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CERTIFICATE OF LIABILITY INSURANCE (7)�� � CE�TIF�CATE DF L1►�B�LITY 1�15V�AN�E °A�`"�"�"' osr�srza�s iH]5 CERTfFiCAiE iS:I5S11F_{} A5 A 1qF1'i'FER OF iNfpRA4A77ql+1 pNLY ANU Cpi�1FERS N4 RIGFii'S UPON 7li� CERFf�Fl.CATE HRl_[]ER. THIS CERTiFICATE �O�S l+1pT AFF1Ft�AAT11fELY RR NEGRFIII�Y AIHFN!], IXTEis1p 4E2 ALTER THE COVERRGE qFFp[;pEp gy 7HE PpL1C[�5 BELOVY. TH[5 CFR1'1fiICA"fE QF. iiVSllRRNC� OQ�S AfDT C�idSTFftifE A COH'F[ip�CT SE'1'1fYEE�1t TFI� FSSilibFG IPlSEFRER{Sjr ALkTH�€ifZEO R�PFtES�NTAiiVE flR pROa[10ER,.ANQ THE CERi'lFfCATE H�LUEIZ 1�fPORTANT_ [i the eertificaie halder is an AQf}tiiQNAL iH511R�O, She pqlicy(ies] rnust 8e enriorsed. If SCiBROGAi7flN IS WAiVED, suhject to ihe f�iRIS 2IId C6[Id1IJpF1S �pF H!e Pq�[F]I, �ertain paEi�Ies�.may requsre an �endnise�nertF. q staterrient on lhis cerlifeate daes not eunfer rights ta�the ceftificate hof�er Iri [ie�t oT such ertdn�sement{s]. r�arn�c.Ea �acr �L[P F'rogram Support Veraciry 1ns�iranae.SoEutions, �E..C. w,�"H :�,_ 844 520-G992 F"" „o,: � 2fiC1 Sauth 25Q� West, $uite 303 E''�: in�a �ii rv ram.cam � � PieasanY Gr��e E]T $4�62 mrsurt�s�nrpoeox�a ca�nar.E T�THa2ctt lHSLiRED Tmm� � �WS�)RER9�: Edward Bates, lJBA }finney's Kitcfieri ,,,s„�c: 1540 Clui] pr r�sunfnn: Tarpon Sprir�gs F� 34f89 rr�n�: Cf}V�RAGES CERTIFICAT� Ni7N[SEl4: REVISE03+[ [Si]NIBER: TNES SS.'fp CERTI�Y ;HAi T] � ppL3CEE5 pF iNSURAldCE LI57ID SF_l.pW F{qyE BEEN l53lfED 3'0 7H� iNSLiR�[7 NAMEp qgp11E FOR 'iHE POfJCY PERIOO INf]ICA7Ef1. NOTWRHS7Ai�1DING.MiY i4�RUIRE?uFENi,'FERA4 pi� GpNDfilON pF A14Y CqNTRACT Oi2 p1}i�R pDCf1{NF�i'T yyf7'� �SPECi 7p YYI-lECH 7IiIS CERTIFECA"i'E h7AY SE iS.,UEi} pR MqY pgZFAf�i, 7NE.INSLRAAIC�C AFFOR� HY: Tk� Pqi.tCIES i7�5CR18E0 HEREIN 15 SUBJ�CT T� AI.I, iHE TERMS, EXCLLi510N5 ANd CflNOFFIONS DF $UCH Rl7I.iCIES. iiFA1TS SHOWN iNRY HA11� QEEN REbtICEp gY pAl6 CLAiMS_ L:R TYF� OP IPtSVRAHGE ��A��S48li � P6iFLYit11N8FR PO O Y FiF Fjq� ....... .,.'. � — GEtiEAA411ASFLTI'Y �t EACF1qGCl1RRENCE �5 ���,OOQrU�I � f COURS�C����JZ�Ly{g[�,j'ry'' j� rI pliERiJ5F5 [�a occixrd�j s �3fl0,UQf f fi �x.+uMs�une � occu�x �� -' I � � � e� tn�v� a�t s S;QQi A .._--I - •----_ -w...__._.. � � � €'i��!]