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Home My WebLink AboutCertificate of InsuranceACORQ CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 11/02/2012 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 SCHLITT INSURANCE SERVICES INC 1717 INDIAN RIVER BLVD SUITE 300 VERO BEACH, FL 32960 NAME: Lois Robertson AIC,No Ell: (772)778 -1416 nlc No: (772) 567 -1188 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Capitol Specialty Ins. Corp. LIMITS INSURED Sebastian Clambake Foundation, Inc. PO Box 780436 Sebastian, FL 32978 -0436 INSURER B: Robert Schlitt 7r. /RII INSURER C: CS0208863 INSURER D: 11/07/2012 INSURER E: $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER: 2012 GL 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 I R ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS GENERAL LIABILITY Robert Schlitt 7r. /RII CS0208863 10/3112012 11/07/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE Fx_1 OCCUR MED EXP (Any one person) $ 5,000 A 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 POLICY PRO LOC JECT $ AUTOMOBILE LIABILITY (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ 1 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIV� W S ATU- O H- TORY LIMBS ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Liquor Liability - A Special Event CS0208836310/31/2012 1110712012 $1,000,000 Occ /$1,000,000 Agg DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION FAX: 589.2566 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Sebastian AUTHORIZED REPRESENTATIVE Iwuwct trw�/ 1225 Main Street Sebastian, FL 32958 Robert Schlitt 7r. /RII U 1988 -2U1U AUOKU GUKPUKAI IUN. Au rlgnts reservea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Sep 28 11 03:55p Want 2 Bounce 772 -878 -9399 p.2 CERTIFICATE OF LIABILITY INSURANCE 9/27 /2011 _ - - -- - -- -- - -- ......... - - - j THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMIATWELY 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 i REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. {MPORTANT: if the certificate holder is en ADDiT]ON/LL INSURED, the poliry(ies) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endomerrknt. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Contact Marne: Lori Badger Coss{o InSUwr,ce Agency Phone 7728781811 Fax PO Box 188 (A/C, No. EWk (MC, NO}: Simpsonville, SC 29681 E- Mail: want2bounce@ad.com (884) 888 -0121 INSURERS) AFFORDING COVERAGE —T — rrsrr_ � INSURED INSURER A. C-n-L Badger Enterprises, Inc dbe Chuck -n -Loris Entertainment INSURER B: 499 SW Namoft Place Port St Lucie, FL 34963 INSURER C: ...... ............. rhdm,Aate Fee & CaaLWV CO (Chicago, IL) National Union Fire Insurance Company (S) INSURER D: j INSURER E t - - -- - - -- - -1.......... 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 HERON IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF POLICY _ ADOL SUER POLICY NUMBER POLICY EFF j POLICY EXP UM rrS _ LTR I I INSR I WVD (MWDONY) t (MMMDMY) ® COMNERCIAL GENERAL UABILIN ❑ ❑ CLAIMS MADE F& OCCUR A ❑ ;X. rn GENL AGGREGATE LIMIT APPLIES PER ® POLICY PROJECT [jLOC AUTOMOBILE LIABILITY ❑ ANYAUTO ALL OWNED SCHEDULED A ❑ AUTOS ❑ AUTOS ❑ HiREDAUTOS 1v1 NON-OWNED AUrOS I I UMBRELLA LIAR n OCCUR .] EXCESS (JAB U CLAIMSMADE Per Occurrence $1,000,000 General Aggregate Per Location $2,000,000 P Mduelsl Compided Operations Ag $2,0OD,0D0 PersonalfAdvertisers Liability $1,000,000 SFE 1001764 I 3/11/2011 3/11/2012 Employee Benefits Llabiry $1,D00,000 j Medical P"I1118nb Excluded Fire Legal Liability $300,000 Set Insured Retention $2,500 i COMBINED SINGLE LIMIT $ 1,000,000 j (Ea awILY INJURY $ SFE 1001754 1 3/11/1011 3/11/2012 (ParPrson) -{I-- BODILY INJURY ) (Peraodden0 PROPERTY DAMAGE $ (Per WC STATU- OTH- TORY LIMITS -ER - PrimallyAoddantllAedirei $10,000 Accidental Deals & Ofamernberrnent $10,000 SRG 9112651 3111/2011 31112012 Aggregate apples to AD &D only $100,000 Deductible None DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, I more space Is req jImM Party Equipment Rentals Operations loCatted at 499 SW No. Place Port St Lucia. FL 34953. Certificate Holder As Additional Insured Amusement devices on isle with the company for special event(s) dated 11/412011 to 11/6/2011 located at Rkws{de Park, 820 Indian River Drive, Sebastian, FL 32963. CERTIFICATE HOLDER: City of Sebastian 1226 Main St Sebastian, FL 32958 ACORD 25 (2010105) - -- --- - - - -.. - CANCELLATION 'SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE i iEXPIRATION DATE THEREOF, NOTICE IMLL BE DELIVERED IN (ACCORDANCE WITH THE POLICY PROVISIONS. i i - - - - -- AUTHORIZED REPRESENTATIVE : The ACORD name and logo are registered marks of ACORD ®1988-2010 ACORD CORPORATION. All rights reserved. O N� M -I DED I I RETENTION 11 WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERIEXECUTNE yJ OFFICERNE BEREXCLUDED? WA (MAandatory