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CERTIFICATE OF LIABILITY INSURANCE (12) DATE(M A�" CERTIFICATE OF LIABILITY INSURANCE M/DD/YYYY) 4/1/DATE(M 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 NAME: Crystal McCarthy Arthur J. Gallagher Risk Management Services, Inc. 727-796-6248 FAX 4350 W. Cypress St, Suite 300 M20%, A/c No 727-791-1613 Tampa FL 33634 ADDRESS:crystal_mccarthy @ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:First Nonprofit Insurance Company 10859 INSURED INSURER B:Technology Insurance Company, Inc 42376 Boys&Girls Clubs of the Suncoast, Inc. INSURERC: 2300 Tall Pines Drive, Suite 150 Largo, FL 33771 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 734413440 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY • X COMMERCIAL GENERAL LIABILITY Y NPP100154100 12/1/2015 12/1/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE XI PREM OCCUR DAMAGETORENTED ISES Ea occurrence $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000 X POLICY ❑ PRO JECT [::] LOC PRODUCTS-COMP/OP AGG $ OTHER: $ • AUTOMOBILE LIABILITY NCA100154201 12/1/2015 12/1/2016 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) • X UMBRELLA LAB X OCCUR NMB100154300 12/1/2015 12/1/2016 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$10,000 $ B WORKERS COMPENSATION TWC3541417 4/1/2016 4/1/2017 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) City of Clearwater Parks and Recreation Department is shown as an Additional Insured solely with respect to General Liability coverage as evidenced herein as required by written contract with respect to work performed by the named insured per Form PL1113 06/06. Umbrella coverage is follow form to the underlying liability coverages as shown above. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater Parks and Recreation Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Avenue Clearwater FL 33756 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD