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PUBLIC MURAL GRANT AGREEMENT (3)PUBLIC MURAL GRANT AGREEMENT This Grant Agreement is made and entered into on this day of April, 2026 between the Clearwater Community Redevelopment Agency, whose address is: 100 S Myrtle Ave., 3rd Floor, Clearwater, FL 33755, ("CRA"), and Sharard X Art & Apparel LLC ("Artist"). WHEREAS, it has been determined by the CRA that public art is highly desirable in the North Greenwood Community Redevelopment Area; and WHEREAS, the Community Redevelopment Agency Trustees voted to approve an allocation of funding to the North Greenwood Art Oasis Mural Festival, and provide support to artists in the form of a grant. NOW, THEREFORE, the parties agree as follows: 1 TERM 1.1 The term of this agreement shall commence on April 9, 2026 and continue through May 30, 2026 ("termination date") unless earlier terminated under the terms of this agreement. 2 RESPONSIBILITIES OF THE ARTIST 1.1 The Artist shall cooperate with the City of Clearwater to ensure that all permits any permits or permissions are secured to install a mural(s) on Isay M. Gulley Center Head Start Building located at 1045 N Martin Luther King Jr Ave, Clearwater, FL 33755 ("Building"). 2.1 The Artist shall enter into a separate written agreement with Clearwater Neighborhood Housing Services, Inc. ("Property Owner") of the Building commissioning a public mural (Exhibit A). 2.2 The Artist shall present the completed design(s) of the mural(s) to the Property Owner prior to the installation of the mural(s). (Exhibit B) 2.3 All Artwork shall be installed no later than May 30, 2026. 2.4 The Artist agrees to maintain in force a liability insurance policy in an amount acceptable to the City of Clearwater and the CRA which will insure and indemnify the City of Clearwater, the CRA, and the Property Owner from any suits, claims, or actions brought by any person or persons and from any and all costs of litigation brought against the Artist, the Property Owner and the City for such injuries to persons or damage to property occurring during the agreement or thereafter that results from performance by the Artist of the obligations set forth in this agreement. The City and the Property Owner shall be included as "additional insureds" on such policy. (Exhibit C) 3 RESPONSIBILITIES OF THE CITY 3.1 The CRA agrees to provide the Artist with a grant of $7,000 (seven thousand dollars) to be paid in two separate payments. First payment ($2,500) to be paid upon completion of this signed and 1 executed contract and second payment ($4,500) to be paid once the mural has been completed. Artist will invoice the CRA for each payment. 3.1.1 The funds granted by the CRA are to be used for all materials and artists fees. 3.1.2 A minimum of 3 photos of the completed work must be provided to the City of Clearwater Cultural Affairs Dept. within three (3) days of completion of the project. 3.2 The Cultural Affairs Dept. will serve as the City and CRA liaison for the Artist 3.3 The CRA agrees to promote the mural festival through normal CRA communications, such as www.mvclearwater.com and www.mvclearwatercra.com, the CRA Facebook page and social media; internal staff communications; flyers; and messages to partner organizations. 4 INDEMNIFICATION Subject to Florida Statute 768.28, the Artist agrees to indemnify and hold free and harmless, assume legal liability for and defend the City, CRA, and their officers, employees, agents, and servants, whether they are current or former, from and against any and all actions, claims, liabilities, assertions of liability, losses, costs and expenses, in law or in equity, including but not limited to attorney's fees at trial and appellate levels, reasonable investigative and discovery costs, court costs, or claims for bodily injury or death of persons and for loss of or damage to property, except as provided for herein, or every kind and nature whatsoever, which in any manner directly or indirectly may arise or be alleged to have arisen or as a result of the duties and obligations as required by this agreement that which has resulted or alleged to have resulted from the negligent acts or omissions or other wrongful conduct of or the infringement of any copyright by the Artist. Nothing contained herein is intended to serve as a waiver by the City of its sovereign immunity, to extend the liability of the City beyond the limits set forth in Section 768.28, Florida Statutes, or be construed as consent by the City to the sued by third parties. 