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CERTIFICATE OF LIABILITY INSURANCE (16) DATE(MM/DD/YYYY) ACORN® CERTIFICATE OF LIABILITY INSURANCE 11/30/2017 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 CONTACT Pe AmOS NAME: ggY Lassiter-Ware Insurance of Tampa Bay a/CNNo Ext: (800)845-8437 AX No: (888)883-8680 1300 N. Westshore Blvd E-MAIL ADDRESS:peg A@lassiter-ware.com Suite 110 INSURER(S)AFFORDING COVERAGE NAIC# Tampa FL 33607 INSURER A:Philade l hia Indemnity Ins. 18058. INSURED INSURER B:Llo dS Of London Boys & Girls Clubs of the Suncoast, Inc INSURER C: 4625 East Bay Drive INSURER D: Suite 103 INSURER E: Clearwater FL 33764 INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 All Lines 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/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 1X OCCUR PREMISES (E.occurrDence) $ 50,000 PHPK1746120 12/1/2017 12/1/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COEaMBINED accident SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ p' ALL OWNEDSCHEDULED AUTOS AUTOS PHPK1746120 12/1/2017 12/1/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident PIP-Basic $ 10,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 PHUB609399 12/1/2017 12/1/2018 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTEI ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Abuse & Molestation APP101197126 12/1/2017 12/1/2018 3,000,000/$3,000,000 One/All Victim A Professional Liability PHPK1746120 12/1/2017 12/1/2018 $1,000,000/$2,000,000 Each Incd/Acc DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Clearwater Parks and Recreation Department is an additional insured under the terms and conditions of the general liability and automobile policies with respect to work performed by the named insured per form PI-GLD-HS (10/11) . Umbrella coverage is follow form to the underlying liability coverages as shown above. CERTIFICATE HOLDER CANCELLATION (727)562-4825 sandra.clayton@myclearwate SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Parks and Recreation Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Avenue Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE Tee Grizzard/PEGA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)