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CERTIFICATE OF LIABILITY INSURANCE (1009)A a � CERTIFICATE OF LIABILITY INSURANCE 16...--' DDrY DATE(MM/020 ) 02/21 /22020 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 have ADDITIONAL INSURED provisions or 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 Arthur J. Gallagher Risk Services for CoAdvantage 250JeffrT Rendes Tequesta Drive Tequesta, FL 33418 CONTACT NAME: HO No, Eat): (866) 854-5423 FAx PHONE (ac, No): E-MAIL cos@coadvantage.com INSURER(S) AFFORDING COVERAGE INSURER A : American Zurich Insurance Company NAIC # 40142 INSURED CoAdvantage Corporation Alt. Emp: Amen Air, Inc 3350 Buschwood Park Drive #200 Tampa, FL 33618 INSURER B INSURER C INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:20FL090907483 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT. CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .ADDL,SUBR: POLICY EFF POLICY EXP LIMITS INSD I WVD I POUCY NUMBER JMMMDDIYYYY) (MM/DD/YVYY) INSR LTR TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR j RECEIVED /1 19AR 02, 2020 EACH OCCURRENCE $ ' 6AMAGSTC RENTETS PREMISES (Ea occurrence) $ __PERSONAL GEN'L AGGREGATE LIMIT APPLIES S PER: ' MED EXP Any one person) ! $ & ADV INJURY j $ GENERAL AGGREGATE I $ POLICY ^PRO- :JECT LOC OTHER: PRODUCTS COMP/OP AGG i $ $ AUTOMOBILE LIABILITY -OFFICIAL RCCORDS AND �` �°-�� . �r yv LEGISLATIVE SRVC DEPT a. COMBINED SINGLE LIMIT I $ (Ea accident) �, ANY AUTO OWNED : SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per person) I $ BODILY INJURY (Per accident) l $ PROPERTY DAMAGE (Per accident) I $ -_��. HIRED NON -OWNED _' AUTOS ONLY AUTOS ONLY I$ T EACH OCCURRENCE ! $. AGGREGATE I $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE DED i l RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y) N Nr A' , WC 56-11-942-06 04/01/2020 ! 04/01/2021 ; I v ' PER : EORH E L EACH ACCIDENT $ 2,000,000 ANVPROPRIETOR PARTNERlEXECUTIVE OFFICERiMEMBEREXCLUDED? E.L. DISEASE EA EMPLOYEE $ .-- E.L. DISEASE - POLICY LIMIT $ 2,000,000 -...- _.._.-. 2,000,000 (Mandatory In NH) II yes, describe under , DESCRIPTION OF OPERATIONS below Location Coverage Period: 04/01/2020. 04/01/2021 Client# 19779 -FL DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Coverage is provided for Amen Air, Inc only those co-employees10137 Midas Dr of, but not subcontractors Port Richey, FL 34668 to: CERTIFICATE HOLDER CANCELLATION City of Clearwater 112 S Oceola Ave Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Fr. ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and loao are registered marks of ACORD 2* of 2 42804 Artex Risk Solutions, Inc. FLO90 8840 E Chaparral Rd Suite 275 Scottsdale, AZ 85250 42804 1 AB 0.416 42804 111111111111111111111111111111IIiIII1111/1iiluiliIII111111iIIiII CITY OF CLEARWATER 600 CLEVELAND ST FL 6 CLEARWATER, FL 33755-4167 1* of 2 42804