CERTIFICATE OF LIABILITY INSURANCE (14) ACCPRV CERTIFICATE OF LIABILITY INSURANCE PATE(MMtDDNYYYJ
11/06/2019
I CERTIFICATE ISI D INFORMATION L T CERTIFICATE L
I
IIA T AFFIRMATIVELY NEGATIVELY END,EXT ALT COVERAGE AO THE POLICIES
FRErRESENTATrVE L . TI FIC T INSURANCE I A T ISSUING I (S),AUTHORIZED
PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT, If the certificate holder Is an ADDITIONAL INSURED,the olic (ies)must have ADDITIONAL INSD provisions or be andoraidT.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an
this certificate does not confer rights to the certificate holder in lieu of such endorse ent(a).
PRODUCER NTACT Jam Parents
ME•
ARCW Insurance PHONENo.E,, (727)544-8841 c No c (727) 842
9067 Belcher Rd AIL
DRESS: ji a insuran ,gym
ISURER(S)AFFORDIG COVERAGE NAILS
Pinellas Park FL 33782 INSURERA: Philadelphia Indemnity Ins Co 18058
INSURED INSURER B; Progressive Express 10193
AItz4 LlfeAcademy Inc. INSURER C: Burlington Ins. 23620
1606 N.Highland Ave INSURER D
INSURER
Clearvvater FL 33756 INSU R P
COVERAGES
CERTIFICATE 19120 Master 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.
_SR X=GUOR
L TYPE OF INSURANCE ISD O POLICY NUMBER MPO POLICY E 1t7CY P LIMITS
COMMERCIAL GENERAL L IL EACH OCCURRENCE $ 1,000,000
CLAIMS-MAGE OCCUR P ERER MISES Ea occurrence $ 100,000 '..
MED {Au, one on} $ 5A00
A Y PHPK2025715 10/01/2019 10/01/2020 PERSONAL&ADV INJURY $ 1.000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
POLICY 0
PRO-
JECT LOC PRODUCTS-COMP/OPAGG $ 31000,000
OTHER: $
AUTOMOBILE.LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Es acddgqJt
ANY AUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED Y 03389473-5 12/01/2019 12/01/2020 BOD�PLYNJURY(Per acddent) $
AUTOS ONLY AUTOSHIRED NON-O ED PROTY DAMAGEAUTOS ONLY AUTOS ONLY Perent $
Medlcal payments S 5,000
UMSREULALIAB OCCUR $ 4,000,000
EACH OCCU ENCS
C CESS a CLAIMS-MADE HFF0010235 08/19/2019 10/01/2020 AGGREGATE $ 4,000,000
DED RETENTION$
ERS COMPEN TION $
PER ETH-
AND EMPLOYERS'LIABILnY YIN STAME ER
ANY PROPRIE ARTNE XECUTNE
MIA E.L.EACH ACCIDENT $
OFFICE EMBER EXCLUDED?
(Mandatory in NH)
If yes,describe under E.L.DISEASE-EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
General Aggregate $1,000,000
Directors&Officers
A y PHSD1485583 10/01/2019 10/01/2020 Each Occurrence $1,000,000
Deductible $1,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional'Remarks Schedule,may be attached if more space Is required)
-Please see attached for additional Coverages"
l
I
CERTIFICATE L CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRA71ON DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwater
ACCORDANCE WITH THE POLICY PROVISIONS.
100 S.Myrtle Avenue
AUTHORIZED REPRESENTATIVE ;..
Clearwater FL 33756 f
a
1988-20 15 ACORD CORPORATION. I rights served.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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