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CERTIFICATE OF LIABILITY INSURANCE (13) DATE(MM/DD/YYYY) A�"® CERTIFICATE OF LIABILITY INSURANCE 07/21/2020 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 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 CONTACT Hilleri Dickey NAME: CertiSure,Inc PHONE (863)293-4653 FAX (863)293-5862 (AC, C No Ext): A/C,No): 147 Avenue C SW E-MAIL hdickey@certipay.com ADDRESS: Ste. 101 INSURER(S)AFFORDING COVERAGE NAIC# Winter Haven FL 33880 INSURERA: Associated Industries Insurance Cc Inc. 23140 INSURED INSURER B Artz 4 Life Academy,Inc. INSURER C: 1751 Kings Highway INSURER D: INSURER E: Clearwater FL 33755 INSURER F: COVERAGES CERTIFICATE NUMBER: 20-21 WC COI 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO TED CLAIMS-MADE ❑OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ [P—_ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ PRO- JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accide nt) $ AUTOS ONLY AUTOS HIRED NON-OWNEDPROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident r 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ A OFFICER/MEMBER EXCLUDED? � N/A AWC1147381 04/08/2020 04/08/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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 Client Copy ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACCOR CERTIFICATE OF LIABILITY INSURANCE DATE p 11/0612019 THIS CERTIFICATEIS 1 s E F INFORMATION LYAND F N I P T CERTIFICATEL .THIS CERTIFICATED TAFFIRMATIVELYTIEL END ALT H E AFFORDED YT POLICIES BELOW. THIS CERTIFICATE I T CONSTITUTE A T ISSUINGINSURER(S),AT TAT D T CERTIFICATEHOLDER. IMPORTANT. If the certificate holder is n A I IO L I ,the policy{i )must have A I AL I visions or endo If SUBROGATION ISWAIVED,subject t a terms and conditions of the poll ,certain policies may requirea endorsement- A statement on this certificate does confer nigh to the certificateholder in lieu such endo a ent(s). PRODUCER CONTAC Jam Parent! E• ARCW Insurance PHONN . (727)544-8841 c Na: (727)5 -8 2 9067 Belcher Rd E-MAILADDRESS: lim arewinsuran . INSURER(a) FORDING COVERAGE NAIC 0 Pinellas Park FL 33782 IN$URERA. Philadelphia Indemnity Ins Co 18058 INSURED Progressive EX ress INSURER e: P 10193 Artz4 Life Academy Inc. INSURERC Burlington Ins. 23620 1606 N.Highland Ave I u D SURER E Clearwater FL 33755 INSURER F COVERAGES CERTIFICATE NUMBER: 19120 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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, ILS TYPE OF INSURANCE INSD D POLICY NUMBER M CYEFF ICY P LIMBS COMMERCIAL LL YsnY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE 19 OCCUR PREMISES Ea cur ansa $ 10"00 MED (Anyone aon) $ 5,000 A Y PHPK2025715 10/01/2019 10/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 3,000,000 POLIGY1:1 JET LOC PRODUCTS-COMPIOPAGG $ 3,000.000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,0o0,00a Ea a ant — ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y 03389473-5 1 12/01/2019 12/01/2020MAGGREGATE V(Par occident) $ AUTOS ONLY AUTOS HIRED NON-OWNED AMAGE AUTOS ONLY AUTOS ONLY $ ments $ 6,000 UM® LLAL OCCUR OCCURRENCE $ 4,000,000 C cess L CLAIMB E HFF0010235 08/19/2019 10101/2020 $ 4,000,000 DED RETENTION$ $ WOR C PENSArON PER OTH- AND PPERS'u ILITY YIN STATUTE ER ANY PROPRI RIP NE CUTIVE $ OFFICERIMEMBER EXCLUDED? NIA E.L.EACHACCIDENT (Mandatory In NH) If yea.describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Directors&Officers GeneralAggregate $1,000,000 A Y PHSD1405583 10/01/2019 10/01/2020 Each Occurrence $1,000,000 Deductible $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,AddItIonal Ramadrs Schedule,maybe attached Itmorn space Is required) `"Please see attached for additional Coverages- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE VWLL BE DELIVERED I City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. r 100 S.Myrtle Avenue AUTHORIZED REPRESENTATIVE 1p Clearwater FL 33756 r 0 1988-2015 ACORD CORPORATION. All rights se ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1 AGENCY CUSTOMER ID: 00017244 �m00000i�q,, LOC .� ADDITIONALPage of AGENCY NAMEDINSURED ARCW Insurance Artz 4 Life Academy Inc. POLICY NUM13ER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM TITLE: Certificate of Liability Insurance:Notes 1)Cyber Liability Insurer:Evolve NAIC:See Attached Policy#:EVOPNU444082 Policy Effective Date:8119119 to 8119120 $500,000 Each Claim $500,000 Annual Aggregate $2,500 Self-Insured Retention Retroactive Date:8119119 2)Abusa and Molestation Liability Insurer:Philadelphia Indemnity Ins Co. NAIC:18058 Policy#:PHPK2025715 Policy Effective Date:10101119 to 10/01/20 $1,000,000 Each Claim $3,000,000 Annual Aggregate $0 Deductible 3)Directors and Offioers7Employment Practices Liability Insurer:Philadelphia Indemnity Ins Co. NAIC;18058 Policy#:PHPK2025715 Policy Effective Date:1010 1119 to 10/01/20 $1,000,000 Each Claim $1,000,000 Aggregate $25,000 Self-Insured Retention Retroactive Date:01/01/2002 $0 Deductible 4)Crlme Insurance Insurer:Travelers NAIC:19046 Policy#107139057 Policy Effective Dates:8119119 to 8119120 $300,000 Employee Dishonesty$1,000 deductible $300,000 Forgery orAleration$1,000 deductible $300,000 Robbery(on or off premises)$1,000 deductible $300,000 Computer Fraud$1,000 deductible $300,000 Funds Transfer Fraud$1,000 deductible 5)Professional Liability Insurer.Philidelphia lndemnfty Ins Co. NAIC:18058 Policy#PHPK1888077 Policy Effective Dates:1 010 111 9-1 010 1 12 0 $1,000,000 Each Claim $3,000,000 Aggregate $0 Deductible J, J ACORD 101(2008101) 0 2008 ACORD CORPORATION. All rights reserved. r1 The ACORD name and logo are registered marks of ACORD 1!lli Additional Named Insureds ............. 11k fixr �o, [in[Bured 1,iir ,, Il OFAIPPINIF OOPYRFaMT2007,AMS SERVICE'S INt ADDITIONAL REMARKS SCHEDULE ISSUED 11-07-2019 ATTACHED TO AND FORMING PART OF THE CERT OF INSURANCE FOR ARTZ 4 LIFE ACADEMY INC 8-19-2019 TO 8-20-2020 POLICY NUMBER EVOPNU444082 THE CYBER LIABILITY SUBSCRIPTION LIST HAS NAIC NUMBERS AS SHOWN BELOW AXS 1686-NAIC NUMBER-AA-1120256 ASP 4711--NAIC NUMBER-AA-1120090 AMA 1200-NAIC NUMBER-AA-1127200 XLC 2003-NAIC NUMBER-AA-1128003 ATL 1861-NAIC NUMBER-AA-1129000 MKL 3000-NAIC NUMBER-AA-1129000 ENH 5151-NAIC NUMBER-AA-1120080 NAV 1221-NAIC NUMBER-AA-1127221 ARG 2121-NAIC NUMBER-AA-1128121 EVE 2789-NAIC NUMBER-AA-1120172 HDU 382-NAIC NUMBER-AA-1126382 RNR 1458-NAIC NUMBER-AA-1120102 AES 1225 1.000005-NAIC NUMBER-AA-1127225 THE UMBRELLA IS OVER THE PACKAGE POLICY,AUTO POLICY, EMPLOYERS LIABILITY; SEE ATTACHED SCHEDULE OF UNDERLYING COVERAGES-FORM IFG-FB-000-0318 UMBRELLA INCLUDES COVERAGES UNDER THE PACKAGE POLICY WITH POLICY#PHPK2025715 ONLY 1