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CERTIFICATE OF LIABILITY INSURANCE (18) ® p p® p� DATE(MMIDDIYYYY) A�V CERTIFICATE OF LIABILITY INSU NCE 10/3/2023 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: Kelly DdVltt _. .-m..._... -- .......�. ARCW Insurance PNCNo sy (727)544-8641 1 FAX No: nz7)s44-BB42 �, 9067 Belcher Road E-MAIL ADDRESS:kelly@arcwinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Pinellas Park FL 33782 INSURER Indemnity Insurance Com-ar C18058 .,.. _... INSURED INSURER B Philadelphia Insurance Comanies R18667 Art2 4 Life Academy Inc. INSURERC: 1751 Kings Hwy INSU�. INSURER E: Clearwater FL 33755 INSURER F: COVERAGES CERTIFICATE NUMBER:CL2310307750 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP LIMITS _ LTR TYPE OF INSURANCE POLICY NUMBER__ (MMIDDNYYY 'MMH)DJYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE a OCCUR PREMISES iEa o currrrence $ 300,000 X PHPK2608341 10/1/2023 10/1/2024 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 X JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 3,000,000 POLICY El PRO OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accidents ANY AUTO BODILY INJURY(Per person) $ p' ALL OWNED SCHEDULED - AUTOS _X AUTOS X s PEPK2608341 10/1/2023 10/1/2024 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS fPer accidents _ - Uninsured motorist BI split limit N�''.$ 200,000 X UMBRELLA UAB OCCUR I EACH OCCURRENCE '$ 4,.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED !RETENTION $ 1.883585 10/1/2023 110/1/2024 $ WORKERS COMPENSATION .STATUTE )TH AND EMPLOYERS'LIABILITY IN ANY PROPRIETORIPARTNER/EXECUTIVE Y .N/A E.L.EACH ACCIDENT _ $ OFFICER/MEMBER EXCLUDED? El '..(Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A DIRECTORS S OFFICERS X PHSD1825801 10/1/2023 10/1/2024 D&O Liability 1,000,000 [[AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is additional insured with respects to the general liability, as required by written contract, subject to the terms and conditions of the policy. **Please see attached form for additional coverages** CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 100 S. Myrtle Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33756 - AUTHORIZED REPRESENTATIVE Chuck Wasson/KEDAVI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMENTSIREMARKS 1)Cyber Liability Insurer: Underwriter's at Lloyd's London NAIC: 15792 Policy #:K7266CYLA230 Policy Effective Date:8/19/23 to 8/19/24 *Please see policy declarations for confirmation of all coverage 's/limits Retroactive Date: 8/19/19 2)Abuse and Molestation Liability Insurer: Philadelphia Indemnity Ins Co. NAIC: 18058 Policy #:PHPK2608341 Policy Effective Date:10/01/23 to 10/01/24 $1,000,000 Each Claim $3,000,000 Anuual Aggregate $0 Deductible 3)Crime Insurance Insurer: Travelers NAIC: 19046 Policy #107139057 Policy Effective Dates:8/19/21 to 8/19/24 $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 OFREMARK COPYRIGHT 2000, AMS SERVICES INC. 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