in NH) If yes, describe under i DESCRIPTION OF OPERATIONS Ddde : B Aw4dent Medical i Per Occurrence $1,000,000 General Aggregate Per Location $2,000,000 P Mduelsl Compided Operations Ag $2,0OD,0D0 PersonalfAdvertisers Liability $1,000,000 SFE 1001764 I 3/11/2011 3/11/2012 Employee Benefits Llabiry $1,D00,000 j Medical P"I1118nb Excluded Fire Legal Liability $300,000 Set Insured Retention $2,500 i COMBINED SINGLE LIMIT $ 1,000,000 j (Ea awILY INJURY $ SFE 1001754 1 3/11/1011 3/11/2012 (ParPrson) -{I-- BODILY INJURY ) (Peraodden0 PROPERTY DAMAGE $ (Per WC STATU- OTH- TORY LIMITS -ER - PrimallyAoddantllAedirei $10,000 Accidental Deals & Ofamernberrnent $10,000 SRG 9112651 3111/2011 31112012 Aggregate apples to AD &D only $100,000 Deductible None DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, I more space Is req jImM Party Equipment Rentals Operations loCatted at 499 SW No. Place Port St Lucia. FL 34953. Certificate Holder As Additional Insured Amusement devices on isle with the company for special event(s) dated 11/412011 to 11/6/2011 located at Rkws{de Park, 820 Indian River Drive, Sebastian, FL 32963. CERTIFICATE HOLDER: City of Sebastian 1226 Main St Sebastian, FL 32958 ACORD 25 (2010105) - -- --- - - - -.. - CANCELLATION 'SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE i iEXPIRATION DATE THEREOF, NOTICE IMLL BE DELIVERED IN (ACCORDANCE WITH THE POLICY PROVISIONS. i i - - - - -- AUTHORIZED REPRESENTATIVE : The ACORD name and logo are registered marks of ACORD ®1988-2010 ACORD CORPORATION. All rights reserved. O N� M Sep 2811 03:55p Want 2 Bounce 772 -878 -9399 p.3 CERTIFICATE OF LIABILITY INSURANCE 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 AMEN% EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF NdSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IN"MgS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THECERTIFICATE HOLDER _ __ _ _ -W-A-1 _ IMPORTANT: II the osriificam I%>Ider• is an ADDITIONAL INSURED, the po11cy(ies) must be endorsed. If SUBROGATION IS V ED, subject to the terns and aondilons of the poNey, oartaln policies may require an endorsemenl. A stabrnrcnt on IN* certificate does not corder dghte b the certificate holder in lieu of such endorsement(s). PRODUCER Nam: i Lan) Badger Cossio Insurance Agency 7728781811 IF@x PO Box 188 NA EW I N# Simpsonville, SC 29681 Mad: wanftounce@aolcom (864) 688-0121 INSURER(S) AFFORDING COVERAGE INSURED C-n-L Badger Enterprises, Inc cibe Chuck -n -Loris Entertainment 499 SW Namcit Place Port St Lucie, FL 34953 INSURER 1l' ,Interstate Fire & Casually CO (ChkaM IQ DATE 9/27/2011 INSURER B: •NeDoral Union Fire lnsurarce Company (S) INSURER C: INSURER D: INSURER E: r COVERAGES CERTIFICATE NLIMBER REVISION NUMBER: THIS 13 70 CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDI NO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERT/UN, 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. { ILI$R i TYPE OF POLICY �INSR I POLICY NUMBER ( i POLICY MEX» LNAITS j GENERAL LIABILITY Peroocurrenoe $1,000,000 �( COMMERCIAL GENERAL LIABILITY - r OCCUR CLAIMS MADE ❑ o I � GeremlApprogaEa Per Locatlon 82,000,000 Pm&jcW lComplded Operations Ag 52,000, 000 LiatrNily $1,000.000 � A to SFE 10D1754 I 3M IM11 3/1112012 I Employee BeneBb Libbilly, $1,000,000 i n Medical Payments Excluded Flo Lao LiablTdy $300,000 i mwl- AGGREGATE LIMIT APPLIES PER SeN IBaured Retendorl $2,500 ..... .I - ® POLICY [] PROJECT C LOC - SFE10176 ! 311011 W11122 COMBMEDSINGLELMT (EaaodeeM $ 1,000,000 AUTOMOBILE LIABILITY ANY ALTO i ALL SCHEDULED A 0 � Al BODILY INJURY ��) $ $ eODILY INJURY I_I HIRED ALTOS ❑X NDN-OWNED AUrOS ❑ I (Per arridsnq PROPERTY DAMAGE (Per acddars) I $ UMBRELLA LLAB U OCCUR n EXCESS UA8 F1 CLAINSMADE DED 0 RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? I I WA (Manclatory In NH) If Tea, desoibe under DESCRIPTION OF OPERATIONS bellow I B Acaderd Medical SRG 9112951 3/1112011 I 3/11/2012 VC STATU- TORY LIMITS Primary Accident Medical _ ............. $10.000 Accidental Dean a OWnembemrerd $10,00(> Appregele applies b AD 6D only $100,000 Dedwtible None DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddAional Remarks Sdwdukk if mars space is reqused) Party Equlpnwt Ratans opaeem boated at 499 SW Namo(t Place Port St Lucie, R. 34853. Certificate Holder As AddillarIN WISAW Amusement devices on file wit the company fix special avant($) dated 11MM11 to 1118!2011 located E 1660 US Mghway 1, Sebastiol, FL 32956. CERTIFICATE HOLDER: Sebastian Clambake Foundalion 9611 N US Highway 1 Sebastian, FL 32958 CANCELLATION —]SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EKPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ANCE WITH THE POLICY PROVISIONS. /—'% [AUTFIOR)ZED REPRESENTATIVE J ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 01988-2010 ACORD CORPORATION, All rights reserved.