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CERTIFICATE OF LIABILITY INSURANCE (842) 7412812017 E(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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 CONTACT Brenda K. Prestigiacomo 1st Class Insurance, Inc. PHONE (727) 796-2600x FAX (888) 794-9277x A/C No Ext: A/C,No 1155 Tampa Road E-MAIL ADDRESS: b p resti 1classinsurance.com Brenda Prestigiacomo Palm Harbor FL 34683 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Hartford Insurance Company INSURED INSURER B: Progressive Insurance Company All American Canteen, Inc INSURER C 4004 Poincina Ct. INSURER D: INSURER E: Palm Harbor FL 34684 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 V COMMERCIAL GENERAL LIABILITY 01 SBMRG6042 912312016 912312017 EACH OCCURRENCE $ 1000000 DAMAGE RENTED O CLAIMS-MADE IV I OCCUR FIR EMISEI(E.oc ",.nce) $ 1000000 MED EXP(Any one person) $ 10000 PERSONAL&ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000000 V POLICY ❑ PRO JECT [::] LOC PRODUCTS-COMP/OPAGG $ 2000000 OTHER: $ B AUTOMOBILE LIABILITY 03924022-0 911712016 911712017 COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ 100000 ALL OWNED V SCHEDULED BODILY INJURY(Per accident) $ 300000 AUTOS AUTOS NON-OWNED Per accident) PROPERTY DAMAGE $ 50000 HIRED AUTOS AUTOS UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 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 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included under the blanket additional insured with repect to the general liability coverage. 0 CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100 S Myrtle Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clearwater, FL 33756 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1ST CLASS INS INC PR99RE.0111F 1155 TAMPA ROAD COMMERC/AL PALM HARBOR,FL 34683 Named insured Policy number: 03924022-0 Underwritten by: Progressive Express Ins Company September 20,2016 ALL AMERICAN CANTEEN INC Policy Period:Sep 17,2016-Sep 17,2017 4004 POINCIANA CT Page 1 of 2 PALM HARBOR,FL 34684 progressiveagent.com Online Service Make payments,check billing activity, print policy documents, or check the status of a Commercial Auto claim. 1-727-796-2600 Insurance Coverage Summary 1ST CLASS INS INC Contact your agent for personalized service. This is your Declarations Page 1-800-444-4487 For Your coverage has changed unavaitomeortoreeotacagentis unavailable or to report a claim. Your coverage began the later of September 17,2016 at 12:01 a.m. or at the time your application is executed on the first day of the policy period. This policy period ends on September 17,2017 at 12:01 a.m. This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto, unless the policy contract allows the stacking of limits.The policy contract is form 6912 (06/10).The contract is modified by forms 2852FL (10/04), 1652FL (08/12),4757FL (01/13), 1198(01/04),4852FL (10/04),4881 FIL (01/13)and Z228(01/11). The named insured organization type is a corporation. Policy changes effective September 17, 2016 ............................................................................................................................................................................. Premium change: $20.00 ............................................................................................................................................................................. Changes: The additional insured information has changed. The changes shown above will not be effective prior to the time the changes were requested. Outline of coverage Description Limits Deductible Premium ............................................................................................................................................................................. Liability To Others $1,582 Bodily Injury Liability $100,000 each person/$300,000 each accident Property Damage Liability $50,000 each accident ............................................................................................................................................................................. Uninsured Motorist Non-Stacked $50,000 each person/$100,000 each accident 483 ............................................................................................................................................................................. Basic Personal Injury Protection 280 Without Work Comp-Named Insured Only $10,000 each person $0 ............................................................................................................................................................................. Medical Payments $5,000 each person 77 ............................................................................................................................................................................. Comprehensive 106 See Auto Coverage Schedule Limit of liability less deductible ............................................................................................................................................................................. Collision 115 See Auto Coverage Schedule Limit of liability less deductible Subtotal policy premium $2,643 ............................................................................................................................................................................. Fees 20 ............................................................................................................................................................................. Total 12 month policy premium and fees $2,663 In Continued Form 6489 FL(01/15) Policy number: 03924022-0 ALL AMERICAN CANTEEN INC Page 2 of 2 Rated driver ....................................................................................................................................................................... 1. NATASHA VI IARET Auto coverage schedule 1. 2000 Ford Econo/Club Wgn Actual Cash Value (plus$2,000.00 Permanently Attached Equip) VIN: 1 FTRE1424YHB66075 Garaging Zip Code: 34684 Radius: 100 Liability Liability UM/UIM BI PIP Med Pay .................................................................................................................................................................. Premium $1,582 $483 $280 $77 Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total .................................................................................................................................................................. Premium $500 $106 $500 $115 $2,643 Premium discounts Policy ............................................................................................................................................................................. 03924022-0 Package Vehicle ............................................................................................................................................................................. 2000 Ford Econo/Club Wgn Anti-Lock Brakes and Air Bag Additional Insured information .................................................................................................................................................................... 1 . Additional Insured NATASHA VILARET 2690 CORAL LAND PALM HARBOR,FL.34684 Agent signature et Company officers Secreta ry Form 6489 FL(01/15)