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CERTIFICATE OF LIABILITY INSURANCE (946) I STCLASS INS INC xlsoTAMPA ROAD Cm»Afs?nowL PALM HARBOR,pIL 3468 Named insured Policy number: 03924022-2 Underwritten by: Progressive Express Ins Company September|9,281V ALL AMERICAN CANTEEN|N[ Policy Period;Sep//.Zu1V Sep 17.zu19 4nV4POINCIANA(T Page of PALM HARBOR,ea^oo4 pm0ress|weagent.rmm Online Service Make payments,check billing activity,print policy dommvnt5,mcheck the�tatus of Commercial ommerciaN Auto claim. 1-727-796`2600 N��N�� m�� QN�� 1�c�sINS INC ��"°��===�"°=° ~�~��^�~~~��~~ Summary [vmmct your agent for personalized ewm. This ^ �� | � [� your Renewal 1-800-444-4487 Declarations f~ �� ] For customer mm��yo�ngrmi, ��ec4ar��0ns Na � unavailable mmreport nclaim, Your coverage began unSeptember 17'2O18at12V a.m. This policy expires omSeptember 17'209at 12:01a'm. This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto,unless the policy Contract allows the stacking of limits.The policy contract is form 6912(06/10).The contract is modified by forms 2852FL (10/04), 1852FL (08/12)'475/FL (01/13). 1198(01/04).4852FL (10/04).4881FL (QV13)and ZZ28(01/i11)� The named insured organization typ bacorporation. Outline of coverage Description Limits o�,�h� Premium ---------------------------------------------------------' Liability To Others $3'468 Bodily Injury Liability $100,000 each person5300,000 each accident _pmpe��Damage�UabUhX____________$5I�OODeacha��e�� UninsuredMnmhstNon-Stacked $50,000 each 0lOOOeach accident 568 ---------------------------------------------------------- Basic Personal Injury Protection 240 _Without Work Com |mm�dOn�_____$1�O�OO�ea�ch�p��______________$8 Medical $5,0OD�each person________________________&5 Comprehensive 136 See Auto CoverageS�edu<e �mjtofUabHky|eoded��Ne ----------------------------------------- .......—......— ....... .............. —' Collision 248 See Auto Coverage Schedule Limit ofliability less deductible Subtotal policy premium $4^740 __ _ . ------------------- .............. _ _ ------------- ...... ........ Fes ZO _ Total 12 month policy�premium�and fees $4,760 Discount ifpaid in full _655 ............. _.......... _....................._ .......................... ........ ...... _ ............ ... Total 12 month policy premium ifpaid|nfull $4,105 Bated driver -------------------------------------------------------' l. MATA5HAY|LARET Continued Form a48oI'Lm1o$ Policy number: 03924022-2 ALL AMERICAN CANTEEN INC Page2 of 2 Auto coverage schedule 1 2003 Ford Econo/club Wgn Actual Cash Value (plus$2,000,00 Permanently Attached Equip) VIN: IFMRE11123HB64231 Garaging Zip Code: 34684 Radius: 100 Liability Liability....... �uIM Bl N_P'-I...... Med,Pay-----------................. ... ...... ........ Premium $3,468 $563 $240 $85 Comp comp collision colfisiort Physical Damage DeductiblePremium Deductible Prf!rrijurn ............... Total __.-----------I ....I.........1111111 . . ............ ........ Premium $500 5136 $500 $248 $4,740 Premium discounts Policy ...........1.1...1..---.--.- 0392 022- -----03924022-2 Business Experience and Package Vehicle, ............... ..................... ........... ....................... ............................. ........ 2003 Ford Econo/Club Wgn Anti-Lock Brakes,Air Bag and Anti-Theft Device 2 Additional Insured information ........ .................................. .. ....... ............................. .. .............................................................. ......... I Additional Insured NATASHA VILARET 2690 CORAL LAND PALM HARBOR,FL 34684 Agent signature tk).4t Company officers Secretary Form 6489 FL(01,115) DEPARTMENT OF FINANCIAL SERVICES Division of Risk Management STATE RISK MANAGEMENT TRUST FUND Policy Number: GL-1000 General Liability Certificate of Coverage Name Insured: Department of Education General Liability Coverage provided pursuant to Chapter 284,Part 11, Section 768.28, Florida Statutes, and any rules promulgated thereunder. Coverage Limits: General Liability: $200,000.00 each person $300,000.00 each occurrence Inception Date: July 1, 2018 Expiration Date. July I, 2019 DT--5-DM63 (REIV.07/17) Ac L> CERTIFICATE OF LIABILITY INSURANCE °ATE`MM1°Dff`"YI ll.. 9125/2418 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE 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{les)must be endorsed. If 900169ATIM 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 NAME: Vicki Klooz PHO 11 1 st Class Insurance,Inc. AfCNNv Ext} 727-796 26{10 Ext 103 �( C,.Nog: 888-794-9277 —.. 11SSTampaRoad ADDRESS: bprestl@1 classinsurance.corn -__- INSURER(S)AFFORDING COVERAGE NA1C# - Palm Harbor FL 34683 INSURER A: Hartford Flee Insurance Co INSURED INSURER S: Progressive Insurance 10193 All American Canteen,Inc INSURER C 4004 Poincina Cf. INSURER D: INSURER E:- Palm Harbor FL 34684 INSURER r COVERAGES CERTIFICATE NUMBER: 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 EFl POLICY EXP I_ LTR' TYPE OF INSURANCE INSD WVD, POLICY NUMBER IMMIDDfYYYY) (MNIIDDNYYY) LIMITS X_..COMMERCIAL GENERAL.LIABILITY EACH OCCURRENCE $ 1000000... r- ERCF - DAMAGE TO _ ..._. CLAIMS-!MADE f X�OCCUR PREMISES[Ina occurrence) $ 100000 -- MED FXP(Any one person) $ 10000 ... A 01 SBMRG&042 9/23/2018 912312019 PERSONAL&ADV INJURY $ 14100000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 .X.� JEGT LOC POLICY PRC- l ff7 .. ..... __ ,._ .J PRODUCTS-COMP/OPAGG S 24100000 -- OTHER. ...... ._._. $ AUTOMOBILE LIABILITY IEa ace den13-- $ -- BODILY INJURY Per person) $ ANY AUTO I � �-- ( I1e �1 000()O _. ALL OWNED -..."SCHEDULED f B AUTOS AUTOS 03924022-1 � 9/1712018 i 9/17/2019 BODILY INJURY(Peracddena)€$ 300000 _ _ NON-OWNED ! -PROPERTYDAMAGE— —C -- -- HIREDAUTOS AUTOS (Per accident) —_....-- $ 50000 $ .... UMBRELLA.LIAB OCCUR EACH OCCURRENCE I .... EXCESS LIAR CLAIMS-MADE AGGREGATE $ _... DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS`LIABILITY STATUTE RIH ANY PROPRIETO1tIPARTNERIEXECLiTIVE Y f N E L.EACH ACCIDENT 5 ..._. __ ... ((as d scribe NH) EDS N 1 A -.EL .- .... .O --- SER EXCLUD .-.- .- (Mandatory in � E L..DISEASE EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below , E.L.DISEASE POLICY LIMIT $ I I l DESCRIPTION OF OF f LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule.,may 6e attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE.POLICY PROVISIONS. City of Clearwater 1045 Myrtle Ave AUTHORIZED REPRESENTATIVE Clearwater' FL 33756 7 f # a -- --------- ----- --- 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/41) The ACORD name and logo are registered marks of ACORD