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CERTIFICATE OF LIABILITY INSURANCE (3) AC V CERTIFICATE OF LIABILITY INSURANCE r DATE(MMIDRIYYYY) 03/2812018 THIS CERTIFICATE IS.ISSUED AS A {NATTER 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[iesy 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 endors ement(s]. PRODUCER CONTACT NAME: Colleen B.Burke _ Burke Insurance Services, Inc PHONE Lsl�Nom ]: 94727-441-30 7q 277-449-0102 P QBox 1134nfl R` ss _colburke@hotmail.Gam _TM Dunedin, FL 34697 INSURER 5 AFFORDING COVERAGE NAIC# INsURERA; United 5tatesLiatiiEi> Insurance Cpmpany INSURED INSURER B: Florida Worker GpmpeilsatignJoint Underwriting Assr': Youth Development initiatives; Inc. INSURER C: ' 900 Martin Luther King Avenue Clearwater,.FL :33755 INSURER D; INSURER E: INSURER F: m...........—...�...-...�..m..._._......_.v__....__ � . COVERAGES CERTIFICATE.iNUMBER: 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- NOTWITHSTAND].NG ANY REQUIREMENT,TERMOR CONDITION OF ANY CONTRACT OR.OTHER DOCUMENT VATH 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. §Y6RPpCY EFF POLICY EXP T �....._" LTR' TYPE OF INSURANCE POLICY NUMBER MMIpR1YYYYLS �(MMIDDffYYYI LIMITS A COM MERCIALGFNERALLIABILITV x NPN555973808101.12017 .asiailzo1s EACHOCCURRENDE $ 1,000 000 F OCCUR DAMAGE TO RELATE CLAIMS-MADE ❑ . i _EMI,S�ES(Ea oocurrenc9 $ 100,000 }XI Sexual Abuse.&Molestation i MED EXP(Any one per s 5,D00. � wEach Claim 1,QOD,aQI} 1PERSONAL&ADV INJURY' S 1,Oa9,40D. GEN'LAGGREGATE LIMITAPPLIES PER. I GENERAL.AGGREGATE $ 2,000,0.00 I JC POLICY DPRO- r,^ ]ECT LLOC. E PRDDVDTS-DDMPlDPAGG S 1,ODO;DOD OTHER:. E $ _m. ..._. .. A 'I AUTOMOBILE LIABIUTY Ix I COMBINED.SINGLE LIMIT $ 0810112017 08101/2018 JEa eccder;li...w...� BODILY INJURY Per person). $ ANY AUTO I _ I Pe ). IP ALL AUTOS SCHEDAUTOSULED i BODILY INJURY(Per acradent] S NON-OWNED'. PROPERTY DAMAGE $ x H1RE❑AUTtaS AUTOS 1 Per accident w ; i Included in Aggregate s 2,000,000 UIrSBRELt:A L)AB ; ;OCCUR EACH OCCURRENCE S EXGESSUA9 CLA1M51v4ADE= AGGREGATE u� 5 _ i_ ....M.._�...._ DED RETENTION 5 3 WORKERS COMPENSATION f 10312fi12018 I)312fiI2(319 )( PER.. LOTH.. B 5F13UB-7D75466-6718 STATUTE + ER _ AND EMPLOYERS'LIABILITY I; ANY PRDPRlE70R1PARFNER)ExECU7IVE N f E.L..EACHACCIDEW S 100,000- OFFICERIMEMBER EXCLUDED? H I A [ 1(Mandatory in NH] E.L. LELtASE-EAEMPLOYEE $ 100,000 J,yes;.describe under. ""'""'"" (DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT I S 500,000 P DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES(ACORD 101,Addlitonal Remarks Schedule;may be aKached.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 ri.Ll@ THE EXPIRATION .DATE' THEREOF, NOTICE WILL. BE DELIVERED IN 900 Martin Luther Kin PlVe ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater,:FL 33755 AUTHORIZED REPRESENTATIVE. Colleen B.Burke ©1988=2014 ACORD CORPORATION. All rights reserved. ACO RD 25(2014101) The ACORD name and logo are registered marks of ACORD