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HomeMy WebLinkAboutCertificate of Insurance�RD,M CERTIFICATE OF LIABILITY INSURANCE 10/29 /2010 PRODUCER (772) 567 -1188 FAX (772) 778 -1416 SCHLITT INSURANCE SERVICES INC 1717 INDIAN RIVER BLVD SUITE 300 VERO BEACH, FL 32960 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Sebastian Clambake Foundation, Inc. PO BOX 780436 Sebastian, FL 32978 -0436 INSURERA. Capitol Specialty Ins. Corp. POLICY EFFECTIVE INSURER B. LIMITS INSURER C. INSURER D: CSC326721 INSURER E. 11/09/2010 nwoonn�e 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' WAR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS Riviera Beach, FL 33404 GENERAL LIABILITY CSC326721 11/03/2010 11/09/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE FX] OCCUR MED EXP (Any one person) $ 5,000 A X PERSONAL & 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 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND OR LIMIT ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. DISEASE - EA EMPLOYE $ OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DPSCRIPTIQN OF OPERATIONS I LOCATIONS / VEHICLIES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Riverview Park, U.S. #1 & Harrison St., Sebastian, Fl. 32958 Certificate holder is additional insured. rFRTIFIr.ATF wni rIFR rANrFI I ATION ACORD 25 (2001108) © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Sysco Southeast Florida LLC 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1999 Dr Martin Luther King Ir BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Blvd OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Riviera Beach, FL 33404 Robert Schlitt 7r. /RII ACORD 25 (2001108) © ACORD CORPORATION 1988 ACORD - DATE (MMlDD/YY) _� ±. =_ Cf_I r_ ;I t_= i ;4 . ,. G.FI F : r.. t I ; >' 1012712010 PRODUCER (772) 567 -1188 FAX (772) 778 -1416 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SCHLITT INSURANCE SERVICES INC 1717 INDIAN RIVER BLVD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SUITE 300 COMPANIES AFFORDING COVERAGE VERO BEACH, FL 32960 COMPANY Capitol Specialty Ins. Corp. Attn Lois Robertson Ext 126 A INSURED Sebastian Clambake Foundation, Inc. PO Box 780436 COMPANY B -- _ -- - - -_ -__ - - -- - - -- - - -_ ___ -- _ Sebastian, FL 32978 -0436 COMPANY C COMPANY D e HOOKER-" ,yam � : � � 'T �' ,yt l .. ter,: 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. CO LTR TYPE OF INSURANCE IIj t POLICY NUMBER k POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATION DATE (MMIDD /YY) I COVERED PROPERTY LIMITS PROPERTY iI a BUILDING is �CAUSES OF LOSS � BASIC j PERSONAL PROPERTY BUSINESS INCOME F1$ $ BROAD EXTRA EXPENSE I$ I $ IF$ - SPECIAL EARTHQUAKE I I BLANKET BUILDING BLANKET PERS PROP I $ FLOOD I 1_ I s- BLANKET BLDG & PP is — � �X INLAND MARINE S0326721 11/03/2010 11/09/2010'1 X -Trailer I $ 80,000 $ TYPE OF POLICY I A 6Equipment Floater L$ CAUSES �— OF LOSS 1$ X N PERILS OTHER Special Form 6NAMED I 1 CRIME TYPE OF POLICY E I $ �$ ¢ ;$ IA BOILER & MACHINERY $ I Is P - OTHER I L 0 CA OF PREMISES/D S RIPTION OF PR QERTY 01 Ter is owne y certi icateholder. Certificateholder is additional insured & loss payee. rra SPECIAL CONDITIONS /OTHER COVERAGES MEN= I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Sysco Southeast Florida LLC 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1999 Dr Martin Luther King Jr BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Blvd OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robert Schl i tt I r. /RII go j M-IME-10--mm-mmilffin Riviera Beach, FL 33404 I W17 EC co ■ ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID MA DATE(MM/DD/YYYY) 1 HAPPY -2 10/28/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Black Bear Insurance Agency 260 Wekiva Springs Rd Ste1000 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Longwood FL 32779 DATE MM/DD/YY LIMITS Phone:407- 774 -2327 Fax:407- 786 -2327 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Maryland Casualty Company 19356 INSURER B: $2000000 A Happ y FHet, Ina. 1101 North Keller Road Suite D Orlando FL 32810 INSURER C: PAS02468793 INSURER D: 07/23/10 INSURER E: $ 2000000 %IUV 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L NSR TYPE OF INSURANCE POLICY NUMBER DATE MM /DDS DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $2000000 A X COMMERCIAL GENERAL LIABILITY PAS02468793 07/23/09 07/23/10 PREMISES(Eaoccurence) $ 2000000 MED EXP (Any one person) $10000 7CLAIMS MADE rX] OCCUR PERSONAL BADVINJURY $ 2000000 GENERAL AGGREGATE $ 4000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 4 0 0 0 0 0 0 POLICY F1 PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO H OTHER THAN EA OTHER $ $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—I CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND C EMPLOYERS' LIABILITY T OWR Y LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Re:Show Dates: Friday November 6,2009 2:OOPM- 9:OOPM Saturday November 7.2009 10:00AM- 9:00PM Sunday November 8,2009 10:00AM- 5:00PM I,CRI Irm mi C riuLDER CANCELLATION The Sebastian Clambake Foundation P.O.Box 780436 Sebastian FL 32978 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 0 ACORD CORPORATION 1988