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CERTIFICATE OF LIABILITY INSURANCE (15) DATE(MM/DDIYYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 10/06/2020 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 Debra Viveiros NAME: PHOARCW Insurance AICNNo Exti: (727)544-8841 (A//C Na ): (727)544-8842 9067 Belcher Rd E-MAIL debra@arcwinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Pinellas Park FL 33782 INSURERA: Philadelphia Indemnity Ins Co 18058 INSURED INSURER B: Progressive Express 10193 Artz 4 Life Academy Inc. INSURER C: Burlington Ins. 10328 1606 N.Highland Ave INSURER D: INSURER E: Clearwater FL 33755 INSURER F: COVERAGES CERTIFICATE NUMBER: 2020 Master Cert 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 ADDL SUER TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE_7TED CLAIMS-MADE � OCCUR PREM SESOEa oc/currrence $ 100,000 MED EXP(Anyone person) $ 5,000 A Y PHPK2175738 10/01/2020 10/01/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X JECT LOC PRODUCTS AG $POLICY F-1 PRO 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y 03389473-5 12/01/2020 12/01/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 C EXCESS LIAB CLAIMS-MADE HFF0014516 10/01/2020 10/01/2021 AGGREGATE $ 4,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEF—] N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability Each Occurrence 1,000,000 A Y PHPK2175138 10/01/2020 10/01/2021 Aggregate 1,000,000 Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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 City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 100 S.Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater FL 33756 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED ARCW Insurance Artz 4 Life Academy Inc. POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes 1)Cyber Liability Insurer:Evolve NAIC:See Attached Policy#:EVOPNA595489 Policy Effective Date:8/19/20 to 8/19/21 $500,000 Each Claim $500,000 Annual Aggregate $2,500 Self-Insured Retention Retroactive Date:8/19/19 2)Abuse and Molestation Liability Insurer:Philadelphia Indemnity Ins Co. NAIC: 18058 Policy#:PHPK2175738 Policy Effective Date:10/01/20 to 10/01/21 $1,000,000 Each Claim $3,000,000 Anuual Aggregate $0 Deductible 3)Directors and Officers/Employment Practices Liability Insurer:Philadelphia Indemnity Ins Co. NAIC: 18058 Policy#:PHSD1570959 Policy Effective Date:10/01/20 to 10/01/21 $1,000,000 Each Claim $1,000,000 Aggregate $25,000 Self-Insured Retention Retroactive Date:01/01/2002 $0 Deductible 4)Crime Insurance Insurer:Travelers NAIC: 19046 Policy#107139057 Policy Effective Dates:8/19/20 to 8/19/21 $300,000 Employee Dishonesty$1,000 deductible $300,000 Forgery or Aleration$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 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Life Force Cultural Arts Academy, Inc. Not for profit org, Insured Multiple Names OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC ADDITIONAL REMARKS SCHEDULE ISSUED 10/1/2020 ATTACHED TO AND FORMING PART OF THE CERT OF INSURANCE FOR ARTZ 4 LIFE ACADEMY INC 8-19-2020 to 8/19/20201 POLICY NUMBER EVOPNA595489 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# PHPK2175738 ONLY