�6�-�Q7372$ osra�r2ais oe�irzaxo p�soHn�a,ao�+�uar a 7:fl0t3.OQf ' �G"�"E�TILAGGREG4TELEA4RAPPlIES�PE7i: ]I . n I POltGY�� '� E� �� LQF ! .ALTOM48tLEL1ABli17Y � �� ANY�At1T0 �ACL�dVIfHEp �. �((''`jjj 5CNF_OIILFD �{ AVTOS � � AIYSqg NpN�DYJ71m � !-}]R�R[iTOB q�g � f t �LMfArzci i a CSAti }"m'.f pCCIfR � F![[:�CS �$ � � F I �GCAiA45 �MARE � � oE� rR�rrtmn s woxr�xs cwar�swnor� aluz m�rLnr�rss �isnm- IW9' PROf�Fi[EiOR1HRR7HETire7�Ci7riVE Y1 H OFFICFlA1ERfHER E]fCL1H7EAt: ❑ H IA [R�andatory in ny] IF yea. eesrn�c.u�dcr GENERAL�AGGREGR7E� S PlEOE7LIG"�S=COi�9PIdPRGG 5 fWIRU1LBAILE� S 9aAILYiHJ1IRYip�i�� S Bdp1iY IM,t[1RY tP�ruaadmq 5 �PRGPER L7WMGE� 5 ���..... .Y_� 5 EACH OGCf7FkRENC�,.._..__ �_ 5. AGGREGATE� s ��L_FJICFfACCtflCAf1' $ ELflISFJ15E-EAEMPLQ 5 E.LOtSFJ1,5�E-pp�ICY�LIM[r 5 OESCf2iFiI0H tlf 01�ERAiI�NS 7EOCA71OIiS1YQi1C4E$ [AlLic7� ACPRD T01, RdCltloe�d3fieawt5 Schada[qii+lpm spac� iS Iuql�hsu} Cei-ti�icate haider had..�ee�s added as addiiianal:insitt'ed r�gardir�g fhe abflve �ne.nti�ned palEcy p�r aitached Additiana] Insured.- Less�r vf Leased �qui�m�nt.�CG 2� 34 Ed. a4 '[3} CER City.of Clearwater 2115 Myrtle•A�e Ciearwater RCflR� 25 S2fl94fR7} 13�jS472J j203d911 TtON S!l�iSl.fl ATIY UF THE FI6UYE PESGIaiBE➢ PALECiES BE CAPiCEL4ED SEFORE r�t� �anort �ar� �ieo�, �uvnce. v+n� a� oe�iG�eea �r� RCCORORNCE VYI'TN Tii� FOLlCY PRUYISi�viS. FL 33755 A�o ��+ra�rive ������� - - -- ---------- - ---- ---------- - ---- --O-t988-�874-P�GaR��fl#2PORf�[ot�t74Elztghtsrt��rV��`------ 'ihe RCQl7J7 nasrre.�d lvga are regfsfered marks af ACORI] �� Fd�D . � LlABIL1iY ;� _ IE+1SElR,�l+�CE C=��3. . , PR�GRi4[� �1.►��,�dc�,ti . . � f!lSllflqfl�,L GRQUP .r F F;7:I: l: se'J.'-'�1C5.i�'C3n7. :'A!i f $44-52Q=5992 GroskAmeiecan.AEfianca htsuras:ce Carrrpany Powere� 6yVerar3tylnsurarrce 301 E. FourEh SA�et, 25 5 Sdcr7ians. i.LC. Cl�cuu�afi, DH 45242�209 GOR�AMEF�CIA�. GENERAL LiABi[:ITY CdVEl�I,GE PART - OCCURRENGE FaRM CERTiFiCATE PAGE ET 15 AGREEI7 �'HAT THfS CEFt7iFICATE 15 1551JE� Ta THE CERTl�i.CATE HdL€]ER 1,153Ei] BELQW TQ CERTIFY C�VERAGE C]N{]ER 3�� C�MMERCIAl. GENEF2AL �.lAB1L,iil' FiVSLfRAMC� MASTER PO�ICY LI5TE0 BELaW, €NSURAHCE C�MPAMf_ GREAT AM�fiICAN ALLFANCE INSURA�fGE COAAPANY NAME� [NSUREa: 6�AUlY H�7H & `iRA�E ALUAISC� CERTiFtCATE FlOLD�R: Edward Bafes, I]SA fCfrtney's FCichen AFIi]RESS: 754U Club pr, 7arpon Spririgs,.Florida 34&89 P�I.ICYPERt[}D: U$!l�4J2f1'[9io 08![M72i�20 72aiA.Gi51a�dTanes�lhnAd�xssa[Tr.or�.r��}iy�ar �[lV1Ff5 p� IH5L33�AlJC� Genera] Aggregate. Lirait {�iherihsn Products-CQmpfeied Operations) Prvducts�ompleted.Operafians.R99�9afe �irrrii Personal and Adver€ising:lnjury I..imit General Each.Occ�rrence irm�t �� Q.amsge fo PrerriEses Rented. fo Yau Limit Medical Expense Lim�t �fC1fES51afk3� �OVEi9� �JC[ER5161'I. PQLECY. lltUlVf@ETi: PL22E0�6Q CERTfFfCATE NLJMBER: �OT3'i�8 � 2,Odq,p00 � 2�[iaU,UO� 3 T.OU�.00� � �,ano.ada $ 3Q6,OU0 Ar�y One Pr�mises $. 5,40{] Any Qna Persnn $ ivot3�urd•rased �a� Gfaim S ivat Purti�ased Aggregate Ptaiessinnai Covetage peducfible � Nat Purchased Ea�h Claim Lia�iiity dedvc643e �{�� F�RNI O.� SEJSIN�SS: 5vfe ProprieforlEr�dNiduai PiiEMIIIM: $ 351. S�1T�l Fe�: $ 84 1'OTAL AHNUAL COS�: �' S84 {ihe cast is f�0% earnedlnnn refundab[ej CflDE idl1MSER: 11968 PRf�MiliHf BA5i5: Gross Sates IXPaSiIRE: $5.Q,QQ1�100;[#D� B!1$1NE5S D�5CFi1F'"['1flN: TH15 I3tii5iJRANCE ES SUBJEGi" 70 ALL THE. iERA9S i4ld#] C�lVp1T[DN5,11�Cl.UdiNG. APPL[CA6LE ENDDRS�AAENTS, QF THE GOMIulERC1A(.. GENERAL LlA81i.1TY INSURA�fC� MASTER POLiCY. A CflP1' QF �HE.�p1uINfERCfAL GENERA� LIABILITY kNSl1RANCE MAST��2 POl�kCYACCflia9PANIES 7�i15 CERTiFI.CATE, App1'�E�€JAL COPi�S WI31.BE.PR4V€D�[1.Tq iH� GERTIFIGATE H�LI]ER: PI�ASE.R�Ap THE POL1CYAlV� A!L EiVC1DRSEMEt�i'S. ........ .. .......................... . .......... ............._....... .. . ., ........ .. .... ,. .... .... .... .,.....: .. .. .....: .......,... .... ....... .. .. ...... ... . .. . ....... .. . .. . ... N� A[]M�55tQN �F LfAB€LlTY MAY BE MADE ER'H�R 11��B�L�LY DR TN WRCiiNG F�iJ1.E. DEl"A[L.�F ANY iiVCi��NT SH�Ui,D BE SENT 11N3vIED1ATELY BY EhW1L TO.:C�'��1���i�VCP1�S.C:C3A ` QR gY LErT�R T� VERACfTY IN5€1RAA�CE 50LIJTfd1�S: !LC 2fi6 SOLlTH 25�� W�ST SLJfi�:3D3. P�EASAIYT GFZOVE; UT 84p62. FORMS A14i1 �{VR(?RSEMEIi1TS applicable ta af! Co�erage Parts arsd. made �art of fltis Pvli.cy af �me of Essue. are: iist�d ors the attached Farrris and Endorsements 5�hetlule f L 88 47 .{'t 9185}, aDf�'�Ixisr�x,ar�n sv i�� � . ��� V�PdCity ��.naiiidl?(R'. �Q�[1�Qjj$. � 260 Soulh25� West SuFle 343 Pfaasant Grove.Uiah 84U62 8B8-56B-6Sd8 �?�:a �i:nr�____�ram.;.�rr, fOR'$ S CG 20 34 tEd. Q413j Pi.3�SD�fiD-�073i28 l7i[5 E�iODiZ���,7�NT ��#.