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HomeMy WebLinkAbout2017lk.�' R- CERTIFICATE OF LIABILITY INSURANCE °ATEtMMODM YY) 1a16no1s 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 enciorsement(s). PRODUCER CONTACT JODI DELAPORTE E• KE Insurance Agency 990 Us Highway 1 Suite A PHONE (772) 589-1600 PAX Nol: (772) 388-2067 andrew@keagency.com INSURERS AFFORDING COVERAGE NAIC e Sebastian, FL 32958 INSURERA: USLI Phone (772) 589-1800 Fax 772) 388-2067 INSURED INSURERS: INSURER C : Senior Activity Center of Sebastian Incorporated INSURER D: 1255 Main St INSURER E Sebastian FL 32958 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 L TYPE OF ADD UB POLICY NUMBER POLICY EFF fMMIDDNYYYl POLICY EXP (MMIDDNYYYlUNITS A COMMERCIAL GENERAL LIABILITY FI) © OCCUR ❑ Y NPP1572614 09/30/2016 09/30/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any we arson) $ 5.000 ❑ PERSONAL a ADV INJURY s 1,000,000 GENL AGGREGATE LN11r APPLES PER: ❑ POLICY ❑ JET [-] LOC ❑ OTHER GENERAL AGGREGATE S 2,ODO,000 PRODUCTS -COMP/OPAGG $ 1,000,000 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ OWNED ULED AUTOS ONLY E]AUTOS ❑HIRED ❑ NON -OWNED AUTOS ONLY AUTOS ONLY ❑ ❑ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY(Perpersm) $ BODILY INJURY (Per seciderIp s PROPERTY DAMAGE $ Per eccitlem $ ❑ UMBRELLA UAB ❑OCCUR ❑ EXCESS UAB ❑ CLALMS-MADE I EACH OCCURRENCE $ AGGREGATE $ DED E RETENTION $ $ WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORMARTNERIEXECUWN ] OFFICERMIEMBER EXCLUDED? (Mandatary in NH) M yes, describe under DESCRIPTION OF OPERATIONS below NIA OTH- El STATUTE E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE S E.L. DISEASE - POLICY LIMB $ DESCPJPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION @ 198&201fACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) QF The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SEBASTIAN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1225 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. SEBASTIAN FL 32958 AUTHORIZED REPRESENTATIVE @ 198&201fACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) QF The ACORD name and logo are registered marks of ACORD A,� �'® CERTIFICATE OF LIABILITY INSURANCE (MMIDDNYYY AM DS/30/2016 1 TYPE OF INSURANCE ADOLS 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:CT ANDREW RICH A. RICH CONSULTING LLC DBA KE INSURANCE PHONEFA% 990 US HWY 1 STE. A NC No: no Riess: SERVICE KEAGENCY.COM SEBASTIAN FL 32958 PERSONAL& ADV INJURY $$1,000,000 INSURERS AFFORDING COVERAGE NAICe (772)589-1800 (772)388-2067 INsuRERA. FEDERATED NATIONAL INSURAN( 10790 INSURED INSURER 5: SENIOR ACTIVITY CENTER OF SEBASTIAN INC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HREDAl1TOS AUTOS INSURERC: INSURER D 1255 MAIN ST SEBASTIAN, FL 32958 INSURER E: BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADOLS POLICY NUMBER MMIDDY EFF MMIDDY� LIMITS GENERAL LIABILITY ✓ COMMERCIAL GENERAL LIABILITYP CLAIMS -MADE EDOCCUR ✓ HM -0000014448-00 08/31/2016 08/31/2017 a� EACH OCCURRENCE x$1,000,000 MI Eae Tnc $$100,000 MED EXP (Any we Pawn) $$5,000 PERSONAL& ADV INJURY $$1,000,000 GENERALAGGREGATE $ $2,000,000 GENL AGGREGATE ✓ POLICY LIMIT APPLIES PER: PRC-IFCT LOC PRODUCTS-COMPIOPAGG $INCLUDED $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HREDAl1TOS AUTOS COMBINED SINGLE LIMIT Ilia n BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Wer accidentl UMBRELLA LU,B EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBER EXCLUDED? (Mandatory In NH) Udescribe Under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTM- E.L. EACHACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THIS IS AN ADDITIONAL INSURED SENIOR ACTIVITY CENTER CITY OF SEBASTIAN 1225 MAIN ST 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 ©1988-2010 ACORD CORPORATION. All Fights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD