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CERTIFICATE OF LIABILITY INSURANCE (7)AC D® CERTIFICATE OF LIABILITY DATE INSURANCE12/18/2017 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 Burke Insurance Services Inc P 0 Box 1134 Dunedin, FL 34697 CONTACT Colleen B. Burke NAME: PHONEFAX INC No. Ext): 727 441-3094 (ac, No): 727-449-0102 EMAIL ADDRESS: colleen burkeinsserviceS.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ALLIANCE OF NONPROFITS FOR INSURANCE RISK RETENTION 10023 INSURED Dr. Martin Luther King Jr. Neighborhood Family Center Inc 900 Martin Luther King Jr. Avenue Clearwater, FL 33755 INSURER B : 2018-4596 2018-4596 INSURER C : 01/01/2019 01/01/2019 INSURER 0 : $ 1,000,000 INSURER E : INSURER F : A 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A _ X COMMERCIAL GENER�ALLLIABILITY X 2018-4596 2018-4596 01/01/2018 01/01/2018 01/01/2019 01/01/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE A OCCUR DAMAGE TO RX PREMISES (EaEoccur NTEence) $ 50+000 PROFESSIONAL MEDEXP(Anyoneperson) $ 20,000 X DIRECTORS & OFFICERS $1,000,000 PERSONAL & ADV INJURY $ 1,000,000 GE X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 $ A _ AUTOMOBILE X LIABILITY ANY AUTO AL AULTOOWS HIRED AUTOS AUNED SCHEDTOSULED NON -OWNED AUTOS X 2018-4596 01/01/2018 01/01/2019 COMBINED SINGLE LIMIT (Ea accident) $1,000 000 + BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE 2018-4596 01/01/2018 01/01/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A AUTO PHYSICAL DAMAGE X 2018-4596 01/01/2018 01/01/2019 $1,000 COMPREHENS VE DEDUCTIBLE $1,000 COLLISION DEDUCTIBLE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached M more space Is required) 2017 Chevrolet #1 GAWGEFF3H1186307 2017 Chevrolet #1GAWGEFFXH1188779 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER PARKS AND RECREATION DEPARTMENT 100 S. MYRTLE AVENUE CLEARWATER, FL 33756 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE COLLEEN B BURKE ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD