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CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE OF LIABILITY INSURANCE F DA.TEIMMMDFYYYYI --^ 1 3/16/2018 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 polcy(ies) must have ADDITIONAL INSURED provisions or 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 NAMRR Kelly Nape _.. Arthur J. Gallagher Risk Management Services, Inc. PHONE _m. .. -FAX 407370-3057 200 S. Orange Avenue 1AIC,NO,Extr IAIC,3Vr] Suite 1350 E-MAIL MAIL Kell _Nace a Co — _ADDRESS____ _ � m _.... ... � ..___ ---...___....,... .._ _. Orlando FL 32801 �r�sURERtsjelRFo�DINccovERACE NAic# -INSURER A:United Educators Ins 10020 INSURED FLORCOL-01 INSURER B:Safe ..IYatie�nal Casualty COrp_oration 115105 -11 — _ St. Petersburg College INSURER C:Qualified Self Insurer PO Box 13489 _- St. Petersburg, FL 33733-3489 INSURER D: rNSURER E _... INSURER.F COVERAGES CERTIFICATE NUMBER:993774080 REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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 'a` SURRA POi.ACY EFF rfOLICY E%P�' ,.-.-.._.- LTR'. (. D wVD I POLICY NUMBERMM7DDIYYYYI (MNUDD1YYYY1 LIMITS A ! X COMMERCIAL GENERAL LIABILITY I I !06930 31112018 ' 3/112019 EACH OCCURRENCE $8030,000 -.. ...__ IAGE TO FYEP+I`E17 .... CLAIMS-MADE j X OCCUR PREMISES �t 1 j DR EMISESI� ceurren $ i MED EXPLAane person) $ i ......; ...... _...._�.._.„ _._._ !. IPERSONAL&ADV INJURY I$ GENL AGGREGATE LIMIT APPLIES PER ; G FRO- t GENERAL AGGREGATE $3,200,000 POI-ICY, JEOT I ,....I LOC PRODUCTSCOMPIOPAGG S Is A (AUTOMOBILE LIABILITY J06930 31112018 31112019 ,GO acca�dentJ,IN L 1 5800,000._.. .ANY AUTO,. ........._. .—... . _. I BODILY INJURY(Per person) Sa l OWNED SCHEDULED I AUTOS ONLY .._._ AUTOS BODILY INJURY(Per accVdenk)�S _^.,. .. HIRED NON-OWNED AUTOS ONLY AUTOS ONLY I PRO0PERTY I} MAGE Per acpidanl) A UMBRELLA LIAR X JQ693Q 1 31112018 31112049 ...1 L3CGSIR EACH OCCURRENCE $4,000,000 I X 7 EXCESS UAB .. l CLAIMS MADEI _ 1, -. .- _ .._� AGGREGATE -_......-_ S4^0001040 DD X RETENTION 51,400,4441 , .. (5 ... B I WORKERS COMPENSATION SP4058295 31112018 31112419 X AND EMPLOYERS"LIABILITY PER OTH Y 8 NI STATUTE,., Eri. --a ANY PROPRIETORIPARTNE:R/EXECUTIVE I ._. iOFFICEMMEMB.ER EXCLUDED? � N I A i ( E.L..EACH ACCIDENT J$2 000 000 1(Mandatory In NH) I.DISEASE EA EMPLOYEE $2 000,000 Ifes ppdescdt)e under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $2,000,000 C WORKERS COMPENSATION RMC20180301 31112418 311124119 Seltlnsured $754,444 AND EMPLOYERS LIABILITY I � I Retention I DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(ACORD 101,Additional.Remarks Schedule,may be attached If more space Is required) "General Liability and Auto Liability policies shown above are subject to a self-insured retention of$200,000 per occurrence. Excess Aggregate applies to Products, Completed Operations, Employee Occupational Disease, Sexual Molestation and Athletic Traumatic Brain Injury.' License to use multiple sites for athletics CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Bax 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758-4748 AUTHORIZED REPRESENTATIVE rr r X71888-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,` ►" CERTIFICATE OF LIABILITY INSURANCE DATE IhJlMtIJ C31YYYYj 2121I201 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. It the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 endorsements PRODUCER CONTACT Arthur JAME !felly Nace Gallagher Risk Management Services, Inc.InoPRONEiAx {nu — 4177-370-3057 200 S.Change Ave c No,Ext!. _ I A1C,Nal Suite 1350 ADDRESS,Keily_Nace@ajg.com Orlando FL 32801 INSURERIS)AFFORDING COVERAGE NAIL# _ INSURERA:Qualifiied Self Insurer INSURED ,.INsuREREI:Safety"„National Casualty Corporation 15105 St. Petersburg College INSURER c PCI Cox 13489 St. Petersburg, FL 33733-3489 INSURER 0: INSURER€ .... .._.._.. __._.u INSURER F: COVERAGES CERTIFICATE NUMBER: 1701236479 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. ,AOOL'9UBR ____.. "......_ LTR TYPE OF INSURANCE INSO wVD POLICYNUMBER MMLId-y- r ' MPOiIrur7drY'YEYYY -.......— _LIMITS _.......-- A x COMMERCIAL GENERAL LIABILITY RMC20180301 3/112018 311'2019 EACH OCCURRENCE 5200,000 .__ ......._. CLAIMS-MADE x OCCUR CA MAGE TORENTEDPRE,MISES_{E_a occ.rrrenoe � ...... MED EXP(Any one person PERSONAL.S ACV INJURY S ...... ____. OENL AGGREGATE LIMIT APPLIES PER ..... GENERAL AGGREGATE $ PRO- POLICY ( PRC- LOC .._ _. ....._. _ JECT PROs`UCTS-COMPIOPAGG S OTHER: Ea Occurrence Agg 5300,0L30 __ A AUTOMOBILE LIABILITY :RMC20180301 31112'.018 311/2015 COMBINED N L.:LIMIT.. u ANY ALTO (kaaccioentr ._ .... BODILY INJURY(Per person) 5200,000 x OrVNED SCHEDULED AUTOS ONLY .._,AUTOS I � BODILY INJURY(Per acadent)I 5300.000 ..._ HIRED Nl7N-r7`r^.'NFD r X AUTOS ONLY X NON-0 ONLY bROPERTY DAMAGE Slncluded (Par acc dent) I� UMBRELLA LIAR OCCUR EACH OCCURRENCE _ e EIXC11 ESS LIAR CLAINIS MFDE_: I { .AGGREGATE 5 �DED_ ..-._.RETENTION$ ...__ _... S ..._ _..._ B WORKERS COMPENSATIONSP4058255 3/112018 3/1/2019 PER OTH ” AND EMPLOYERS'LIABILITY Y 1 N `'... STATU"TE_ ANY PR OR E'TCR PARTNER EHEC"UTiVE �"'�"�..,.N 1 A( E L EACH ACCIDENT .._ 52 000 00(0 O,I -.. FICER- MEMBEREXCLUDED't _... ..._ _ IMandatory In NH) E.L.DISEASE-EA EMPLOYEE;52,000 004 ...... I€yes describe under — ....... DESCRIPTION Ow OPERATIONS below E.L.DISEASE-POLICY LIMIT '$2,000,000 A !WORKERS COMPENSATION RMC20180301 31112018 31112019 !Self insured $$750,000 AND EMPLOYERS'LIABILITY iFtetelttican DESCRIPTION OF OPERATIONS I LOCATIONS F VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CL-Self Insured per Florida Statute 768.28-$200,000 per Person 1$300,000 per Occurrence Aggregate, WC-Statutory Excess of$750,000 Self Insured Retention. License to use multiple sites for athletics CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WELL BE DELIVERED IN PC Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758-4748 AUTHORIZED REPRESENTATIVE C 1988-2015 ACCIRD CORPORATION, All rights reserved. ACORD 25(20'!81'03) The ACORD name and logo are registered marks of ACORD