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CERTIFICATE OF LIABILITY INSURANCE (6) DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 12121/2017 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 NAMEACT COLLEEN B BURKE BURKE INSURANCE SERVICES, INC PHONE 727-441-3094 FAX No:727-449-0102 P O BOX 1134 E-MAILo Ext DUNEDIN, FL 34697 ADDRESS: COLBURKE @HOTMAIL.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ALLIANCE OF NONPROFITS FOR INSURANCE RISK RETENTION 10023 INSURED INSURER B: DR. MARTIN LUTHER KING JR NEIGHBORHOOD FAMILY CENTER, INC 900 MARTIN LUTHER KING JR AVENUE INSURER 7 CLEARWATER, FL 33755 INSURER D7 INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A X COMMERCIAL GENERAL LIABILITY X 2017-4596 01/01/2017 01/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(E.oc ",.nce) $ 50,000 X PROFESSIONAL 2017-4596 01/01/2017 01/01/2018 MED EXP(Any one person) $ 20,000 X DIRECTORS&OFFICERS$1,000,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PELT � LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ COMBINED SINGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILITY X 2017-4596 01/01/2017 01/01/2018 Ea accident ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LAB X OCCUR 2017-4596 01/01/2017 01/01/2018 EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE X AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ AUTO PHYSICAL DAMAGE X 2017-4596 01/01/2017 01/01/2018 $1,000 COMPREHENSIVE DEDUCTIBLE A $1,000 COLLISION DEDUCTIBLE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 2014 FORD E340 #1 FBNE3BL9EDA36810 2014 FORD E350 #1 FBNE3BLOEDA36811 Certificate Holder listed below is named as Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CLEARWATER PARKS AND RECREATION DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 S. MYRTLE AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER, FL 33756 AUTHORIZED REPRESENTATIVE COLLEEN B BURKE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DRMARTI-01 TGODFREY ACORO"° CERTIFICATE OF LIABILITY INSURANCE DAT1/9/2 D/YYYY) �..•�—''" 1/9/2017 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 CONTACT NAME: Hub International Southeast PHONE FAX 600 Cleveland Street (A/C,No,Ext): (727) 797-0441 (A/C,No):(727) 669-0673 Suite 600 ADDRESS: Clearwater,FL 33755 INSURERS AFFORDING COVERAGE NAIC# INSURERANiking Insurance Com an of Wisconsin 13137 INSURED ' INSURER B: Dr Martin Luthrl��ig Jr INSURER C: Neighborhp+afnily Cen �1n 900 N. INSURER D: Clearwlt FL 3375 = INSURER E: r INSURER F: COVERAGES " C FzRTTIF IC %FIUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT I HE POL� JE ,C ISURAN LINED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY IEk1iMENT f141 CSR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAIN, THESUFtFr AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUO ICI S.LIMN yS$HOWItf / HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE `X`ADDL J& „y-pOLIC 4�MBER POLICY EFF POLICY EXP LIMITS LTR "" INSD, S '^P MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR i%= DAMAGE TO RENTED PREMISES Ea occurrence $ MEDEXP(Any one person) $ ,r PERSONAL&ADV INJURY $ GEN'L AGGREGATE GENERAL AGGREGATE $ POLICY Y PRODUCTS-COMP/OPAGG $ OTHER $ i.�` COMBINED SINGLE LIMIT AUTOMOBILE L$ABiITY Ea accident) ANY AUTOX'"�, i' BODILY INJURY Per erson $ OWNED °I SCHEDULED , AUTOS ONLY AWTPS BODILY INJURY Per accident $ HIRED '�*!k'S WNED �i r'; r PROPERTY DAMAGE AUTOS ONLY 'r; ¢gF ONLY' ::r ;%' Per accident $ $ UMBRELLA LIAB OCCQ ,, CURRENCE $ EXCESS LIAB CLAI( ADE r t ''AGGf� AL $ DED RETENTION$ �" A WORKERS COMPENSATION �, PER AND EMPLOYERS'LIABILITY Y/ � % r, r � '' STATUTE OERH �Y: 'WC66 11: 01/07/2017 1 07/2018 '- y 500 000 ANY PROPRIETOR/PARTNER/EXECUTIVE - , H ACCIDEIy' $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) 500 000 E LChISEASEq, pL `Y $ f yes,describe under 500,000 DESCRIPTION OF OPERATIONS below ,v,r E.L.DISE �LICY LINE �`'f,. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks SchedCje ikia a ' gtl a#Ipre space is required) RE:Insurance Verification - r ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Clearwater Parks&Recreation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 Clearwater,FL 34618 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD