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HomeMy WebLinkAboutCerfificate of InsuranceClient#: 154049 MEADGOI ACORD. CERTIFICATE OF LIABILITY INSURANCE 0TE TYPE OF INSURANCE 3120/2IDD/YYYY) 312012017 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 CONTCT NAME• Rebecca St. Pierre CBIZ Weekes & Callaway PHONE 561-900-1656FAX AIC No Ext: AIC No 3945 West Atlantic Avenue ADDRESS: rstpierre@cbizwc.com Delray Beach, FL 33445 INSURER(S) AFFORDING COVERAGE NAIC if 561 278.0448 INSURER A: Hartford Fire Insurance Co. 19682 INSURED INSURER B: American Guarantee & Liability 26247 International Golf Maintenance, Inc.INSURER C Zenith Insurance Co. 13269 5385 Gateway BoulevardINSURER D: Hartford Fire Insurance Co. 02231 Suite 12 21UENHV1311 Lakeland, FL 33811 INSURER E: COMBINED SINGLE LIMIT 1,000000 Ea acudent $ r BODILY INJURY (Per person) S 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 CONTRACTOR 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 ADD INSR WUB VD POLICYNUMBER POLICY EFF MD m POLICY EXP MMIDD/YYYY LIMBS A X COMMERCIAL GENERAL [ABILITY CI-AIMS-MADEOCCUR X BI/PD Ded:10000 210ESOF7135 3/0112017 03/01/201E EACH OCCURRENCE S1000000 PEaocaxrence $300000 EREMISES MED EXP (Any one person) $10,000 PERSONAL B AOV INJURY $1,000,000 GEN'L AGGREGATE LIMITAPPLIESPER: X POLICYF—] J CT F LOC OTHER: GENERAL AGGREGATE 52,000,000 0 PRODUCTS-COMPIOPAGG 52,000,000 S D AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIREDAUTOS X NON -OWNED AUTOS X riveOthCar 21UENHV1311 3101/2017 03/0112018 COMBINED SINGLE LIMIT 1,000000 Ea acudent $ r BODILY INJURY (Per person) S BODILY INJURY (Per acculent) $ PROPERTY DAMAGE S Par accident Uninsrd Mot $1,000,000 B X UMBRELLA DAB EXCESS LIAB i X OCCUR CLAIMS-MAOE AUC557147205 3/01/2017 03/01/201 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED I I RETENTIONS I S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOMPARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (MandatoryJn NH) _ I es.describe under DESCRIPTION OF OPERATIONS below NIA M1108906 __ _ 3/01/2017 03/0112016 X 1PETARTuTE OTH- E.L. EACH ACCIDENT S1000000 E.L DISEASE -E_A_EMPLOYEE 51,000,000 E.L. DISEASE -POLICY LIMIT 51,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace la required) Florida statute requires Ten (10) Days Notice of Cancellation for Non Payment of Premium. City of Sebastian Sebastian Golf Course 101 E Airport Drive Sebastian, FL 32958 ACORD 25 (2014101) 1 of 1 #S1513398/M1508982 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 CBIZ Insurance Services, Inc. @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8ORS A�� DATE(MM/DD/YYYY) ® CERTIFICATE OF LIABILITY INSURANCE 3/3/2016 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 Rebecca St. Pierre NAME: CBIZ Weekes & Callaway IA/o No.Eztl: (561)278-0448 FAX (A/c,No): (561)278-2391 3945 West Atlantic Avenue E-MAILADDRESS: P rst ierre@cbizwc.com INSURER(S)AFFORDING COVERAGE NAIC# Delray Beach FL 33445-3902 INSURERA:COlony Insurance Co 39993 INSURED INSURER B:Hartford Fire Ins Co 19682 International Golf Maintenance, Inc. INSURER C:American Guarantee 5385 Gateway Boulevard INSURERD:Zenith Insurance Company 13269 Suite 12 INSURER E: Lakeland FL 33811 INSURERF: COVERAGES CERTIFICATE NUMBER:2016-17 IGM Liab Master 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 i 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 IMMIDD/YYYY) IMM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR 103GL000050803 3/1/2016 3/1/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 pRo-TIPOLICY n JF- n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 21UENHV1311 3/1/2016 3/1/2017 BODILY INJURY(Per accident) $ AUTOS _ AUTOS — NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) Underinsured motorist $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 0 A,UC557147204 3/1/2016 3/1/2017 $ D WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYTORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED'? N/A (Mandatory in NH) N1108904 3/1/2016 3/1/2017 E L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION Or OPFRATInNS below E L DISEASE-POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Florida statute requires Ten (10) Days Notice of Cancellation for Non Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Sebastian ACCORDANCE WITH THE POLICY PROVISIONS. Sebastian Golf Course -- - 101 E Airport Drive AUTHORIZED REPRESENTATIVE Sebastian, FL 32958 Kimila Silvia/JGLAUG ie_ /0-17C"---' I ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 7/30/2015 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 CBIZ Weekes 6 Callaway 3945 West Atlantic Avenue Delray Beach FL 33445-3902 CONTACT Rebecca St. Pierre NAME: PHOAX AICNE (j61)278-0448 FA - No: (561)278-2391 EAbMpAg'LEss.rstpierre@cbizwc.