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CERTIFICATE OF LIABILITY INSURANCE (18) A/^ ® �/30/2018 E(MM/DDNYYY) �. CERTIFICATE OF LIABILITY INSURANCE 1740R" 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 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 Pe Amos NAME: Peggy Lassiter-Ware Insurance of Tampa Bay AIM Ext: (800)845-8437 (AIc,No);_c888)883-9680 1300 N. Westshore Blvd E-MAIL ADDRESS:peg A@lassiterware.com Suite 110 INSURER(S)AFFORDING COVERAGE NAIC# ------------------------------------------ Tampa FL 33607 INSURER A:Philadel hia Indemnity Ins. 18058. INSURED INSURER B:Lloyds Of--London Boys & Girls Clubs of the Suncoast, Inc INSURER C: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 4625 East Bay Drive INSURER D: Suite 103 INSURER E: ---------------------------------------------------------------------------------------------------------------------- Clearwater FL 33764 INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 All Lines 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN D WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A ____ CLAIMS-MADE [X] OCCUR .PREMISES„(Ea occurrence) �_$ 100 000 PHPK1912613 _ 12/1/2018 _ 12/1/2019 . MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY _ $--_ 1,000,00-0 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2 000,000 X _ POLICY_ JECT PRO _ LOC -PRODUCTS COMP/OP AGG $ 2,000,000 X OTHER:Professional Liability $1,000,000 Occurrence $ 2,000,000 Agg AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _Ea accident).......................................... A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED PHPK1912613 12/1/2018 12/1/2019 _ BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERTY DAMAGE $ HIRED AUTOS AUTOS {Per accd_e_nt) PIP-Basic $ 10,000 X UMBRELLA LIAB X OCCUR _ EACH OCCURRENCE _ $ 4,000,000 AEXCESS LIAB CLAIMS MADE REGATE $ 4 000 000 ED XDRETENTION$ 10 000 PHUB656152 12/1/2018 12/1/2019 ['99 $ WORKERS COMPENSATION _ PER _OTH .AND EMPLOYERS'LIABILITY Y/N --- STATUTE -------_-ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u N/A _..._ ...._..._. ..._..._..._ ......_... ......._......_... (Mandatory in NH) -E L DISEASE EA EMPLOYE $ If yes,describe under __-- _-- ----- -- -- -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Abuse & Molestation PHPK1912613 12/1/2018 12/1/2019 $1,000,000 Occurrence $1,000,000 Agg B Abuse & Molestation-Excess AC1804877 12/1/2018 12/1/2019 2,000,000 XS$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Clearwater Parks and Recreation Department is an additional insured under the terms and conditions of the general liability and automobile policies with respect to work performed by the named insured per form PI-GLD-HS (10/11) . Umbrella coverage is follow form to the underlying liability coverages as shown above. CERTIFICATE HOLDER CANCELLATION (727)562-4825 sandra.clayton@myclearwate SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Parks and Recreation Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Avenue Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE Tee Grizzard/PEGA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401)