5 REMOVAL OR RELOCATION All Artwork shall be installed no later than May 30, 2026, and maintained on the property until May 30, 2027 by the Property Owner. The Artwork shall not be altered, modified, relocated, or removed for a period of one (1) year from date of completion per the Agreement to Commission a Public Mural (Exhibit A). After this time, and pursuant to 17 U.S.C. §106A(e), the Artist specifically waives any protections afforded to the Artist under 17 U.S.C. §106A with respect to the Artwork and the uses of the Artwork as described in this agreement. Artist also specifically acknowledges that removal of the Artwork from the property may subject the Artwork to destruction, distortion, mutilation, or modification. In addition, in the event there is a condition or accident that occurs outside the reasonable control of the City, such as an act of God, resulting in damage or destruction of the Artwork, then the Artwork may be removed or replaced. At any time after the execution of 2 this Agreement, the City may request that the Artwork be removed from the site due to hardship, and the Artist and the City will consider that request in good faith. 6 NOTICE Any notice required or permitted to be given by the provision of this Agreement shall be conclusively deemed to have been received by a party hereto on the date it is delivered to such party at the address indicated below: City of Clearwater Community Redevelopment Agency 600 Cleveland Street, 6th Floor Clearwater, FL 33755 Sharard X Art & Apparel LLC 7333 Hunters Greene Circle Lakeland, FL 33810 7 DEFAULT Failure or refusal by the Artist to perform or do any act herein required shall constitute a default. In the event of a default, in addition to any other remedy available to the City, the City, upon thirty (30) days written notice, may terminate this agreement and demand repayment of grant funds provided. Such termination does not waive any other legal remedies available to the City. 8 TERMINATION Either party may terminate this agreement with thirty (30) days written notice without any further obligation. The City may terminate this agreement immediately for failure to adhere to any of the provisions of this agreement as determined by the City in its sole discretion. 9 DISCLAIMER OF WARRANTIES This agreement constitutes the entire agreement between the parties on the subject hereof and may not be changed, modified, or discharged except by written amendment duly executed by both parties. No representations or warranties by either party shall be binding unless expressed herein or in a duly executed amendment hereof. 3 In witness thereof, the parties hereto have caused this Artist and Public Mural Grant Agreement to be executed on the date and year first written above. Sharard X Art & Apparel LLC Sharard Saddlers Sharard Saddlers Chief Executive Artist CITY OF CLEARWATER Jesus Nino CRA Director Approved as to form: Owen Kohler CRA Attorney Signature: Sharard Saddlers (Apr 13, 2026 13:13:37 EDT) Email: sharardxart@gmaiL.com Attest: Rosemarie Call City Clerk 4 Exhibit A AGREEMENT TO COMMISSION PUBLIC MURAL •This agreement is entered into this 7 qday of p << k , 2026 by and between Sharard Saddlers dLakeland) called "Artist") and Clearwater Neighborhood Housing Services, Inc. (hereafter (hereafter called "Owner"). I. Owner's Obligations a. The Owner recognizes that the purpose of the project, which is to enhance the community, is mutually beneficial to the Artist and the Owner, and therefore desires to have a mural(s) (hereafter called Artwork) painted on the exterior of their building(s) located at 1045 N. Dr.Martin Luther King Jr Av. Clearwater FI, 33755 (hereafter called "Building"). (Gulley Center) b. The Owner agrees to allow the Artist to paint Artwork on the Building. The dimensions and location(s) of the Artwork will be Front corner of Blding(2Walls) Wall 1- 21'9"W x13'6"H Wall 2- 20"W x 13'6"H c. The Owner understands that the Artwork shall, in no way, be used for advertising. d. The Owner will inform the Artist if the Artwork is damaged or in need of repair. e. The Owner agrees to keep the Artwork for a minimum of 1 year. II. Artist's Obligations a. The Artist shall cooperate with the City of Clearwater to ensure that all permits any permits or permissions are secured to install Artwork on the Building. b. The Artist shall present the completed design(s) of the Artwork to the Owner prior to the installation of the mural(s). The Owner can request that the Artist make reasonable adjustments to the design(s). The Artist shall then present the