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Colonv Insurance Co 39993 INSURED International Golf Maintenance, Inc. 5385 Gateway Boulevard Suite 12 Lakeland FL 33811 INSURERB:Hartford Fire Ins Co 19682 INSURER CAmerican Guarantee INsuRERD:Zenith Insurance Com an 3269 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2015-16 IGM Liab Master 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- ILiR TYPE OF INSURANCE AOD BR Jm POLICY NUMBER POLICYEFF MOM/LIDDY�Y UNITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Es dcmrrence $ 100, 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR 103GLOOD050802 /29/2015 /1/2016 MED EXP (Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 $ X POLICY PRO LOC 7 JFCT AUTOMOBILE LIABILITY EaaccdenIN LE LIMB i $ 1,000,000 BODILY INJURY (Par person) $ 13 1 ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 211JENHV1311 /29/2015 /1/2016 BODILY INJURY (Par accident) $ P80�12dT DAMAGE $ NON -OWNED HIRED AUTOS Underinsured motorist $ 11000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 L. EXCESS LIAS CLAIMS -MADE DEO I X I RETENTIONS C $ FLUC557147203 /29/2015 /1/2016 D WORKERS COMPENSATION AND EMPLOYERS'LIASIUTV YIN ANY PROPRIETOMPARTNERIEXECUTIVE� X WC STATU- OTH- IMITS ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N/A 108904 /1/2015 /1/2016 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under _ DESCRIPTION OF OPERATIONS below - E.L DISEASE -POLICY LIMIT $ 11000,000 B Garagekeepers 21UENHV1311 /29/2015 /1/2016 $300,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Florida statute requires Ten (10) Days Notice of Cancellation for Non Payment of Premium. '15 A©!J 12 PM12:20:54 City of Sebastian Sebastian Golf Course 101 E Airport Drive Sebastian, FL 32958 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 Silvia/JGLAUG /I /C . &- 0 1988-2010 ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds International Golf Maintenance Inc. Corporation, Insured Multiple Names OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC ADDITIONAL COVERAGES Ref # Description Employee Benefits Coverage Code EBLIA Form No. Edition Date Limit 1 1,000,000 Limit 2 1,000,000 Llmlt 3 Deductible Amount 1,000 Deductible Type Dollars Premium Ref # I Description Liquor Liability Coverage Code LIQUR Form No. Edition Date Limit 1 1,000,000 Limit 2 1,000,000 Limit 3 Deductible Amount 2,500 Deductible Type Dollars Premium Ref # Description Medical payments Coverage Code MEDPM Form No. Edition Date Limit 1 5,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description PIP-Basic Coverage Code PIP Form No. Edition Date Limit 10,000 Limit Limit Deductible Amount Deductible Type Premium Ref # Description Uninsured motorist combined single limit Coverage Code UMCSL Form No. Edition Date Limit 1,000,000 Limit2 Limit Deductible Amount Deductible Type Premium Ref # I Description Combined single limit Coverage Code CSL Form No. Edition Date Limitl 1,000,000 Limit Limit Deductible Amount Deductible Type Premium Ref # Description Underinsured motorist combined single limit Coverage Code UNCSL Form No. Edition Date Limit lLImIt2 1,000,000 Limit3 Deductible Amount Deductible Type Premium Ref # I Description Garagekeepers Coverage Code Form No. Edition Date Limit 1 300,000 Limit 2 Limit 3 Deductible Amount 5,000 Deductible Type Premium Ref # DescriptionCoverage Medical payments Code MEDPM Form No. Edition Date Limit 1 5,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description PIP-Basic Coverage Code PIP Form No. Edition Date Limit 1 10,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Uninsured motorist combined single limit Coverage Code UMCSL Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. ADDITIONAL COVERAGES Ref # Description