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CERTIFICATE OF LIABILITY INSURANCE (5) R.. VN'A IV"", RV Nm f TO P,fdYSOCI n I'ES TINSURAINd I,iBIR pica ins,TING SpecialtyInsurance Pr ct Clearwater Audubon Society Insurance Policy Number: NAAO00036435 Po Box 97 Clearwater , FIL 33757 Tell. (800) 364 2433 lMalilll suIpII) u,,t@ii,vrnucclio.coii,i-n CMI"'nHi ne Irvii'nu icclio.coirrn Office, 1.01.48 Riveir;n ide IDidve Totuca II....a ke, CA 9.1602 Your 1101SUrance Y, What's included: cur Ceirtificate(s) of Ilrn bur rice A copy of your Apphc thorn v Youir eII' noIraII,ndaIrn cur Coverages g cur Quote II....ettei Vhaink you for clhaaaasirn g IfR.V. Illucclio&A;nsocliate llrnsur lrnce (Brokers, Il lrnc. ........... e took,foir arcs to lineups i n liflh yoursuj,,)ecli ky insurance needs. AUDATE(MM/DD/YYYY) ® 02/19/2021 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 NAME CT Robert V. Nuccio R.V. Nuccio&Associates Insurance Brokers, Inc. A/°NN Ext): 800 364-2433 FAX N®: 818 980-1595 10148 Riverside Drive E-MAIL support@rvnuccio.com ADDRESS: pptrvnuccio.com @ Toluca Lake, CA 91602 INSURER(S)AFFORDING COVERAGE NAIC a 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: 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/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY XPK80990413 5/31/2021 5/31/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE✓ TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY NAA000036435 PREMISES Ea occurrence $ CLAIMS-MADE l✓ OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 G®EN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 V POLICY L PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWN ED 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 YIN 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 NPOD00057076 5/31/2021 5/31/2022 $1,000,000 B AD&D Medical Plus NPOAM0040350 5/31/2021 5/31/2022 $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Robert V. Nuccio {'"J. O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD SCHOOL SUPPORT GROUP/NONPROFIT GANIZATI N COMMERCIAL PACKAGE INSURANCE POLICY MEMORANDUM OF INSURANCE Master Policy Number: XPK80990413 Memorandum Number: NAA000036435 Issuing Company: National Program Administrator: The American Insurance Company R.V.Nuccio&Associates Insurance Brokers,Inc. 1465 N.McDowell Blvd 10148 Riverside Drive Petaluma, California 94954 Toluca Lake,CA 91602 Nationwide Claims: 1-888-347-3428 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 5/31/2021 12:01A.M. to Expiration Date 5/31/2022 12:01A.M. Standard Time at the Named Insured's address as stated above. 03. BUSINESS TYPE ❑PTA ❑PTO ❑Booster Club ❑Educational Foundation ONonprofit Organization 04. COVERAGE PART LIMIT OF INSURANCE DEDUCTIBLE PREMIUM a. INLAND MARINE PROPERTY COVERAGE PART $ 0.00 Business Personal Property/Equipment $ Not Covered $ Not Covered b. INLAND MARINE CRIME COVERAGE PART $ 0.00 (01)Employee Dishonesty $ Not Covered $ Not Covered (02)Forgery Or Alteration $ Not Covered $ Not Covered (03)Theft,Disappearance And Destruction Of Money (a)Inside The Premises $ Not Covered $ Not Covered (b)Outside The Premises $ Not Covered $ Not Covered c. GENERAL AND AUTOMOBILE LIABILITY COVERAGE PART $ 136.00 (0I)General Aggregate $ 2,000,000 $ 0 (02)Products/Completed Operations Aggregate$ 2,000,000 (03)Personal And Advertising Injury $ 1,000,000 (04)Each Occurrence $ 1,000,000 (05)Damage To Premises Rented To You $ 100,000 (06)Medical Expense $ 5,000 (07)Non-Owned And Hired Automobiles $ Not Covered State Guarantee Fund $ 0.00 05. TOTAL PREMIUM Due At Inception $ 136.00 06. FORMS AND ENDORSEMENTS ATTACHED AT INCEPTION Date Issued:02/19/2021 By Form NUmber:NPOUWS001 Robert V.Nuccio 3/20/2008 NPOUWS001 ©Copyright 2008. All rights reserved. R.V.Nuccio&Associates Insurance Brokers,Inc. 818-980-1413. SCHOOL SUPPORT GROUP/NONPROFIT GANIZATI N DIRECTORS & OFFICERS LIABILITY INSURANCE POLICY MEMORANDUM OF INSURANCE Master Policy Number: USF0769320 Memorandum Number: NPOD00057076 Issuing Company: National Program Administrator: Fireman's Fund Insurance Company R.V.Nuccio&Associates Insurance Brokers,Inc. 225 W. Washington Street, Ste 1800 10148 Riverside Drive Chicago,IL 60606-3484 Toluca Lake,CA 91602 Nationwide Claims: 1-888-347-3428 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 5/31/2021 12:01A.M.to Expiration Date 5/31/2022 12:01A.M. Standard Time at the Named Insured's address as stated above. 