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CERTIFICATE OF LIABILITY INSURANCE (714)Client#: 25804 ETHOSRIS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 06/23/2016 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). PRODUCER Bouchard Insurance (CLW) 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: (NC, No, Est): 727 447-6481 (A/c, No): 727 449 -1267 ai E-MAIL SS: cicerts @bouchardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Lloyds of London LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Ethos Risk Services, LLC 300 1st Ave South Saint Petersburg, FL 33701 INSURER B : Everest National Insurance Co 10120 INSURER C 10/07/2016 INSURER D $ 5,000,000 INSURER E : $ 250,000 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) POUCY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y PSE02150067 RECEIV'E .J JUN UN 2 2016 10/07/2015 D 10/07/2016 EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 250,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ GENERAL AGGREGATE $5,000,000 GEN'LAGGREGATELIMITAPPLIESPER: POLICY PRO- JECT LOC PRODUCTS - COMP /OPAGG $5,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y Y PSE02 4i RECORI LEGISLATIVE SRVCS /T 15 DEPT DEPT 10/07/2016 (Ea acciden SINGLE LIMIT $5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN yj N / A Y 5300003571161 06/26/2016 06/26/2017 X TO TO RY Y LIMITLIMIT S OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 $1,000,000 E.L. DISEASE - POLICY LIMIT A Professional Liab Y Y PSE02150067 10/07/2015 10/07/2016 $5,000,000 Each Claim $5,000,000 Aggregate $7,500 Ded Per Claim DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is required) (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION BONNAMY AND ASSOCIATES LLC MAIL RETURNED 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 #S471919/M471896 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VICDE DESCRIPTIONS (Continued from Page 1) " Workers Comp Information " Other States Coverage Proprietors /Partners /Executive Officers /Members Excluded: Edward Cotilla Martin Petrie 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. SAGITTA 25.3 (2010/05) 2 of 2 #S471919/M471896