CERTIFICATE OF LIABILITY INSURANCE (18) ACC)IREP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
1 01/03/2019
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATI(57N—
East Main Street Insurance Services,Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Will Maddux HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 1298 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Grass Valley,CA 95945
Phone:(530)477-6521 Email:info@theeventhelper.com INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Evanston Insurance Company 35378
Listen Here!Records/Vellamo&Joni Tiala INSURER 8:
Pia Leirionen
254 Lawrence Drive NSUI R,ER-C: .......
West Townshend.VT 05359 INSURER D:
................................................
INSURER E!
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
IN ADD-11- POLICY EFFECTIVE-ECTIVE-PO-LI-CYEXPIRATl&-N LIMITS
LTP IN S" TYPE OF I NS URAN C E POLICY DATE(MMiDDffY1 DATE IMMfDDTYYI
EACH OCCURRENCE INCLUDE-,
GENERAL LIABILITY S 1,000,000
-
SOGILY INIJTIbPROPER"bAMAgE
A I X COMMERCIAL GENERAL LIABILITY 3DS5466-M 1125446 01/22/2019 01/23/2019 MED EXP(Any one parson) 5.000
CLAIMS MADE OCCUR' 12:01 AM 12:01 AM PERSONAL&ADV INJURY 11000,000
...........
-.....I'ost
.....Host Liquor Liability GENERAL AGGREGATE $ 2.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG , $ 1,000,000
--- -] PRO- E LOC i $ ----
POLICY DEDUCTIBLE 1 1,000
Retail Liquor Liability Wu $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
............................... Y.
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS (Per person)
................
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE S
(Par accident)
GARAGE LIABILITY AUTO ONLY-EAACCIDENT
ANY AUTO OTHER TITAN EA ACC, S
AUTO ONLY AGG I $
EXCESSfUMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
..........
DEDUCTIBLE
RETENTION $ $
ATU- OTH-
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE B.L.EACH ACCIDENT.............. $
OFFICERIMEM13ER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
If yes,describe under ........ ----
SPECIAL
....................................
SPECIAL PROVISIONS below E,L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS
Certificate holder listed below is named as additional insured per attached CG 20 26 07 04,
Attendance:60,Event Type:Concert-Folk Music.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn:Rosanne Lacey DATE THEREOF,F,TH E ISSUING INSURER RER WILLwMAI L30
DAYS WRITTEN
City of Clearwater P.O.Box 4748
Clearwater,FL 33758 NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT,
M PQ 6 E P 1 9 086'GA:RG N 0 R WAS 0 F AN*KIP!13 WPO 11 Tl 16 6 WRER,1%AG Ell 1*16 0 F4
REPRESEN*A*1k%&-.
AUTHORIZED REPRESENTATIVE
ACORD 25(2001/08) 0ACORD CORPORATION 1988
Policy Number: 3 D S5466-M 1125446 COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Persons Or OEganization(s)
City of Clearwater
Attn: Rosanne Lacey
City of Clearwater P.O. Box 4748
Clearwater, FL 33758
Information required to com2lete this Schedule, if not shown above, will be shown in the Declarations.
Section 11 — Who Is, An Insured is amended to in-
clude as an additional insured the person(s)or organi-
zation(s) shown in the Schedule, but only with respect
to liability for "bodily injury", "property damage" or
"personal and advertising injury" caused, in whole or
in part, by your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A, In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
Cr. 2n 2A n7 04 nc i.,;n Prr)nprtipq Inn qnn4 pang 1 of 1 r_1