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CERTIFICATE OF LIABILITY INSURANCE (12) DATE(MM/DD/YYYY) ACCOR" CERTIFICATE OF LIABILITY INSURANCE 12/21/2020 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 Colleen B. Burke NAME: Burke Insurance Services Inc PHONE FAX P O Box 1134 A/C No Ext): 727-441-3094 A/C,No: 727-449-0102 E-MAIL Dunedin, FL 34697 ADDRESS: colleen@burkeinsservices.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ALLIANCE OF NONPROFITS FOR INSURANCE RISK RETENTION 10023 INSURED INSURER B: National Liability& Fire Insurance CO 20052 Dr. Martin Luther King Jr. Neighborhood Family Center Inc 900 Martin Luther King Jr.Avenue INSURER 7 Clearwater, FL 33755 INSURER D: 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 INSD WVD POLICY NUMBER MWDD/YYY MWDD/YYY A X COMMERCIAL GENERAL LIABILITY X X 2021-4596 01/01/2021 01/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR (includes Improper Sexual DAM Conduct) PREM SESOEa occurrence $ 500,000 X PROFESSIONAL 01/01/2021 01/01/2022 MED EXP(Any one person) $ 20,000 X DIRECTORS&OFFICERS$1,000,000 2021-4596 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICYEl PELT � LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ A AUTOMOBILE LIABILITY X 2021-4596 01/01/2021 01/01/2022 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LAB X OCCUR 2021-4596 01/01/2021 01/01/2022 EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION A9WC11246 01/07/2021 01/07/2022 PER X OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 AUTO PHYSICAL DAMAGE X 2021-4596 01/01/2021 01/01/2022 $1,000 COMPREHENSIVE DEDUCTIBLE A $1,000 COLLISION DEDUCTIBLE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Clearwater is named as additional insured with respects to General Liability and Auto Liability 2017 Chevrolet #1GAWGEFF3H1186307 2017 Chevrolet #1 GAWGEFFXH 1188779 CERTIFICATE HOLDER CANCELLATION Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P. O. Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwatert, FL 33756 AUTHORIZED REPRESENTATIVE Colleen B.Burke ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD