CERTIFICATE OF LIABILITY INSURANCE (16) ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATEIMM7f1p)YyYY}
09/05!23
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.CONS.TITUTE 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 policyflesJ must be endorsed. If SUBROGATION IS WAIVED;subject to
the terms and conditions of the policy,certain Policies may requirean endorsement. A statement on this certificate does not confer rights to the
certificate holder in Bell of Such endorsement(s).
PRODUCER. CONTACT
NAME: Helly Davitt
ARCW Insurance PHONE (727)544-8841 Exd: 27ya4-seatA
9067 Belcher Road BdNAIL.
ADDREss:Belly@arcrrinsurance,com
INSURER!$ AFFORDING COVERAGE NA1C#
Pinellas Park FL 33782INSURSRA:Ph ladel hia Indemnity Insurance .compar Pi805s
INSURED INSURERS-PhilaE! hia Insurance Com anies 05777
Axtz 4 Life Academy Inc. INSURER C:
175.1.Kings Hwy INSURER D:
INSURER E
Clearwater FL 33755 FNsuRERi.
COVERAGES CERTIFICATE NUMBER:22/23 Master Cert REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW:HAVE BEEN ISSUED TOTHEINSURED 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 BYTli[E POLICIES DESCRIBED HERE]N IS SUBJECTTOALL THE TERMS,
EKCLUSIC)NSAN❑CONDITIONS:OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REbucED BY PAID CLAIMS.
TR TYPE OF INSURANCE ADDL UBRvmn- POLICY NUMBER .MPMIDDY EFF FYYYYI MM POLICY EXP.
LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE1,060400
A CLAIMS-MADE M OCCUR OA T..RERITEO
PREMISES Ea accurrenca s 300,000
X PHPiC245630p 1Q1112022 .1011/2023 MLO EXP(Any one person). S 5,.000
PERSONAL.&ADV INJURY 5 i,000,Do 0
GEN'LAGGREGATE LIMFIFAPPLIES PER, GENERALAGGREGATE .S 3,000,000
X POLICY DPRO-
JECT LOC PRODUCTS-COMPIOP.AGG :S 3,000,000
OTHER:
AUTOMOBILE UAB1LM I COMBINED SINGLE LIMIT
Ea accident $ 1,000,OOo
A AWAUTO S't1F$,2456300 1011/2022 10/1/2023 BODO INJURY.[Per person] S
ALL OWNED X SCHEDULED
AUTOS AUTOS X BODILY 114JURY(Peraccldent) S
X HIRED AUTOSX NQN-QWNEfJ PROPERTYpAA1AGE
AUTOS. Per aCCidenI 5
S
X UMBRELLALIAB OCCUR I EACH OCCURRENCE S .4 000 000
$
EXCESS LIAO CLAIMS-MADE AGGRE=GATE. S 4,00o,000
DEC I I RETEt� ION 5 PUtW833753 1411/2022 10/1/2023 $
WORKERS COMPENSATION PER
AND EMPLOYERS'LTABILITY YIN STATUTE EER.
ANY PRGPRIETORIPARTNERIEMC;UTIVE E.L.EACH ACCIDENT S
OFFICEtery;n1 NH) —1❑NIA
[Manduaryba tin [t[t[t El DISEASE-EA EMPLOYEE S
IF yss,:dnsclihe under
DESCRIPTION OF OPERAMNS below k El:DISEASE•POLICY LIMIT S
A Professional .Liability X ssak2ass300 10/1/2022 10/1/2023 1,000,000
Deductible $10.000, Aggregate 1,0001000
DESCRIPTION OF.OPERATIONS I LOCATION$!VEHICLES[AC ORD 161,Additional Remarks Schedule,.May be attached 11 more apace is requlrad)
Certificate Holder ms additional Insured with respects to the general liability, as required by written
contract, subject to the terms and conditions of .the policy.
**Please. see att=ached form fo;r confirmation of additional coverage.`s
CERTIFICATE HOLDER CANCELLATION
SHOU LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE6 BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF NOTICE WILL BB1)ELNERED IN
100 S. Myrtle..Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, FL 33755
AUTHORIZED REPRESENTATIVE
i
Ia:ries. Parenti,I.SHs•7ATT -.� �'"'
O 1.988-2014 ACORD CORPORATION. All rights reseryed.
ACORD 25(2014101) The ACORD name and Ingo are registered marks of ACORD
INS025(261401)
COMM ENTSIREMARKS
1 I cyber Liability
InsurP.x: Certain Underwriter s at Lloyd's London.
MAIC: 32727
Folicy ;i.:K726&-CYTLA 230
P:oli:cy Effective Da.te:8/19/2.3 to 8/19124
*Please see policy declararigns. for car. 1T3F1i1�:30I3. of all coverage limits
$2;.500 Self-Insared retention
Retroactive Date. Full P.rio-- Acts
Continuity Date: 8119!19
)Abuse ar:d Molestatian Liability
Insurer: Philadelphia Indemnity ins. Co..
:NAIL: 18058
Policy tl:PfIPK2468300
Policy Effective Date.10/01/21 t.o. 3.0/0j/2
"1,0C.0,000 Each Claim,
$3,000:,Op.O Anuua.l Aggregate
$c Deductible
3)Directors and Officers/Employmen't Practices Liability
Insurer: Phi.iude.Iphdia Indemn.it:y :ins Co.
APIC: 1805.8
Policy k:PHSDI7461
Policy Effective Dat_e:10 01/2:2 to. 101-.01/23
$1,000,000 Each Claim
$.1,000,bOC Aggregate
525,00.0 Self-Tr,sured. Retention
Retroactive Date: 0.1 '01./20.[.2
$0 [D.educt ihle
4jCrime lmsu.rance
Insurer: Travelers
NAIQ: 1904
Policy 010.713H5,7
Policy- Effective Dates:8119/2.1 to 8/19/24
$3.00,000 Emp?a.yee Dishonesty $1,.000 deductib`e
$30.0,000 F.orger.yO-r A1era.tion '$1,0Q.0 ded:uc.tib].e
$300,000 RQbbite.ry. (on or off premises) $1,000 de.ductibi-e
300,000 Computer. Fraud .$1,0.00 deductible
$300,.000 Funds Transfer Fraud $1;000 dedu-t4ble
5)Profc-5sic.nal Liability
IT.surei: Philide:lphi•a Indemnity Ins :Co..
N-A C,: 1805.8
Policy 9Pr=k24.68,300
Pol.icy Effective Dates: ?ul0i/22-10/01/1;3
$1,000,0[]C Each Claim
$3,Qu.0,000 Aggregate
YO Deductible
UFREMARK COPYRIGHT 2000, -AMS SERVICES INC.