03. RETROSPECTIVE DATE:5/31/2021 04. BUSINESS TYPE ❑PTA ❑PTO ❑Booster Club ❑Educational Foundation ❑Nonprofit Organization 05. COVERAGE LIMIT OF INSURANCE RETENTION PREMIUM a. DIRECTORS&OFFICERS LIABILITY $ 150.00 01. Each Claim $ 1,000,000 $ 0 02. Amival Aggregate $ 1,000,000 $ 0 b. EMPLOYMENT PRACTICES LIABILITY $ Excluded $ Excluded State Guarantee Fund $ 0.00 06. TOTAL PREMIUM Due At Inception $ 150.00 07. FORMS AND ENDORSEMENTS ATTACHED AT INCEPTION Date Issued: 02/19/2021 By Form NUmber:NPOUWS001 Robert V.Nuccio 3/20/2008 NPOUWS001 ©Copyright 2008. All rights reserved. R.V.Nuccio&Associates Insurance Brokers,Inc. 818-980-1413. SCHOOL SUPPORT GROUP/NONPROFIT GANIZATI N ACCIDENT MEDICAL INSURANCE POLICY MEMORANDUM OF INSURANCE Master Policy Number: 60271000013077001 Memorandum Number: NPOAM0040350 Issuing Company: National Program Administrator: Nationwide Life Insurance Company R.V.Nuccio&Associates Insurance Brokers,Inc. 1 Nationwide Plaza 10148 Riverside Drive Columbus,OH 43215 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 5/31/2021 12:01A.M. to Expiration Date 5/31/2022 12:01A.M. Standard Time at the Named Insured's address as stated above. 03. BUSINESS TYPE ❑PTA [:]PTO [:]Booster Club ❑Educational Foundation ❑Nonprofit Organization 04. COVERAGE PART BENEFIT DEDUCTIBLE PREMIUM ACCIDENT MEDICAL INSURANCE $ 81.00 a. Accidental Death $ 5,000 $ 25 b. Accidental Dismemberment $ 5,000 $ 25 c. Accident Medical Expense $ 25,000 $ 25 d. Dental Maximum $ 250 $ 25 State Guarantee Fund $ 0.00 05. TOTAL PREMIUM Due At Inception $ 81.00 06. FORMS AND ENDORSEMENTS ATTACHED AT INCEPTION o Date Issued:02/19/2021 By Form NUmber:NPOUWS001 Robert V.Nuccio 3/20/2008 NPOUWS001 ©Copyright 2008. All rights reserved. R.V.Nuccio&Associates Insurance Brokers,Inc. 818-980-1413. ­ZV Applicant Information Master Organization-Nonprofit Chapters National Audubon Society Chapter Name Clearwater Audubon Society Contact First Name Madeleine Contact Last Name Bohrer Address Po Bax 97 City Clearwater State FL Zip Cade 33757 Phone 727 748 6885 E-Mail maddogbee22@gmail.com Website Address http://www.clearwateraudubonsociety.org/ Membership dues (Enter Dollar Amount) 0 Cash grants/gifts (Enter Dollar Amount) 0 Alcohol/Liquor Sales (Enter Dollar Amount) 0 Food/Nan-Alcohol Beverage Sales (Enter Dollar Amount) 0 Bingo Games (Enter Dollar Amount) 0 Other Fund Raising Activities (Enter Dollar Amount) 10000 Total Annual Revenues/Receipts 10000 Haw did you hear about us? Another Nonprofit Organization Underwriting Does your Chapter awn or co-awn any real property, building, structure, premises, facility, No land, vacant land or acreage? Is your Chapter required by a written contract or agreement to manage the affairs and/or No daily operations of any real property, building, structure, premises, facility, land,vacant land or acreage? Is your Chapter required by a written rental agreement or written lease agreement to clean, No repair or maintain any real property, building,structure, premises, facility, land, vacant land or acreage? Does your Chapter have any activities, events or operations involving the use of live, No popper or blank ammunition, guns, gun props,starter pistols or any other weapons of any type or kind? Does your Organization have any other Organizations,Auxiliaries, Clubs, Chapters, No Groups or Entities operating along with, attached to,subordinate to or under your Organization;or any other Organizations,Auxiliaries, Clubs, Chapters, Groups or Entities over which you exercise any control and to which you might expect this insurance to also provide insurance coverage? Does your Chapter or Club have any activities, events or operations involving the