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CERTIFICATE OF LIABILITY INSURANCE (1026)® ACGMD fes-,- CERTIFICATE OF LIABILITY INSURANCE DATE(M 2/YYYY) 05/15/20 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 Aonon Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 CONTACT NAME: Aon Risk Services, Inc of Florida (A/CNNo, Ext): 800-743-8130 (A/C, No): 800-522-7514 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Illinois National Insurance Co 23817 INSURED ADP TotalSource CO XXI, Inc. 10200 Sunset Drive Miami, FL 33173 ALTERNATE EMPLOYER Hispanic Business Initiative Fund of Florida, Inc. 3201 E. Colonial Drive, Suite A20 Orlando, FL 32803 INSURER B : INSURER C : RECEIVED JUN 16 INSURER D : INSURER E : $ INSURER F : CLAIMS-MADE COVERAGES CERTIFICATE NUMBER: 2899753 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. LIMITS SHOWN ARE AS REQUESTED INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DO/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY OCCUR RECEIVED JUN 16 b 2k EACH OCCURRENCE $ CLAIMS-MADE DAMAGE TO PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILECOMBINED — LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _NON _ SCHEDULED AUTOS -OWNED AUTOS ONLY OFFICIAL RFCORDs LCVIJIAT(�s 5VC�pj A 4 ' NI SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, descnbe under DESCRIPTION OF OPERATIONS Y / N N / A WC 027115060 FL 7/1/2020 7/1/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All worksite employees working for HISPANIC BUSINESS INITIATIVE FUND OF FLORIDA, INC., paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. HISPANIC BUSINESS INITIATIVE FUND OF FLORIDA, INC. is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION City of Clearwater City Hall 112 South Osceola Avenue 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 ,,��ff,s�-`.�, OAL i. C#v e& Q,u o f/o'E.:[La ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD gArAg 000411 90005826100 6 02 02 0 0000 0 000 1077428