�;�G�S THE P�LICY: PLEAS� READ 17 CAREFf�LLY. ADDlTIQI+IAL �NSUREf] - LESSDR DF �EASEO E[,�UIPMENT - AUTC]A�Ai'IC STATU� WE��[� R�QUIRE� !Id LEASE AGREEI4AENT W1TH Y�U 7his endarsament.modif�es insurar�ce pro�Eded uRder the €411ouvir�: C�MMEBGIAL GENE�2AL LIR6ILITY CaV�1�AGE.PAFtT A. S�CI'IDN Il - W'i-�0 {a Mi IAiSliiiED is amertaed ta R�dude. as an addiEiaErai insured any persvn�s} or or�anization{s} frnm whom yo� lease eguip�ent r�rhen j+ou and such per son[sj . or orgar�i�ation{s} t�a�e agreed 9n writing in a oonfract or agreemenf tha# such persnn�s} ❑r nrganization{s] E�e added as. an add9tiQna# insared or� yaur pali�jr. 5�i� persvr�[sJ ar or- ganizatson{sj is an ins�red oniy wit3�t. respect tv lia6ility far "6�dily injury" "property damage" �r "persnna[ ar�d arlvertising .injury�` car�sed, in wYsole ar .in part, by Yotrr maintenartce, operafifln or uss af equiprrient ieased to yo� by such persan(s):or vrga.nization(sj, Howe�er, fhe. ii�surance a'ffo�[fed to such ad- difionaE ir�sured: 1. vr�ly appties tv fhe extent permitted t�y law; ar�d $: W� i'eSpect ta #he . insurance. a�Forded to these Acfdi#4onai Insureds. this !E'!Sl1i"df1C9 �q85 nat app1Y tv any "n�currence" whi�h takes place afterthe equipmen# iease expires._ C. Wifh respect ta fhe insr�rance afFoi�ried fo these Addifiunaf fnsureds; the falfgwir�g .is ad- ded #a SECi1GH [li - LiAl11T5 D�' l�5iil�» ANCE: The most we will. pay an hehak€' of the Addi- tianal f�sured is tYre amaunt of inse�ranee: 1, requir.ed by fhe r,antra�t ar agreet'ri�nt you ha�e eniered: into. with. .fhe Addi�bnal In= sured: or 2. a�ailahle .under the ap�lica�i�e Limits of In- suran� shav�n iR #he �eclaia�oris; 2. wi1� not he: broader than fhaf .whi�h you . ........ ...... ... .. ......... .. .. .. ... . .... .... .. .. . _ ..... ..... .. ...... ..... . ...... .... .. ...... ..... .... .... ....... .. . .. .. . . .. ... .. are req�ired by the cantract �r agraersient whi�he�eris.Ee.ss_ to. pro�ide far such additional insi�red. A pesson's nr organixatinn'� .status as an addi- tipnal insured under this endorsement .�nds when their cpntract or agreement with yqu for suc�i leased equipmeni e�ds. This er�dqrsemeni shall nof increase tFie ap- plicahle L'iFnits of Insuranc:e shrnn►n in �t►e Dec- farations. CQpyrigi�#,. �5Q P�operiies, in�_, .20'! �. CG 2� 34 ��dc 041�3}