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Home My WebLink About2017BOYS& -3 OP ID: SF / ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/01/2016 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(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 Brown 8, Brown Insurance - Vero Vero Division 817 Beachland Blvd CAOMEACT Sandy Fe s PHONE 772-469-1512 FAX No : ADDARESS: sfeys@bbvero.com Vero Beach, FL 32963 12/13/2016 Kenneth D. Felten, LUTCF INSURERS AFFORDING COVERAGE NAIC if INSURER A :Great American Ins Co of NY 22136 MED EXP (Any one person) $ 20,00 INSURED Boys 8 Girls Club of INSURER B.Great American Alliance InsCo 26832 Indian River County 172917th Avenue INSURERC:*FFVA Mutual Insurance Co* 10386 INSURER 0: Vero Beach, FL 32960 INSURER E: AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS 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 LTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF fMM1DDIY1rMM POLICY EXP ! D LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X PACISS0596 12/13/2016 12/13/2017 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence s 1,000,00 MED EXP (Any one person) $ 20,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- a JECT LOC OTHER: GENERAL AGGREGATE $ 3,000,00 PRODUCTS -COMP/OP AGG S 3x040,00 Emp Ben. $ 1,000,00 B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS CAP1680597 12/1312016 12/13/2017 COMBINED SINGLE LIMIT g 1,000,00 Ea accident BODILY INJURY (Per person) $ BODILY INJURY {Per accident) S PROPERTY DAMAGE $ Per accident s B X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB1680698 12/1312016 12114/2017 EACH OCCURRENCE $ 4,000,00 AGGREGATE $ 4,000,00 DED I X T RETENTION S 10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYSTATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? F-1 (Mandatory In NH) 11e describe under !�a=ERATIONS bellow N / A C840 -0030781-2016A 09/13/2016 09/13/2017 ER OTH. I ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE, S 500,00 E.L. DISEASE -POLICY LIWL : _SQQ,_QQ A A Abuse/Molestation Professional Liab IPAC1580596 PACIS80596 12/13/2016 12/13/2016 12/13/2017 12/13/2017 Per Occ 1,000,00 Ann Agg 3,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Locations: 1729 8172517th Avenue, Vero Beach, FL; 1415 Friendship Ln, Sebastian, FL; 22 S Orange St, Fellsmere, FL The City of Sebastian 1225 Main Street 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 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD BOYS& -3 OP ID: SF . 1. O CERTIFICATE OF LIABILITY INSURANCE o 08831/2016 Y) `� 0 8131/2 01 6 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 Brown & Brown Insurance - Vero Vero Division CONNAME Kenneth D. Felten, LUTCF PHONE FAX .772.231.2828 c o : 772-231.4413 E-MAh' ADDRE s. 817 Beachland Blvd Vero Beach, FL 32963 X COMMERCIALGENEf AL LIABILITY Kenneth D. Felten, LUTCF INSURERS AFFORDING COVERAGE NAIC# INSURER A:*New Hampshire Ins. Co. 23841 INSURED Boys & Girls Club of INSURERB:*National Union Fire Ins Co PA 19445 Indian River County 1729 17th Avenue INSURER C:'FFVAMutual Insurance Co* 10385 X Vero Beach, FL 32960 INSURER D: INSURER E 12113/2016 INSURER F MED EXP (Any one person) $ 20,000 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 LTR TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLICY EFF MM/OD POLICY EXP D LIMITS A X COMMERCIALGENEf AL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE FRIOCCUR X 01 -LX -086482036-01000 12113/2015 12113/2016 PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 20,000 X Abuse/Molestation PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 POLICY E JECT F1 LOC PRODUCTS -COMNOP AGO $ 3,000,00 Emp Ban. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,00 Me accident BODILY INJURY /Per person) S A X ANY AUTO 01 -CA -084609623-00100 12113/2015 12/1312016 ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROP ffRTY DAMAGE $ Per accident NON -OWNED HIREDAUTOS AUTOS $ X UMBRELLA LIAR OCCUREACH OCCURRENCE $ 4,000,00 AGGREGATE $ 4,000,00 B EXCESS UAB [I 29 -UD -016698721 29 -UD -016698721-0/000 12113!2015 1211412016 DED I X I RETENTION $ 10000 $ C WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTNE YIN C840 -0030781-2016A 0911312016 09113/2017 SPER TH. TATUTE ER E.L. EACH ACCIDENT S 500,00 OFFICENMEMBER EXCLUDED? 1Mendntory In NHl NIA E.L. DISEASE - EA EMPLOYEE $ 500,00 K ye6. dB6C,IbB nndOr DESCRIPTION OF OPERATIONSbelmv E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached K mere apace la required) Locations: 1729 & 1725 17th Avenue, Vero Beach, FL; 1415 Friendship Ln, Sebastian, FL; 22 S Orange St, Fellsmere, FL The City of Sebastian 1225 Main Street Sebastian, FL 32958 SHOULD ANY OF THE ADOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE All rinhtc rncnr nrl ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE BOYS&-3 PAGE INSURED-S NAME Boys & G(rls Club of OP ID: SF Dab 08/31/2016 GL Other Type Ins: - Employee Benefits E&O $1,000,000 Each Claim / $1,000,000 Aggregate (Claims Made Coverage) Retroactive Date 09/13/04