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CERTIFICATE OF LIABILITY INSURANCE (9) A CERTIFICATE OF LIABILITY INSURANCE °A 09108/2020' 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 FLIP Program Support NAME: Veracity Insurance Solutions,LLC. PHONE (844)-520-6992 aC No: 260 South 2500 West,Suite 303 E-MAIL ADDRESS: fli ro nfoC P 9 ram.com Pleasant Grove UT 84062 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Great American Alliance Insurance Co. 26832 ..INSURED _.INSURER B..__. Edward Bates,DBA Kinney's Kitchen INSURER C: 1540 Club Dr INSURER D: Tarpon Springs FL 34689 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'.. INSR WVD POLICY NUMBER MM/DDIYYYY MMI D/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300,000 ...X PREMISES Ea occurrence $ CLAIMS-MADE X I OCCUR MED EXP(Anyone person) $ S+DDD A PL2664771-FO96898 0804/2020 08/04/2021 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER ',. PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY PRO JECTLOC ANIMAL BAILEE $ AUTOMOBILE LIABILITY Ee aec deDISINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS '.. Peracadenl UMBRELLA LIAB OCCUR F 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 -7 NIA E.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? (Mandatory In NPJ P L DISEASE-EA EMPLOYE $ If yesDES, Ttlescrto,untler ION OF OPERATIONS polo E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Certificate holder had been added as additional insured regarding the above mentioned policy per attached Additional Insured-Designated Person or Organization(CG 20 26 Ed.04 13) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 2115 Myrtle Ave Clearwater,FL 33755 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) PL2664771-FO96898 CG 20 26(Ed.04 13) 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 Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. SECTION II-WHO IS AN INSURED is amended to include as an Additional Insured the person(s)or organization(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 omissions of those acting on your behalf: 1.in the performance of your ongoing operations;or 2.in connection with your premises owned by or rented to you. However: 1.the insurance afforded to such additional insured only applies to the extent permitted by law;and 2.if coverage provided to the Additional Insured is required by a contract or agreement,the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B• With respect to the insurance afforded to these Additional Insureds,the following is added to SECTION III— LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement,the most we will pay on behalf of the Additional Insured is the amount of insurance: 1.required by the contract or agreement;or 2.available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Copyright,ISO Properties,Inc.,2012 CG 20 26(Ed.04/13)PRO Page 1 of 1