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CERTIFICATE OF LIABILITY INSURANCE (6) DATE(MM/DD/YYYY) AC40R"® CERTIFICATE OF LIABILITY INSURANCE 07/14/2020 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 Colleen B Burke NAME: Burke Insurance Services, Inc PANIC, Ext: 727-441-3094 A,C,NO: 727-449-0102 P.O. Box 1134 E-MAIL Dunedin, FL 34697 ADDRESS: colburke@hotmail.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United States Liablity Insurance Company INSURED INSURER B: Normandy Insurance Company Youth Development Initiatives, Inc INSURERC: National Union Fire Insurance Companv 900 Martin Luther King Jr Avenue INSURER D Clearwater, FL 33755 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 SUBR POLICY EFF POLICY EXP LIMITS LTR IVSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY X NPP1566973E 08/01/2020 08/01/2021 EACH OCCURRENCE $ 1,000,000 DAM CLAIMS-MADE 91 OCCUR PREM SESOEa oecur ence s 500,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY ECT [::] LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY X NPP1566973E 08/01/2020 08/01/2021 EOaaBINEDtSINGLELIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOSX NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LAB OCCUR BE014571723 08/01/2020 08/01/2021 EACH OCCURRENCE s 2,000,000 C X EXCESS LIAB CLAIMS-MADE AGGREGATE s 2,000,000 DED RETENTION$ 0 $ B WORKERS COMPENSATION NHFL0116322019 03/26/2020 03/26/2021 X STATUTE EERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/NE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE_$ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 500,000 Professional Liability NPP1566973E 08/01/2020 08/01/2021 $1,000,000/2,000,000 Occurence/Aggregate A Directors&Officers Liability w/EPL' X $1,000,000/2,000,000 Occurence/Aggregate Abuse&Molestation $1,000,000/1,000,000 Occurence/Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) L-744NPP 06/10 Blanket Additional Insured .Employment Practices Liability included in Directors&Officers 1,000,000 .Cyber Liability Sub Limit$50,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 S. Myrtle Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE Colleen B. Burke ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD