CERTIFICATE OF LIABILITY INSURANCE (3) Oct 08 18,02:14p P3
CERTIFICATE OF LIABILITY INSURANCE 101 8120�"
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA-mcN ONLY AND CONFERS NO RH3KTS 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 ISSIfING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODLICER,ANOTI E CERTIFICATE HOLDER
IMPORTANT: it die certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. It SUBFICGATION IS WAIVED,subject lo the
farms and condrions of the policy.certaip pollcMs may regukv an endorsement A statement on this certirlcate does not comer rights to i:he
ceriikate hMer in WU 4'i sIICIT elldoysemetli(s)..
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Veracity insurance Solutions,LLC. 4$44)-520-6952 W € a o
260 South 2540 Wes:,Suite 303 rL __in oo0f hp-mgc rarn.cyln
Pleasant Grove LIT 84 062 INaLF Re I$I AFF{YRkItIt6 GDVffkAa€_ ttAIC V
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Edward Bates,DBA Kinney's Kitchen rRC
1540 Club Dr t®:
Tarpon Springs R- 34688 waatrtsleE m _ -- I
COVERAGES CERTIFICATE NUMBER,. REVIMN NUMMI :
TTI IR IS TO C:ER71FY THAT THE PMICIES 011 INSURANCE LIV7eD OFLOW HAVE BEEN fsw'UEU T'4 THE INSURED NAMED ACOVE M9 THE Policy Fmdo
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ININCATI•`_rS- NOTVATHSTANDiNG ANY WQtIIREM94r.TERM OR CCNRI71ON OF ANY CONTRACT OR EITHER.DOCUMENT VATH nm—ECT TO WHICH THIS
CERTIFICATE MAY Bl=ISSUED OR MAY PER-WN.THE m9URANCE AFFORDIEC BY THE POLICIES DESCRISED HEREINiS SUBJECT TO ALL THE TEtWS,
EXCLUSIONS ANIS CONDITIONS OF SUCH POLICIES.LlUrrS SHDWN MOW HAVE BEEW REDUCED BY PWD CLAIMS,
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oE5G152PYKW Of OPM110415 I LOCATIOM I. (Ahab ACORD 181.Ask"gnai Rawks R a rows paes h"quint*
Certificate holder had tseen added as additional Insured regarding the above mentioned policy per attached
Additional Insured- Lessor-of Leased Equlpirlent(CG 20 34 Ed.C14 13)
CERTIFICATE 14OLVER CANCEL.LAnoN
SHOULD ANY OF THE ABOVE DEESCRIBE3 POLICIES BE CANCELLED BEFORE
City Of Clearwater THE EXPIRATION DAA7E THEREOF, NOTICE WILL BE DELIVERED iN
ACCORDANCE YA'TH THE.POLICY PROV=NS'...
2116 Myrtle Ave
Clearwater FL 33755 AUTtloatreen RLPrt gttT1T041
tD 1988-=14 ACORD CORPORATION. All rights rrescf d.
ACORD 25{2a 14011 The ACORD name ants logo ars registemd rnarks or ACORD
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Oct 08 18,02:13p P.1
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30 1 E.Fourth Streo t,25 S
Pow by Veru1risumrwo Cincinnati,OH 462*2-4201
SoPillons,LLC
COMMERCLAIL GENERAL UABILITY COVERAGE PART.OCC-1-1.0-01ENCE FORM
CERTIFICATE PAGE
IT IS AGREED THAT THIS CERTIFICATE IS BSUED TO THE CERTIFICATE HOLDER LISTED UELOWTO CeRTIFYCOVERAGE
UNDER THE COMMERCIAL GENERAL LIABILITY INSURANCE MASTER POLICY LISTED BELOW
INSURANCE COMPANY.GREAT AMERICAN ALLIANCE JNSURANCE COMPANY POLICY NUMBER:
NAMFD INSURED:BEAUTY HEALTH&TRAuF ALLIANCE PL1744427
CERTIFICATE HOLDER.Edward Bates,DBA Kinney's Kitchen
ADDRESS:1540 Club Dr.Tarpon Springs,Flonda 34689 CERTirICATE NUMBER:
POLICY PERIOD:0810412018 to 0811(1412019 12101".Sftndad n— I 1h.Add,.—I Th.Ge lfi¢a1c F051902
H.1d.,
UMI[TS OF INSURANCE
General Aggregate Limit(Other than Products-Completed Operations) $ 2,000,1000
Produce-Completed Operations Aggregate Limit 3 4000.000
Personal and Advertising Injury UmA $ 1,000,000
General Each Occurrence Limit $ 1,000,000
Damage to Premises Dented to You Limit 300,000 Any One Promises
Medical Expense Limit 5.000 Any One Person
Pro-las sio nal Coverage Extension $ Stet Purchased Each Claim
$ NotPurchased Aggregate
Prolessio"I Coverage Deductible $ Not Puffchased Each Claim
Liabdity Dedtoctible None
lde n 6 y Reco very Co vera go Aggre gate Limit 15,000
Identity Recovery 0*wera go Deductible, 250
FORM Of BUSINESS:Sale Prop 6elor/Ind ivid ua I
PREMIUM: $ 351
BHTA Fee., $ 84
TOTAL ANNUAL COST: $ 435 (The cost Is 100% earned1non refundable)
CODE NUMBER. 11168 PREMIUM BASIS.Gross Sales EXPOSURE:$50.001-$100,000
CLASSIFICATION:Vendor-, Distributor,or Manufacturer of food ptoducts
THIS INSURANCE IS$MECT TO ALL THE TERMS AND CONDMNS,INCLUDING APPLICABLE ENDORSEMENTS,OF THE
COMMERCIAL GENERAL LIABILITY INSURANCE MASTER POLICY.A COPY OF THE COMMERCIAL GENERAL LIABILITY
INSURANCE MASTER POLICY ACCOMPANIES THIS C ER.WCATE.ADDITIONAL COPIES WILL BE PROVIDED TO THE
CERTIFICATE HOLDER.PLEASE READ THE POLICY AND ALL ENDORSEMENTS.
NO ADMISSION OF LIABILITY MAY BE MADE EITHER VERBALLY OR IN WRITING
FULL DETAIL OF ANY INCIDENT SHOULD BE SENT IMMEDIATELY BY EMAIL TO LAIM SOWRACITPINS OR BY LETTER
TO VERACITY INSURANCE SOLUTIONS,LLC 260 SOUTH 2500 WEST Su 'E-aGZ.-PLEASAN- VE.U I 84U 62
FORMS AND ENDORSEMENTS appflQablu to all Coverage PaM and made part ofM PoFcy at time of issue are 15-ted an
the attached Forms and Endorsements Schodde IL 88 01(11185).
ADMIN*TRATEJ?5
IJAI
TO
Vemcityinsurance Solutions.LLC
260 South 25014 West Suiie 303
1519asant Grove Utah 84062'
SR"68-05413
ADMINISTRATOR'S SIGNATURE:
Oct 08 18,02:14p p2
CG 20 34 (Ed.04 13)
PLI744427-FO519G2
THIS ENDORSEMENT CHANGES THE P 0 LICY.P LEASE READ IT CAREFULLY.
ADDITIONAL INSURED- LESSOR Of LEASED EQUIPMENT -
AUTOMAT IC
AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU
This endorserr*nt modifies insurance provided under the I oilowing:
CCMNIERCAL GENERAL LMKJTY COVERAGE PART
A. SECTION 11 - VMO IS AN INSURED is B. With respect to the insurance afforded to
amended to include as an additional insured these Additional Insureds, this insurance does
any person(s) or organization(s) from whom not apply to any "occurrence' which takes
you lease equipment when you and such per- place after tare equipment lease expires.
son(s) or organization(s) have agreed in writing
in a contract or agreement that such person(s) C. With respect to the insurance afforded to
or organization(s) be added as an additional these Additional Insureds. the following is ad-
insured on your policy. Such person(s) or or- ded to SECTION M - LIMITS OF INSUR-
ganization(s) is an insured only with respect to ANCE:
liability fur "body injury;' "property damage'
or 'personal and adveflising injury' caused, in The most we wd! pay on behalf of the Addi-
whole or in part, by your maintenance, operation tional Insured is the amount of insurance:
or use of equipment leased to you by
such peyso n(s}o r o rqanizatio n(s).
1, required by the contract or agreement you
However, the insurance afforded to such ad- have entered into with the Additional In-
ditionat insured: sured:or
1. only applies to the extent permitted by 2. available tinder the applicable Urnits & In-
law;and surance shown in the Declarations:
Z. will not be broader than that which you
are required by the contract or agreement vAiichever is less.
to provide for such additional insured.
A person's or organization's status as an addi- This endorsement shall not increase the ep-
tional insured under this endorsement ends plicable Limits of Insurance shown in the Dec-
when their contract or agreement with you larations,
for s uch leased equipment ends
Copoght,ISO Properties,Inc,2012
CG 20 34 (Ed.04113)