CERTIFICATE OF LIABILITY INSURANCE Client#.4416 ARCTAMPAI
ACORD. CERTIFICATE OF LIABILITY INSURANCE 0513012917
L
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO IRIGHTS UPON THE CERTIFICATE-HOLDER
THIS,
CERTIFICATE DOES NOT AFFRMATIVELY-OR NEGATIVELYAMEND,EkTEND 10RALTER THE%COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSPRANCIE DOES NOT CONSTITUTEA CONTRACT BETWEEN.THE ISSUING IN§UREk(S),,AUTHORIZED
REPRESENTAnVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certirl0ate,holder to an ADDITIONAL INSURED,the policypes)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and conditions of the polity,certain policies rnay' require art endorsement.A statenvent on this cerfirpq
I cat does not confer rights to the
certificate holder in lieu at such endorsernent(s).
PROIJUCER CONTACT
Bouchard Insurancei,.Ind. NAME: PAX
��727 447-64a1 727449-12,67
101 IN Starcrest Dr. AIE.ML
ADPR s. certificates@bquchardinsurance.'co
65m
Clearwater,FL 337Ea . '
727 447-6481 INSURER(i)AFFORDW6 CoVERAcE. NAIC#1
INSURERA:MW4.16ibbW 10829
IN3URED INSURERI S 35378
The Arc Tampa Say,Inc.
1601 Npirth-Balcher Rd,Ste 249 INSURER-C
Clearwater,FI. 33765-11102 INSURER D,
INSURER E-
INsukr:R F z
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF-INSURANCE LISTED. BELOW HAYE BEEN-ISSUED TO THE INS URED.-NAMED ABOVE FORTHE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONWTIONQF�ANY CONTRACTOR OTHER DOCUMENT'WITHI RESPECT TO WHICH TH.is
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-,PAIU,CLAIMS.
IN
TYPEOFINSURANCE tAI1DLR WV0rUI1 POLICY EXP_
NSJ
POLICY
POLICY NUM4ZR (MM122= imming= LIM"
A G ERAILLtABILrrY -Y Y FITGL409422017 D61011 017_11116101112018 "CHOCCURRENCE, $1,000006
_X COMMERVIALUEN15RALLIABILITY YA A13E E11UTME11_a;21
_R $1,060,000
_tady
X2
A
J.00CUR MW EXP.(Any one pemoM sll[l.-00
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE
GFNIL AG43REGATF UMIIT APPLIESPER. rZID-ICTS-COMPIOP'as x3'000'0001
PO_
X POLICY OJPECT El Loc I I
Auromowua UARILMY Y Y FITA640942�017 00101/2017 061011201 =NE.D SINGLE LIMIT
cd*A) 0,000,000
v ANY AUTO BODILY INJURY(Pw pmon) S
SCHEDULE
ALL OV,WCQ D
AUTOS AUTOS BODILY I NJURY(Pur acddanQ $
HlSED AUTOS, x NOWOWNED 'Y DAMAGE $
AUTOS,
$
A LI M BREULALIAB I x i Occw Y Y FITXS4094220.17 610112017 06)011201 EACH OCCURRENCE
ENCE $2.000,000
X EXCESS LIAR CLAW&MADE AGGREGATE $2,000,000
Dto I _I KATE TION$ $
B, WORKERS COUPENSAMN 0
AND-EMP'L0YSRWUAOiLftY FrrWC409422017 0610112017 0610112 v%vjcsTATLI 1 'On'-
YIN QRy_1Nl1aJ__LFa_
ANY PRQPRJETOkiPARTNER1EXECUTr4E NIA r:.L.A�NdHACCIDENT_ s2LO&D,000
OFFICeIRIMEMBtll FXCLUDED7
Ilaanaaiveyon VIII F-L.USEASE-F-A EMPLOYEE i2,000,000
�YENd'[`I`�Mt t0x�MPEPAT ION S:b.Iw E.LML
SEASE-POLICY IMIf t2'00
A- Professional Liab Y Y FITGL409422017 )6/011201710610112018 $1,000,00043,000,000
A AbluselMolestation Y I Y FITGL409422017 D6/011201710610112018 $1,000,0001$3'000,000
IDESCIMPTION OF OPERATIONO I LOCATIONS IVEHICLES(Attach ACOROAD1.A4,diVe 6al Remarks Schedule,Il imr6 apdev Is iaq uwscq.
Certificate holder is,additional-insured as respects General Liability,Professional essional&AbuWMOJestation,
Auto&Excess.only if required by written c4ntradt,-and subject to the terms,conditions-and exclusion as
specified In,the policy.
(-96e Attached 1)6sceiptkons)
CEPTirICATEMOLDER CANCELLATION
THE CITY OF CLEARWATER SHOULD ANY'OF THE-ABOVE 0.ESC I RIBED POL.ICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO'BOX 4148 ACCORDANCE WrTH-'THE POLICY PROVISIONS.
MtARWATER,FL.33756
AUTHDRIZEti REPRESENTATIVE
1988-1010 ACORD CowPORATION;All rights reserved.
ACORD 26(2010105) 1 of2 The ACORD name and logo are registered marks of ACORD
#86836711M68365.0 ROBST
�sv--\ &
C? CRI PTlS { ant�nu�d dram ige.
A waiver bf subrogation applies in respect to General Liability,Professional&Abuselmolestation,Auto
Liability,Excess Liability Wherc•required by wri#ten contract.
Excess is follow form.
RE:THE LONG CENTER,1501 N BELCHED Flt}.,CLEARWATER,Ft 33706
s,aGirrA 25.3�2001o5) 2 of 2
6$3671IM683650