Combined single limit Coverage Code CSL Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # I Description Underinsured motorist combined single limit Coverage Code UNCSL Form No. Edition Date Limit 1Limit 1,000,000 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Medical payments Coverage Code MEDPM Form No. Edition Date Limit 1 5,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # I Description PIP -Basic Coverage Code PIP Form No. Edition Date _ Limit 10,000 Limit Limit Deductible Amount Deductible Type Premium Ref # Description Uninsured motorist combined single limit Coverage Code UMCSL Form No. Editicn Date Limit 1,000,000 Limit2 Llmit3 Deductible Amount Deductible Type Premium Ref # I Description Combined single limit Coverage Code CSL Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Underinsured motorist combined single limit Coverage Code UNCSL Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Medical payments Coverage Code MEDPM Form No. Edition Date Limit 1 5,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description PIP -Basic Coverage Code PIP Form No. Edition Date Limit 1 10,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Uninsured motorist combined single limit Coverage Code UMCSL Form No. Edition Date Limit 1Limit 1,000,000 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Employee Benefits Coverage Code EBLIA Form No. Edition Date Limit 1 1,000,000 Limit 2 1,000,000 Limit 3 Deductible Amount 1,000 Deductible Type Dollars Premium OFADTLCV Copyright 2001, AMS Services, Inc. ``� �® CERTIFICATE OF LIABILITY INSURANCE DATE 9/26/2014rr) 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 pollcy(les) 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 Weekes 6 Callaway, Inc. 3945 West Atlantic Avenue Delray Beach FL 33445-3902 CONTACT Rebecca St. Pierre NAME: FAX (561127a-2391 PHONE i'c-i(7p5lerre@w�kescallaway.com -MAIL .rs erre@waekescallawa .com INSURER(S) AFFORDING COVERAGE NAIC p INSURERA;Colony Insurance Co INSURED International Golf Maintenance, Inc. 8390 Champions Gate Blvd Suite 200INSURER Champions Gate FL 33896-8388 INSURERB:Hartford Fire Ins Co 19682 INSURER c.American Guarantee INSURERD:Zenith Insurance Company 3269 E: IN F: COVERAGES CERTIFICATE NUMBER:2014-15 I@1 Liab Master REVISIONNHMRFR- 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. MN TYPE OF INSURANCE Sebastian Golf Course POLICY NUMBER POLICY EF MWD POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES His ocwmence $ 100,000 A X. COMMERCIAL GENERAL LABILITY CLAIMS -MADE OCCUR 03GL0000508-01 /29/2014 /29/2015 MFDEXP(Anyoneperson) S 5,000 PERSONAL B ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG S 2,000,000 X POUCY PR0. LOC JrCT E AUTOMOBILE LIABILITY F,...Id.m1 S 11000,00 B X. ANY AUTO ALL OWNED SCHEDULED AUTOS AIJros 1UMPP3795 /29/2014 /29/2015 BODILY INJURY (Per Person) S BODILY INJURY (Per accident)3 HIRED AUTOS gtUJTNO9ED (PROBER A GE cdautill $ Underinsured motorist $ 1 000 000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE S 10,000,000 AGGREGATE $ 10,000,000 L. EXCESS UAB CWMSMADE DED I X. I RETENTIONS C S PkUCS57147202 /29/2014 /29/2015 D WORKERS COMPENSATION3 T - AND EMPLOYERS' LABILITY YIN ANY PROPRIETOR/PARTNEIVEXECUTNE OFFICERMEMSER EXCLUDED? (Mandatory In NH) If yea, describe under DESCRIPTION OF OPERATIONS calm NIA 1108903 /1/2014 /1/2015 Y11 I E.L EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY LIMB S 11000,000 B Garagekeepers lUENPP3795 /29/2014 /29/2015 $300,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLESAttach ACORD 101, Additional Homeric; Schedule, If more space is required) Florida statute requires Ten (10) Days Notice of Cancellation for Non Payment of Premium. CERTIFICATE HOLDER ('ANr:FI I ATInN A V UKU Lb (LUT W06) INRlPIA,sn,ms, n, ®1988-2010 ACORD CORPORATION. All rights reserved. TL.. nrnen ..n..... ....A In.... n.n .nnf..an.n.!..,..d.n -1 Arnon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Sebastian ACCORDANCE WITH THE POLICY PROVISIONS. Sebastian Golf Course AUTHORIZED REPRESENTATIVE 101 E Airport Drive Sebastian, FL 32958 /J Kimila Silvia/SGLAUG A V UKU Lb (LUT W06) INRlPIA,sn,ms, n, ®1988-2010 ACORD CORPORATION. All rights reserved. TL.. nrnen ..n..... ....A In.... n.n .nnf..an.n.!..,..d.n -1 Arnon