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CERTIFICATE OF LIABILITY INSURANCE (778)
A D 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD /YYYY) 8/3/2016 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 have ADDITIONAL INSURED provisions or 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 Phone: (813)251 -4900 Fax: (813)253 -2676 Professional Insurance Center, Inc. 2003 West Kennedy Blvd Tampa, Florida 33606 CONTACT Professional Insurance Center Inc NAME: PHONE FAX (A /C, No. at): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Ascendant Commercial Insurance, Inc. 13683 INSURED FLORIDA FREE RIDE, INC 614 PINELLAS STREET STE B CLEARWATER, FL 33756 INSURER B : INSURER C : INSURER D : $ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1494 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. 4NSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD /YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i $ CLAIMS -MADE OCCUR DAMAGE PREMISES O(Ea occu ence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS - COMP /OP AGG $ OTHER; $ A AUTOMOBILE LIABILITY FH- 24173 -0 g C q$ 888 «VIII 7/2/2016 \; E 7/2/2017 _- COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ 125,000 OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY BODILY INJURY (Per accident) $ 000 00 000 300 0 PROPERTY DAMAGE (Per accident) $ NO $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE AUG 1 t RECORDS c i1F AND EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 1. /1L Rim OFFICIAL LEGISLATIVE pj/�°� JLr \t t r +� 7�' DEPT PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Y / N N / A E1. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Continued on Att1Ched Supplement. CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED: 2004 - TOYOTA - SIENNA - 5TDZA23C74S078137 2007 - TOYOTA - SIENNA LE - 5TDZK23C77S051876 2008 - DODGE - CARAVAN - 2D8HN44H58R746393 2008 - DODGE - CARAVAN - 2D8HN54P78R697873 2011 - DODGE - CARAVAN - 2D4RN4DGXBR692867 CERTIFICATE HOLDER CANCELLATION Holder's Nature of Interest : Additional Insured CITY OF CLEARWATER 100 SOUTH MYRTLE AVE CLEARWATER, FL 34697 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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES (CONTINUED) : 2013 - DODGE - GRAND CARAVAN - 2 C4 RDGCG1DR6 10 6 5 8 2008 - DODGE - GRAND CARAVAN - 1D8HN44H08B191657