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CERTIFICATE OF LIABILITY INSURANCE (3) POLICY NUMBER: XPK80990413 COMMERCIAL GENERAL LIABILITY EFFECTIVE DATES: 5/31/2019 to 5/31/2020 CG 20 26 07 04 CERTIFICATE NUMBER:NAA000032918 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 Organization(s) City of Clearwater PC Box 4748 Clearwater ,FL 33756 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s)or organk 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. i CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ TE(MMIDDfYYYY) `./ CERTIFICATE F LIABILITY INSURANCE 02/19/2019 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 NAME: Robert.V.Nuccio R.V. Nuccio&Associates Insurance Brokers, Inc. P"AALcoo EXt). (800)364-2433 FAX•Nal; (818)980-1595 10148 Riverside Drive n DR1Ess SUPPOrt@rvnuccio.com Toluca Lake,CA 91602 ^^ INSURER SAFFORDING COVERAGE NAIC# A: Fireman's Fund Insurance Company _ 21873 INSURED _INSURER INSURER B: Nationwide Life Insurance Company 66869�u Clearwater Audubon Society INSURER C: _ Po Box 97 INSURER D: Clearwater, FL 33757 INSURER E INSURER F: 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 TYpE OF INSURANCE ADDL SUBF2 POLICY EFF POLICY EXP I LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A GENERAL LIABILITY ✓ XPK80990413 5/31/2019 5/31/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE1 RENTED COMMERCIAL GENERAL LIABILITY NAA000032918 PREMISES(Ea occurrence S 100,000 CLAIMS-MADE OCCUR ! MED EXP(Any one person) i$ _ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2;000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ✓❑1 POLICY IF7 PRO- LOC ---- - S JECT AUTOMOBILE LIABILITY ( COMBINED SINGLE LIMIT ANY AUTO I BODILY INJURY(Per person) S �--- i ALL OWNED F SCHEDULED AUTOS AUTOS li BODILY INJURY(Per accident)S HIRED AUTOS NON-OWNED PROPERTY DAMAGE. S AUTOS Per accident _ $ UMBRELLA LIAR _ OCCUR fI I EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE i _ AGGREGATE_ S DED RETENTION$ 5 WORKERS COMPENSATION IWC STATU- OTH- AND EMPLOYERS'LIABILITY YIN LTO_RY L I ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? � NIA 1 -- (Mandatoryin NH) E.L.DISEASE-.EA EMPLOYE $ If yes,describe Under DESCRIPTION OF OPERATIONS below I E.L.DISEASE POLICY LIMIT S A Directors&Officers NPOD00047762 5/31/2019 5/31/2020 $1,000,000 B AD&D Medical Plus (NPOAM0036493 5/31/2019 1 5/31/2020 $25,000 I , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured Wording:City of Clearwater Start Date:5/31/2019 End Date:5/31/2020 Event Description: Bird Events CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater ,FL 33756 AUTHORIZED REPRESENTATIVE 1 Robert V. Nuccio ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD