CERTIFICATE OF LIABILITY INSURANCE 0 �A� C ATE IEwaIA)ONYYY)
► + CERTIFICATE OF LIABILITY INSURANCE
11/0112016
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. THUS CERTIFICATE Of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 'I SUING IN,SURIER(S), AUTH01RI ED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED,the Poaiicy(les)IErllust be endorsed. It SU'BRECGATION IS WAIVED, saukgect to
the ternn and conditions of the policy,certain policies;may require an endoraenrant,.A statement on this certificate does not confer rights to the
certificate holder in lieu of such andloar enent(s).
PRIarAaIE:ETL CONTACT Shelley BryRani
Coleman Insurance Agency,Inc PHONE
..E4. t727,j_441-9911 TTAX
[ ,Nml: (727)441-9566
1255 Belcher Road E-MAJL Shelley�t clo r raJ4gencyFL cam
K&U RER ISIAFFOROiE!C f3
GCOVERA .Eu..mm..mm ..,_..�... N,AICIIf
Ounedin FL 34698 INSURERA. MT VERNON FIRE INS CO
IMSraI1Ea INSURER a. TFOHIYNCII_OOY INNS CO 42376
C:lAa w ester For Youth Inc INSURER C...__... ....... � ._ _......
_. .._ ......_ ..................... .. .
15£11 N Flelctaer Rd Ste 236 INSURER b
INSURER E.
Clearwaler FL 33765 INSURER F::
COVERAGES CERTIFICATE,NUMBER: RMSION NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF 04SURANCE LISTED BELOW"HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NKOTMVrrHSTANCIING ANY REQUIREMENT, TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WVI'TT°I RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR I+A'.AY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLJSI?ONS AND CON 0I-nONSOF SUCH ICI In-ES-LIIUIrlS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_.. __ _.._._w_., .–. —.
IMSR 1. PE,�IIC"r EFYI POLIC'h" P UWTS
LrR I-YPE CfF IN tEJraANC'E� gym... F4'.ILIS'Y NIIaIIIIER� paRN147CFf1aa, .'�aRA!- ,�
COMINERCIAL GENERAL LIABILITY EACH DOCURRENCE ; 1, 0,6'��,.........
_
CLAIUS-MADE FXIOCCUR PRE VISE s pcWC ce9_. I 100,000
UAEO E,xP(Any on•'e person) s 6,000
A NPP2656717C 01111)2016 01111/2017 PERSONAL&AOVINJURY C Excluded
GEN'L�RCwG � AP�1 PE'R: G _; 2. 0.. _..
,.®. NFIRAt AE^,I"�RFC,ATE $ 2,IT00,tI0t3
P ,,.ICY LOC f ,.,.,
JECr C]pnJGr�" CC7MP C Arm 6 Excluded
OTHER I
AUTOMOBILE uAOKM � E m7IkBENEr7&NCrE E 4MI
BODILY INJURY Met pemoMi S
AW A'UT'O _
ALL O;NNEI7 SCHEDULED BOMY INJURY(Pera=kleryj S
.... AUY9S _.. NON-OWNED
HW.OA.ITOS AU70S
S
I UMBRELLA LIAS CCCUR EAE':H E]CCIfRREc'N E S"
EXCESS LIAR h:..I.AIkiS:-MADE AGGREGATE tG
'4NGR r] CfAFMIPI M'A-NT
nrD RETEId�EON S I
AAI'rPI3E PRIEII7RrI'AE#T'NIETtrE/CCUTVE NIA ms.µ. ,r
ATION �*, STATUTE ER ..
ANC EMFLOVERr LIABILITY YIN ......
B IArY OMIEIEREARTNt1CD. NN TWC3553301 06116r2016 061I6r2017 E.um.oncepncoxlrXNrr s 60£IOGtY
(Nandsto q In roll .. E.L..OISEASE-EA EMPLOYE t 900,000 ._
yEr yes,dercroucEEnder ...
IUSCMIMON OF OPERATIONS Wow .w E.R..hI.;FAV-PCH Cy LIMIT S 500,000
DESCRIPTION:OF OPERAPIONS E LOCATIONS E YF3nCLES(ACORD asv,Add WcmeI Rerr ks ScheJule,mays bL,att"hed II anerer apace IF rgg4j radl
Certificate holder Is listed as Additional Insured with respect to General Lltabllity.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE':ABOVE Of-SCRIBED POLIG4ES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE MVITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
Po Box 47A
Clearwater FL 33758-4746
Q 19818-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014101) The ACORD narne and logo are registered marks of ACCT RD