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CERTIFICATE OF LIABILITY INSURANCE (16) Client#: 22073 RUTHECKE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/15/2017 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 NAME: Bouchard Insurance(CLW) PHONE 727 447-6481 FAX 727 449-1267 A/C,No Ext): AIC,No 101 N Starcrest Dr. E-MAILs: cicerts@bouchardinsurance.com Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIC# 727 447-6481 16535 INSURER A:Zurich American Insurance Co INSURED INSURER B:American Guarantee&Liability 26247 Ruth Eckerd Hall, Inc. INSURER C RetaffirstInsurance Company 10700 1111 McMullen Booth Rd INSURER D: Clearwater, FL 33759 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 CONTRACTOR 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 /YLIMITS LTR INSR WVD POLICY NUMBER MM/DDYYY MMIDDIYYYY A GENERAL LIABILITY Y Y CP0017156802 05/31/2017 05/31/2018 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $100,000 CLAIMS-MADE 4 OCCUR MED EXP(Any one person) $10,000 X BI PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY JERo- LOC $ MBINED A AUTOMOBILE LIABILITY Y Y CP0017156802 05/31/2017 05/31/201 COEaINGLE LIMIT accidentS $1,000,000 X 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 B X UMBRELLA LIAB X OCCUR AUC967294109 05/31/2017 05/31/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$0 $ C WORKERS COMPENSATION 052046229 01/01/2018 01/01/2019 X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEF--] E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Abuse/Molestation GLCO17156902 05/31/2017 05/31/2018 $1,000,000/$1,000,000 RETRO: 05/31/2013 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is an additional insured with respect to general liability including ongoing and completed operations,where required by written contract and subject to the terms, conditions and exclusions of the policy. Four parking spaces in#49-52 in City Owned Parking Lot (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S776898/M776890 KEVCO DESCRIPTIONS (Continued from Page 1) Loc#2-405 Cleveland Street; Clearwater, FL Building#1 Capitol Theatre Loc#4- 112 Osceola Ave; Clearwater, FL SAGITTA 25.3(2010/05) 2 of 2 #S776898/M776890