CERTIFICATE OF LIABILITY INSURANCE (13) A` DATE(MM/DD/YYYY)
ACCOR"® CERTIFICATE OF LIABILITY INSURANCE
12/21/2021
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 CONTACT Colleen B. Burke
NAME:
Burke Insurance Services Inc PHONE 727-441-3094 FAX 727-449-0102
1460 Beltrees Street,Suite 11 E-MAIL/C Lo Ext): A/C No
Dunedin, FL 34698 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 2022-4596 01/01/2022 01/01/2023 EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE XOCCUR (includes Improper Sexual DAMAGE PREM SESOEa occurrRENTEDence $ 500,000
X PROFESSIONAL Conduct) MED EXP(Any one person) $ 20,000
X DIRECTORS&OFFICERS$1,000,000 01/01/2022 01/01/2023
2022-4596 PERSONAL&ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
X POLICY PELT � LOC PRODUCTS-COMP/OPAGG $ 3,000,000
OTHER: $
COMBINED SINGLE LIMIT $ 1,000,000
A AUTOMOBILE LIABILITY X 2022-4596 01/01/2022 01/01/2023 Eaaccident
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 LIAB X OCCUR 2022-4596 01/01/2022 01/01/2023 EACH OCCURRENCE $ 5,000,000
A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
B AND EMPLOYERS'LIABILITY Y/N A9WC327726 01/07/2022 01/07/2023 STATUTE X ER
ANY PROPRIETOR/PARTNER/EXECUTIVEE.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 2022-4596 01/01/2022 01/01/2023 $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