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CERTIFICATE OF LIABILITY INSURANCE (5)
DATE(MM/DD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 1�-`' 08/02/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Doug Jones PHONE 480 951-4177 FAX (480)951-4266 c/o Artex Risk Solutions, Inc. (A/C, A/c No Ext: ( ) A/C No: 8840 E.Chaparral Rd.;Suite 275 E-MAILr SDL.BSD.Certificates@artexrisk.com Scottsdale,AZ 85250 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: American Zurich Insurance Company 40142 INSURED INSURER B: Oasis Acquisition,Inc Alt.Emp:CLEARWATER FOR YOUTH,INC 2054 Vista Parkway Suite 300 INSURER C: West Palm Beach,FL 33411 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:18FL075969114 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RE CLAIMS-MADE 1:1 OCCUR PREM SES Ea oNcurrDence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 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 LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEEL EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? ❑ N/A WC 29-38-687-16 06/01/2018 06/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Location Coverage Period: 07/23/2018 06/01/2019 Client# 18925-MAIN DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CLEARWATER FOR YOUTH, INC Coverage is provided for only those co-employees 1501 N BELCHER RD#236 of,but not subcontractors CLEARWATER, FL 33765 to: CERTIFICATE HOLDER CANCELLATION CLEARWATER FOR YOUTH, INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1501 N BELCHER RD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN #236 ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER, FL 33765 AUTHORIZED REPRESENTATIVE tG.+ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and loao are reaistered marks of ACORD