adjusted design(s) to the Owner for approval. III. Artist's Rights a. The Owner shall notify the Artist in writing upon the adoption of a plan or alteration of the Building which would entail removal or relocation of the Artwork which might result in the Artwork being destroyed, distorted, or modified. The Artist shall be granted the right of consultation regarding the removal or relocation of the Artwork. If the Artwork cannot be successfully removed or relocated as determined by the Owner, the Artist may disavow the Artwork or have the Artwork returned to the Artist at the Artist's expense. b. The Artwork may be removed, relocated, or destroyed by the Owner should the Artist and the Owner not reach mutual agreement on the removal or relocation of the Artwork after a period not to exceed ninety (90) days after written notice to the Artist. During the ninety (90) day period, the Parties shall engage in good faith negotiations concerning the removal or relocation of the Artwork. c. In the event of changes in building codes, zoning laws, or regulations that cause the Artwork to conflict with such codes, laws, or regulations, the Owner may authorize the removal or relocation of the Artwork without the Artist's prior permission. In the alternative, the Owner may commission the Artist by a separate agreement to make any necessary changes to the Artwork to render it in conformity with such codes, laws, or regulations. d. If the Owner reasonably determines the Artwork presents imminent harm or hazard to the public, other than as a result of the Owner's failure to maintain the Artwork as required under this Agreement, the Owner may authorize the removal of the Artwork without the prior approval of the Artist. e. This clause is intended to replace and substitute for the rights of the Artist under the Visual Artists Rights Act of 1990 to the extent that any portion of this Agreement is in direct conflict with those rights. The Parties acknowledge that this Agreement supersedes that law to the extent that this Agreement is in direct conflict therewith. f. Owner's obligations under this section III. shall expire one (1) year from execution of this agreement. IV. General a. The parties agree to be fully responsible for their and their agents own acts and omissions during the performance of their obligations under this Agreement. Owner's liability hereunder is subject to the monetary limitations and defenses contain in sections 768.28, F.S. IN WITNESS WHEREOF, the Parties have caused this Agreement to be signed in its corporate/legal name by its authorized representative or persons authorized to execute this Agreement on the date and year first above written. April 7, 2026 Owner Date Frank Cornier, President & CEO 4/8/2026 Artist Date 4/13/26, 10:20 AM Mike Twitty, MAI, CFA Pinellas County Property Appraiser Property Details I Pinellas County Property Appraiser Parcel Summary (as of 10 -Apr -2026) Parcel Number 10-29-15-00000-240-0100 • Owner Name CLEARWATER NEIGHBORHOOD HOUSING SVC INC • Property Use 7238 Private Schools & Colleges, Day Care Centers • Site Address 1045 N MARTIN LUTHER KING JR AVE CLEARWATER, FL 33755 • Mailing Address 608 N GARDEN AVE CLEARWATER, FL 33755-3826 • Legal Description FROM SW COR OF SE 1/4 OF NW 1/4TH N 541.23FT TH S89DE 30FT FOR POB TH N 102FT TH S89DE 145FT TH S 92.91 FT TH S57DW 16.28FT TH N89DW 131.4FT TO POB • Current Tax District CLEARWATER (CW) • Year Built 1945 Heated SF Gross SF Living Units Buildings 5,332 5,332 0 1 https://www. pcpao.gov/property-details?s=152910000002400100&input=1045+N+Martin&search_option=address&start=0&length=l 0&order_column=... 1/4 4/13/26, 10:20 AM IExemptions Property Details 1 Pinellas County Property Appraiser Year Homestead Use % Status Property Exemptions & Classifications 2027 2026 2025 No No No 0% 0% 0% Institutional Miscellaneous Parcel Info 1 Last Recorded Deed Sales Comparison Census Tract Evacuation Zone Flood Zone Elevation Certificate Zoning Plat Bk/Pg 12167/1830 Find Comps 262.00 E Current FEMA Check for EC Maps Zoning Map / 12025 Final Values Year Just/Market Value Assessed Value/SOH Cap County Taxable School Taxable Value Value Municipal Taxable Value 2025 $365,000 $365,000 $7,300 $7,300 $7,300 Value History Year Homestead Exemption Just/Market Value Assessed County Value/SOH Cap Taxable Value School Municipal Taxable Value Taxable Value 2024 2023 2022 2021 2020 N N N N N $350,000 $332,000 $332,000 $315,000 $315,000 $350,000 $332,000 $332,000 $315,000 $315,000 $7,000 $6,640 $6,640 $6,300 $6,300 $7,000 $6,640 $6,640 $6,300 $6,300 $7,000 $6,640 $6,640 $6,300 $6,300 2025 Tax Information 1 Do not rely on current taxes as an estimate following a change in ownership. A significant change in taxable value may occur after a transfer due to a loss of exemptions, reset of the Save Our Homes or 10% Cap, and/or market conditions. Please use our Tax Estimator to estimate taxes under new ownership. Tax Bill 2025 Millage Rate Tax District View 2025 Tax Bill 19.3522 (CW). I -Sales History Sale Date Price Qualified / Unqualified Vacant / Improved Grantor Grantee Book/ Page 16 -Aug - 2002 03 -Apr - 1995 25 -Aug - 1989 31 -Dec - 1979 31 -Dec - 1977 $125,000 $85,000 $210,000 $42,500 $40,200 U U MACARTHUR BOYKINS INC DISSOLVE AAJR ENTRP INC DSLV WILLOW RUN INC CLEARWATER NEIGHBORHOOD BOYKINS, MACARTHUR INC AAJR ENTRPRISES INC 12167/1830 08954/0945 07073/1003 04799/1881 04579/1798 2025 Land Information Land Area: - 14,736 sf - 0.33 acres Property Use Frontage and/or View: None Land Dimensions Unit Value Units Method Seawall: No Total Adjustments Adjusted Value Private Schools 102x145 $6.5 14,729 SF 1.0000 $95,737 [2025 Building 1 Structural Elements and Sub Area Information https://www.pcpao.gov/property-details?s=152910000002400100&input=1045+N+Martin&search_option=address&start=0&length=10&order column=... 2/4 4/13/26, 10:20 AM Property Details l Pinellas County Property Appraiser Structural Elements Foundation: Continuous Footing Floor System: Slab On Grade Exterior Walls: Concrete Blk/Stucco Unit Stories: 1 Roof Frame: Flat Living Units: 0 Roof Cover: Built Up Wood Year Built: 1945 Building Type: Offices Quality: Average Floor Finish: Carpet Combination Interior Finish: Dry Wall Cooling: Heat & Cooling Pkg Fixtures: 10 Effective Age: 47 2025 Extra Features Sub Area Base (BAS): Total Area SF: Heated Area SF Gross Area SF 5,332 5,332 5,332 5,332 Description Value/Unit Units Total Value as New Depreciated Value Year CONC PAVE FENCE $10.00 2,400.0 $24,000 $24,000 0 $19.00 250.0 $4,750 $1,900 2000 Permit Data Permit information is received from the County and Cities. This data may be incomplete and may exclude permits that do not result in field reviews (for example for water heater replacement permits). We are required to list all improvements, which may include unpermitted construction. Any questions regarding permits, or the status of non -permitted improvements, should be directed to the permitting jurisdiction in which the structure is located. Permit Number Description Issue Date Estimated Value BCP2024-070103 HEAT/AIR 07/17/2024 $83,090 BCP2022-050935 ROOF 05/31/2022 $20,000 BCP2010-10520 MISCELLANEOUS 10/28/2010 $3,500 https://www.pcpao.gov/property-details?s=152910000002400100&input=1045+N+Martin&search_option=address&start=0&length=10&order column=... 3/4 4/13/26, 10:20 AM Permit Number Description Property Details 1 Pinellas County Property Appraiser Issue Date Estimated Value BCP2010-07005 BCP2010-06594 ADDITION/REMODEURENOVATION MISCELLANEOUS 07/01/2010 06/28/2010 $50,000 $2,376 https://www.pcpao.gov/property-details?s=152910000002400100&input=1045+N+Martin&search_option=address&start=0&length=l0&order column=... 4/4 4/13/26, 10:22 AM Detail by Entity Name DIVISION OF CORPORATIONS %��I'' 'Oal foil of " 1 rr &ilii. �-®( 1._.01 r� i_��rlp rll tt3 an Vicki! lige of Ftvrldtt w bs'rre Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Not For Profit Corporation CLEARWATER NEIGHBORHOOD HOUSING SERVICES INCORPORATED Filing Information Document Number 746169 FEI/EIN Number 59-1898543 Date Filed 03/08/1979 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 05/20/2025 Event Effective Date 10/07/2020 Principal Address 608 NORTH GARDEN AVE. CLEARWATER, FL 33755 Changed: 01/15/2009 Mailing Address 608 NORTH GARDEN AVE. CLEARWATER, FL 33755 Changed: 01/15/2009 Registered Agent Name & Address Anthony P. Granese, P.A. 1012 DREW STREET CLEARWATER, FL 33755 Name Changed: 10/07/2020 Address Changed: 10/07/2020 Officer/Director Detail Name & Address Title Chairman, Director https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=CLEARW... 1/3 4/13/26, 10:22 AM Jones, Jeffrey 608 NORTH GARDEN AVE. CLEARWATER, FL 33755 Title Secretary, Director Harris, Jr., Charles 608 N Garden Ave Clearwater, FL 33755 Title President, CEO Cornier, Efrain, Jr. 608 NORTH GARDEN AVE. CLEARWATER, FL 33755 Title Treasurer, Director Lucas, Victor 608 N Garden Ave Clearwater, FL 33755 Annual Reports Report Year Filed Date 2025 02/04/2025 2025 04/28/2025 2026 02/10/2026 Document Images 02/10/2026 --ANNUAL REPORT 05/20/2025 --Amendment Detail by Entity Name View image in PDF format View image in PDF format 04/28/2025 --AMENDED ANNUAL REPORT View image in PDF format 02/04/2025 --ANNUAL REPORT View image in PDF format 02/16/2024 --ANNUAL REPORT View image In PDF format 04/05/2023 --ANNUAL REPORT View image in PDF format 01/12/2022 --ANNUAL REPORT View image in PDF format 12/07/2021 --AMENDED ANNUAL REPORT. View image in PDF format 07/13/2021 --AMENDED ANNUAL REPORT View image in PDF format 04/08/2021 --ANNUAL REPORT View image in PDF format 10/07/2020 -- REINSTATEMENT View image in PDF format 03/21/2019 --ANNUAL REPORT View image in PDF format 02/15/2018 --ANNUAL REPORT View image in PDF format 01/11/2017 --ANNUAL REPORT View image in PDF format 02/11/2016 -- ANNUAL REPORT View image in PDF format 01/28/2015 --ANNUAL REPORT View image in PDF format 01/30/2014 --ANNUAL REPORT View image in PDF format 03/28/2013 --ANNUAL REPORT View image in PDF format 01/24/2012 --ANNUAL REPORT View image in PDF format https://search.sunbiz.org/Inquiry/CorporationSearch/Search ResultDetai I?i nq uirytype=EntityN ame&di rectionType=1 nitial&search NameOrder=CLEARW... 2/3 4/13/26, 10:22 AM 03/16/2011 --ANNUAL REPORT 02/16/2010 --ANNUAL REPORT 01/15/2009 --ANNUAL REPORT 01/16/2008 --ANNUAL REPORT 01/10/2007 --ANNUAL REPORT 01/09/2006 --ANNUAL REPORT 03/21/2005 --ANNUAL REPORT 01/29/2004 --ANNUAL REPORT 01/13/2003 --ANNUAL REPORT 03/22/2002 --ANNUAL REPORT 04/25/2001 --ANNUAL REPORT 03/14/2000 --ANNUAL REPORT 04/23/1999 --ANNUAL REPORT 04/09/1998 --ANNUAL REPORT 04/17/1997 --ANNUAL REPORT 01/29/1996 --ANNUAL REPORT 02/21/1995 --ANNUAL REPORT Detail by Entity Name View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Florida Department of State, Division of Corporations https://search.sun biz.org/Inquiry/CorporationSearch/Search ResultDetai I?i nqu irytype=EntityName&di rectionType=Initial&search NameOrder=CLEARW... 3/3 Exhibit B PAINT -READY MURAL VERSION (SIMPLIFIED FOR WALL EXECUTION) Palm Tree (Center)- Bridges the past and present—our roots nourish our future. Flying Hook: Education opens doors to endless possibilities and imagination. Books: Represent knowledge, growth, and the building blocks of a brighter future. Greenwood Ave Sign: Honors the rich history and legacy of our community. Mural Wall: Reflects culture. creativity. and the diversity that makes us strong. Playg round: A space for growth, joy, and the development of our future leaders. COLOR PALETTE �■ 11.1■ Exhibit C 1 ® A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 04/15/2026 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 have ADDITIONAL INSURED provisions or 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 Next First Insurance Agency, Inc. PO Box 60787 Palo Alto, CA 94306 CONTACT NAME: PHONEFAX (A1C No. EM(g55) 222-5919 I: (A/C, No): E-MAIL ADDRESS: pp su ort@nextinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Next Insurance US Company 16285 INSURED Sharard Saddlers Sharard X Art & Apparel LLC 7333 Hunters Greene Cir Lakeland, FL 33810 INSURER B : NXTRLT7PY3-00-GL INSURER C : 03/23/2027 INSURER D : $1,000,000.00 INSURER E : $100,000.00 INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: 722146178 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF /DDYYY) (MM/Y POLICY EXP (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X NXTRLT7PY3-00-GL 03/23/2026 03/23/2027 EACH OCCURRENCE $1,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence) $100,000.00 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000.00 PERSONAL 8, ADV INJURY $1,000,000.00 GENERAL AGGREGATE $2,000,000.00 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC PRODUCTS - COMP/OP AGG $2,000,000.00 $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED'? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A PER fUTE ERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is City of Clearwater. Waiver of Subrogation applies on General Liability in favor of the Certificate Holder and as required by written contract usual to the Insured's Operations. This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement. All Additional Insured privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and conditions. • CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: CRAEl•�' PO Box 4748 Clearwater, FL 33758 I LIVE CERTIFICATE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2.cl •• El ! �4': • ; •, ZP!-4;1. _ 4 r�-4:". , •.-D 'fD•i- ,D ' rj t• AUTHORIZED REPRESENTATIVE ar-"L" 'f -'--- El'• •Alr,:l.—r-, Click or scan to view ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD