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CERTIFICATE OF LIABILITY INSURANCE (4) " IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 11 VV �J JkASS�W[A[JS VwY:RA � MO HCRS MSpecialty Insurance Products Clearwater Audubon Society Insurance Policy Number: NAAO00034819 Po Box 97 Clearwater , FL 33757 �.«:^III. 3 2.433 inaalili suliplipoIrt@irvinucc:iicawccalr7n (:)Irullkirue Irvinucclicawccalrn 0f e :101.48 IF iveirsGde IC irGve '11 otuicaa II....aalke,CA 3:1..60:1. u Ir \ ,1huasa:"r lirna:lllu.aded Youlr eirtificaate(s) cifIInsulraancea copy of youir Apphcadoirn Youlr Memorandum Xcaulr Coveiraa ges Youlr Quote Il....ettelr haalnik you for dhoosGing FS. . INUC iica St,Associates linsuiraince BIr kers, Il inc, ...........We lack foirwaIrd to Ihcllplilra g uvith yourslp cWty lilr'nsulraalrnce Irieecis. DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 06/05/2020 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 NAME: Robert V. Nuccio R.V. Nuccio&Associates Insurance Brokers, Inc. a/c"N Ext: 800 364-2433 a/c No: 818 980-1595 10148 Riverside Drive ADMDRESS: support@rvnuccio.com Toluca Lake, CA 91602 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Fireman's Fund Insurance Company 21873 INSURED INSURER B: Nationwide Life Insurance Company 66869 Clearwater Audubon Society INSURERC: Po Box 97 INSURER D: Clearwater, FL 33757 INSURER E 7 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 INSR WVD POLICY NUMBER MMIDD/YYY MMIDD/YYY A GENERAL LIABILITY ✓ XPK80990413 5/31/2020 5/31/2021 EACH OCCURRENCE $ 1,000,000 ✓ DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY NAA000034819 PREMISES Ea occurrence $ CLAIMS-MADE 5,1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 m POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Directors&Officers NPOD00052753 5/31/2020 5/31/2021 $1,000,000 B AD&D Medical Plus NPOAM0038140 5/31/2020 5/31/2021 $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured Wording: Start Date: 6/5/2020 End Date: 5/31/2021 Event Description: Bird events CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater ,FL 33756 AUTHORIZED REPRESENTATIVE Robert V. NUCCio ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: XPK80990413 COMMERCIAL GENERAL LIABILITY EFFECTIVE DATES: 6/5/2020 to 5/31/2021 CG 20 26 07 04 CERTIFICATE NUMBER: NAA000034819 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of Clearwater PO Box 4748 Clearwater ,FL 33756 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s)or organk zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ SCHOOL SUPPORT GROUP/NONPROFIT ORGANIZATION COMMERCIAL PACKAGE INSURANCE POLICY GENERAL CHANGE ENDORSEMENT Master Policy Number: XPK80990413 Memorandum Number: NAA000034819 Endorsement Date: 6/6/2020 Endorsement Sequential Number: 1 Issuing Company: National Program Administrator: Fireman's Fund Insurance Company R.V.Nuccio&Associates Insurance Brokers,Inc. 777 San Marin Drive 10148 Riverside Drive Novato,California 94998-2000 Toluca Lake,CA 91602 Nationwide Claims: 1-800-567-2685 Nationwide: 1-800-567-2685 01. MEMORANDUM HOLDER NAME AND ADDRESS(MEMORANDUM HOLDER MEANS NAMED INSURED) a. Memorandum Holder:Clearwater Audubon Society b. Street Address: Po Box 97 C. City: Clearwater d. State: FL e. Zip Code: 33757 02. COVERAGE PERIOD Inception Date 5/31/2020 12:01A.M.to Expiration Date 5/31/2021 12:01A.M. Standard Time at the Named Insured's address as stated above. 03. BUSINESS TYPE []PTA ❑PTO ❑Booster Club ❑Educational Foundation mNonprofit Organization 04. TYPE OF ENDORSEMENT a. ❑ Addition b. ❑ Deletion c. ® Change 05. TOTAL AMOUNT DUE OR PAYABLE $0.00 Additional Amount Due❑ Return Amount Due ❑ New/Changed Coverages and Premiums Total Premium $0.00 Detailed Policy changes are listed on the following page. Date Issued: 06/05/2020 By �"�J Form Number: NPOUWS001 Authorized Representative 3/20/2008 NPOUWS001 Copyright 2008. All rights reserved. R.V.Nuccio&Associates Insurance Brokers,Inc. 818-980-1413. GENERAL CHANGE ENDORSEMENT Continued From Previous Page Changes to Policy (Endorsements) #of Additional Insureds 1 Additional Insured Name City of Clearwater Address PO Box 4748 City Clearwater State FL Zip Code 33756 Email Address Phone Number Event Description Bird events Event Start Date 6/5/2020 Event End Date 5/31/2021 Special Wording Admin Options:100% Additional Insured Endorsement Wording Primary&Noncontributory n/a Waiver of Subrogation n/a nn WZ� d Mh Al NONPROFIT ANNUAL INSURANCE QUOTE APPLICANT INFORMATION Applicant Name: Clearwater Audubon Society Date: 06/05/2020 Proposed Coverage Date: 5/31/2020 Client ID#: 1608559 POLICY INFORMATION LIMIT COST 1. Liability Plus $1,000,000/$2,000,000 $ 0.00 RVNA, Inc. Administration Charge $ 0.00 RVNA, Inc. Unlimited Additional Insured Charge $ 0.00 2. Bonding Plus Not Covered $ 0.00 RVNA, Inc. Administration Charge $ 0.00 3. Directors & Officers Liability Plus $1,000,000 $ 0.00 RVNA, Inc. Administration Charge $ 0.00 4. Accident Medical Plus $25,000 $ 0.00 RVNA, Inc. Administration Charge $ 0.00 5. Property Plus Not Covered $ 0.00 RVNA, Inc. Administration Charge $ 0.00 RVNA, Inc. Loss Payee Charge $ 0.00 State Guarantee Fund $ 0.00 TOTAL $ 0.00 If you wish to purchase this exclusive insurance product, please log in at protectlournonprofit.com NOTES • This is a quotation only. Prices are subject to change without notice. • Quotation is subject to online completion of the application and underwriting approval. • It is the insureds responsibility to read the policy. Request a sample policy online at rop�ournonprofit.com. • Unless otherwise disclosed in the quotation letter, our professional fees are normally based upon a commission, which is calculated by applying a percentage against the collected premium and paid to us by an insurance company. Additionally, RVNA may receive compensation from an insurance company which is based upon premium volume, growth and loss experience. After you have reviewed your quotation letter, you have no obligation to purchase insurance from us. Should you ultimately choose to do so, you are agreeing to all of the charges displayed within the quotation letter. • Licensing information available upon request. • Policy is underwritten by an A+rated insurance carrier. R.V.NUcclo&ASSOCIATES,INC. • 10148 RIVERSIDE DRIVE•TOLUCA LAKE•CA• 91602. 818-980-1413