use of Not Applicable Snakes or Snake Aversion Training? Does your Chapter or Club have any activities, events or operations involving Animal Not Applicable Rescue? Does your Chapter or Club have any activities, events or operations involving security dog Not Applicable training, protective dog training, attack dog training, guard dog training, police dog training or military dog training? Does your Chapter or Club have any activities, events, or operations involving swimming, Not Applicable diving, or other aquatic activities? Does your Chapter or Club have any obedience training, puppy training, dog training,or Not Applicable leash training classes in which non-club members can participate? Haw many days each year does your Chapter sponsor an activity or hold games, have 30 meetings, gatherings or events of any type or kind? ­ZV RYINUCCTO 9, ASSOCIA[TS, HNC, Coverages Effective Date 5/31/2021 Liability Plus $1,000,000/$2,000,000 Damage to Premises Rented Limit $100,000 Banding Plus No, I do not want to purchase this coverage I understand and agree that no coverage will be provided unless we install and maintain Not Applicable the required accounting procedures at inception and throughout the coverage period. Directors and Officers Liability Plus Limit$1,000,000 Would you like to add EPLI coverage to your Directors and Officers Liability coverage? No Accident Medical Plus Limit$25,000 Property Plus No, I do not want to purchase this coverage. Do you understand and agree that if you misrepresent the Master Organization to which Yes your local Auxiliary,Affiliate, Camp, Chapter, Club, Encampment, or Lodge belongs, it is a material misrepresentation which directly affects our decision to insure you, and that no coverage will be provided should a lass occur? I agree that after diligent inquiry, neither I nor any of our Directors, Officers or Members are Yes aware of any circumstances, conditions, or situations which may give rise to a lass under this insurance. Do you understand and agree that any known or existing circumstances, conditions or Yes situations which may give rise to a lass under this insurance will not be covered by the policy? Do you understand and agree that if you select the Mail-in Check payment option, the Yes effective date will be the date payment is processed by R.V. Nuccio &Associates or the requested effective date,whichever is later? I understand and agree that the underwriter retains the right to review the application for Yes accuracy, and that the policy will not provide any insurance coverage if any application information is falsely reported, falsely stated, incorrectly selected, incorrectly stated, misreported, misrepresented, misstated or wrongly stated,whether or not intentional. I understand and agree that by entering my name below, I am effectively signing this application for insurance. Name Madeleine Bohrer Accepted Date 2/15/2021 Expiration Date 5/31/2022 Memorandum Number D&O NPODO0057076 Memorandum Number NAAO00036435 Memorandum Number AD&D NPOAM0040350 Additional Insureds #of Additional Insureds 0 - NONPROFIT ANNUAL INSURANCE QUOTE APPLICANT INFORMATION Applicant Name: Clearwater Audubon Society Date: 02/19/2021 Proposed Coverage Date: 5/31/2021 Client ID#: 1679585 POLICY INFORMATION LIMIT COST L Liability Plus $1,000,000/$2,000,000 $ 136.00 RVNA, Inc. Administration Charge $ 129.00 RVNA, Inc. Unlimited Additional Insured Charge $ 50.00 2. Bonding Plus Not Covered $ 0.00 RVNA, Inc. Administration Charge $ 0.00 3. Directors & Officers Liability Plus $1,000,000 $ 150.00 RVNA, Inc. Administration Charge $ 112.50 4. Accident Medical Plus $25,000 $ 81.00 RVNA, Inc. Administration Charge $ 75.00 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 $ 733.50 If you wish to purchase this exclusive insurance product, please log in at rotectou rnon ro��tm cow TS • 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 �protectyournonpro��t.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.Ni ccio&ASSOCIATES,INC. • 10148 RIVERSIDE DRIVE•TOLUCA LAKE•CA• 91602. 818-980-1413