREMISES Ea occurrence $ MED EXP(Any one person) $ i% PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIPdI'I'1, "kA �h? �,i ;' !; GENERAL AGGREGATE $ POLICY LOf4< i PRODUCTS-COMP/OPAGG $ OTHER: AUTOMOBILE L,QIITY ,!�� 1 COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNE6 ti SCHEDULED r��, BODILY INJURY(Per accident) $ AUTOS (AUTOS � ' ,j,AWNED PROPERTY DAMAGE HIRED AUTOS iTbS Sri Per accident $ UMBRELLA LIAB OCCk,�,z "" i �,QCURRENCE $ i r EXCESS LAB CLAIfS' DE r �AGGI' A`F $ yr DE D RETENTION$ ` PER WORKERS COMPENSATION .�, , AND EMPLOYERS'LIABILITY Y/ r,,, STATUTE EERH A ANY PROPRIETOR/PARTNER/EXECUTIVE �_ -�''' WC66001'j 01/07/2016 O'I�O7/2017 j� ,`yH ACCIDE�I'C. $ 500,000 OF EXCLUDED? N/A y (Mandatory m NH) E.L.DISEASE 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below o;� „ , y." �:- ,,,�;. E.L.DISEF�,, ,{�Q�'ICY LINE°( 11 ", 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedj0 rAy��r be` fX If fore space is required) - RE:Insurance Verification r ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater Parks&Recreation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater,FL 34618 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD