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CERTIFICATE OF LIABILITY INSURANCE (20) Client#: 26072 FIELDSIN DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 3/28/2018 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 policy(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 any 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: (A/C,No): 101 N Starcrest Dr. E-MAIL ADDRESS: cicerts@bouchardinsurance.com Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIC# 727 447-6481 INSURER A: Specialty United S ecialt Insurance Co 12537 INSURED INSURER B Fields Inc. dba Barefoot Beach House INSURER C: 332 S. Gulfview Blvd. Clearwater, FL 33767 INSURER D: 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. ADDLSUBR LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y USA4159779 01/14/2018 01/14/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE [*OCCUR PREMISESOEa occur°nce $100,000 X Hired/Non-Owned Auto MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECT R - FLOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Clearwater is additional insured as respects to General Liability only if required by written contract,and subject to the terms, conditions and limits as specified in the policy. CERTIFICATE HOLDER CANCELLATION Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A Municipal Corporation ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S840492/M796774 DANSU CGL 1732 1216 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY . HIRED AUTO AND NON-OWNED AUTO LIABILI TY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Insurance is provided by this endorsement only with respect to those coverages for which limits and a specific premium charge is shown below: Coverage Limits Additional Premium Non-Ownership Liability $ 1,000,000 Per Occurrence $ 175 $ 1,000,000 Non-Owned Auto Aggregate Hired Auto Liability $ 1,000,000 Per Occurrence $ 175 $ 1,000,000 Hired Auto Aggregate The limits shown above are included within the limits shown on the Declarations page and do not increase those limits. Payments we make due to coverage provided by this endorsement will reduce the limits for this coverage and those limits shown in Declarations. A. Insurance is provided only for those coverages 2. The following exclusions are added to for which a specific premium charge is shown in Section I. Coverage A of the Commercial the Declarations or in the Schedule above. General Liability Coverage Form: 1. HIRED AUTO LIABILITY This insurance does not apply to: The insurance provided under the a. "Property damage"to: Commercial General Liability Coverage Form, Section I. Coverage A applies to (1) Property owned or being transported "bodily injury" or "property damage" arising by, or rented or loaned to the out of the maintenance or use of a hired insured; or auto by the Named Insured in the course of (2) Property in the care, custody or your business. control of the insured. 2. NON-OWNED AUTO LIABILITY b. "Bodily Injury' or "Property Damage" The insurance provided under the arising out of the act of operating a Commercial General Liability Coverage hired auto or non-owned auto in order to Form, Section I. Coverage A applies to deliver food, beverages, or other goods "bodily injury" or "property damage" arising off the premises. out of the use of any non-owned auto in c. "Bodily injury' to occupants of a non- your business by any person other than owned auto or a hired auto. you. d. "Bodily injury" or "property damage" B. For insurance provided by this endorsement arising out the auto business. only: e. "Bodily injury', "property damage" or any 1. Exclusion g. Aircraft, Auto or Watercraft, other claims against any party other under Commercial General Liability than the Named Insured. Coverage Form, Section I. Coverage A 2. Exclusions is deleted. CGL 1732 1216 Page 1 of 2 CGL 1732 1216 f. "Bodily injury" or "property damage" (3) Any person while employed in or arising out of any shuttle service, public otherwise engaged in duties in or livery conveyance or any other connection with an auto business, activity involving transport of other than an auto business you passengers or cargo for hire. operate; g. "Bodily injury" or "property damage" (4) The owner or lessee (of whom you arising out of the use of a non-owned are a sublessee) of a hired auto or auto or a hired auto for any outside the owner of a non-owned auto or sales activity. any agent or "employee" of any such h. "Bodily injury" or "property damage" owner or lessee and; arising out of or alleged to arise out of (5) Any person or organization for the the rendering or provision of services conduct of any current or past related to driver education. partnership or joint venture that is 3.VVHO IS AN INSURED in the Commercial not shown as a Named Insured in General Liability Coverage Form, Section the Declarations. II., is deleted and replaced for the purposes C. The following additional definitions apply for the of this endorsement by the following: purposes of this endorsement: a.Only each of the following is an insured 1. Auto Business means the business or under this endorsement to the extent set occupation of selling, repairing, servicing, forth below: storing or parking "autos". (1) The Named Insured (also identified 2. Hired Auto means any automobile of the as you or your); private passenger type you hire, borrow or (2) For a non-owned auto, any partner have use of on a temporary basis. This or "executive officer" of yours, but does not include any "auto" you lease, hire, only while such non-owned auto is or borrow from any of your "employees" or being used in your business; and members of their households, or from any partner or "executive officer" of yours. This (3) Any other person or organization, does not include any "auto" you lease or but only with respect to their liability hire for a period of time in excess of five (5) because of acts or omissions of days. an insured under (1) or (2) above 3. Non-Owned Auto means any automobile and arising out of the named of the private passenger type you do not insured's business. own, lease, hire or borrow which is used in b. None of the following is an insured: connection with your business. However, if (1) Any person engaged in the business you are a partner-ship, a non-owned auto of his or her employer for "bodily does not include any "autos" owned by a injury" to any "employee", or to the partner. spouse, child, parent, brother or 4. Automobile of the private passenger sister of that co-"employee" as a type means: consequence of such "bodily injury", a. a motor vehicle of a private passenger or for any obligation to share or station wagon type body; or damages with or repay someone else who must pay damages b. a motor vehicle with a pickup type body, a delivery sedan, or a van. because of the injury; (2) Any partner or "executive officer" for Note: "auto" continues to have the meaning any "auto" owned by such partner or defined in this policy and would include hired officer or a member of his or her auto and non-owned auto. household; ALL OTHER TERMS AND CONDITIONS OF THIS POLICY APPLY CGL 1732 1216 Page 2 of 2