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CERTIFICATE OF LIABILITY INSURANCE (2) DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 11210512017 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 NAME: Colleen B.Burke Burke Insurance Services, Inc a/c°"N Ext: 727-441-3094 (AIC,No: 727-449-0102 P O Box 1134 AD REBS : colburke@hotmail.com Dunedin, FL 34697 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United StatesLiability Insurance Company INSURED INSURER B: Florida Worker Compensation Joint Underwriting Ass( Youth Development Initiatives, Inc INSURERC: 900 Martin Luther King Avenue INSURER D: Clearwater, FL 33755 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 COMMERCIAL GENERAL LIABILITY X NPP1566973B 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,000,000 DAM CLAIMS-MADE X OCCUR PREM SESOEa occurrDence $ 100,000 Sexual Abuse& Molestation MED EXP(Any one person) $ 5,000 X Each Claim $1,000,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JjRO- ECT [::] LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY X 08/01/2017 08/01/2018 EOa acnt ccidesINGLE LIMIT $ NPP1566973B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOSX NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Included in Aggregate $ 2,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS'LIABILITY Y/N 6F 13UB-7D76466-6-17 03/26/2017 03/26/2018 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder Listed below is Additional Insured with respects to Commercial General Liablity and Commercial Automobile. CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 900 Martin Luther Kin Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN King ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33755 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