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CERTIFICATE OF LIABILITY INSURANCE (742)Client#: 13940 KELBYONE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 7/13/2016 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 Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE 727 447-6481 FAX 727 449 -1267 (A/C, No, Ext): (A /C, No): E-MAIL SS: cicerts@bouchardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Federal Insurance Company 20281 INSURED KelbyOne LLC; KelbyOne Events LLC Kelby Media Group; Kelby Training Inc 118 Douglas Rd East Oldsmar, FL 34677 INSURER B:Ohio Casualty Insurance Co 24074 INSURERC:Amerisure Mutual Insurance Comp 23396 Executive Risk Indemnity Inc INSURER D : tY 35181 INSURER E: Essex Insurance Company 39020 INSURER F : CLAIMS -MADE 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 ADDL INSR SUBR IA/VD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP (MM /DD /YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y 35840102ECE fr. � / - 1 a x nt' c ' .. 07/13/2016 r .:, t ti , s, l 07/13/2017 EACH OCCURRENCE $1,000,000 $1,000,000 PREMISES O{Ea occu a nce) CLAIMS -MADE X OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY sin E &O Limit GENERAL AGGREGATE $2,000,000 GEN'L X AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _ SCHEDULED AUTOS NON -OWNED AUTOS 7354259 > -� e«� rr, : - _..,.... S.j?.z�1 ?+- �t°ift3 is,0 —t.), L CJ °'.:: ''w AT S'/ i_..'':f<,rv;i �' �J?��;16 .? rt,t -,:" `. 1, °:,�C' - 07/13/2017 COMBINED SINGLE LIMIT (Ea accident) 81,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EU01755193036 07/13/2016 07/13/2017 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N — N / A Y WC205122009 12/17/2015 12/17/2016 X TORY LIM TS OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 D E E&O Professional Rented Equipment 82223879 IMS35066 07/13/2016 07/13/2016 07/13/2017 07/13/2017 5,000,000 25,000 Per Item 50,000 Max DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER C/O MONICA MITCHELL P 0 BOX 4748 CLEARWATER, FL 33758 -0000 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S480965/M480910 JENCO DESCRIPTIONS (Continued from Page 1} 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. RE: PHOTOSHOOT AT THE LONG CENTER SAGITTA 25.3 (2010/05) 2 of 2 #S480965/M480910