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HomeMy WebLinkAbout2014R'X Date /Tirrle 08/09/2014 10,19 P.002 08/09/2014 SAT 11:08 FAX U002 /003 6 / L1G -"- 7 130YS& -3 OP In: R ' CERTIFICATE OF LIABILITY INSURANCE °AT121061"YY'' III' _ 4zras1l 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlticats holder is an ADDITIONAL INSURED, the pollcy(los) must he ondorsod. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an andorsamant. A statement on this cartiftcata does not confer rights to the Certificate holder In Ilau of such ondorsomont s . PRODUCER Phone: 772 -231 -2828 Brown v Brawn fnauranco Vero Fax: 7T2 -231 -4413 Vern Division 2261E. Sandy Fo s PHONE 772 -469 -4512 FAx $il 6oachland Blvd Vero Beach, FL 32963 AD RES : efe 8 bveroxorn INSURER ($) APPORDIND COVERAGE NA1C r Kenneth D. Felten, 4UTCF INSURERA:'Arch Insurance Company* 91150 S 1,{100,00 INSURED Boys & Girls Club of Indian River County, Inc. 1729 171h Avenue INSURER E,.*Brld afield Em to era Ins Co 10701 IN4VRgj C: NCPKGO191302 _INSURER 0: 12113114 Vero Beach, FL 32960 INSURER E: MFO EXP (Any one croon s 20,00 X Prof Liability THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE IN5uaF M A MED ABOVE FOR THE POLICY PERIOD INDICATEcD, NOTWITHSTANDING ANY REQUIRLMENT, 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 5UDJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF IN3US�ANCE ADOL SUB POLICY EFF FOUCY E P LIM1T1; a LNCRAL uABlurr EACw OCCURRENCE S 1,{100,00 A X COMMERCIAL GENERALLUIBI�ITY CLAIMS -MAUE X OCCUR X NCPKGO191302 12113113 12113114 EKES (Ea accurran. ) t 1,000,00 MFO EXP (Any one croon s 20,00 X Prof Liability PERSONAL 9 AOV INJURY S 1,000,00 X AbuselMolestation GENERAL AGGREGATE S 3,000,00 GE14L AGGREGATELIL11 APPLIES PER: POLICY PRO- L jFrT PRCOUC78- COIhIPlOPAGG S 3,000,00 Eme Bon. s 1,000,00C AUTOMDaILE LIABsLITY E C11111=113INGLE 1,000,00 A X ANY AUTO NCAUT0191302 12113/13 121131114 BODILY INJURY (Per pore n) s ALLOWNED SOHEOULED AU70S AUTOS NON- CVVNCq HIRED ALTO AUTOS BODILY INJURV I Pveccldenl I $ PROFCR7Y OAMGE Pera I n s S UMBRELLA LIAR X CCCUR EACH OCCURRENCE S 4,000,00 A X EXCESCLIA0 CLAIMS-MADE NCFX30191302 12113113 12/13114 AGGREGATE S 4,000,00 QrQ N B WORKERS COMPENSATION AND EMPLOYERS' LIABIL" ANY PROPRIETGFJPARTNCCVCCXCCUTIVE Y� O FFICERIJWEMBER BKCLUDEOT tMandalory In NH) Ins dancilbe under MIA A '830.52976 091113113 09113/14 X I W C STATU• (S H- ITO E.L. EACH ACCIDENT $ 500,00 E.L. DISEAsE - EA EMPLOYEE - - - : 500,00 IF L, DISFA. - ICY LIMIT 5 500 ao In 3� RIPTION Iav _ 00CRIPPON OF OPERATIONS ( LOCATIONS) VeHIC LEO (AIUmh ACORD 101, Admuonyl Ripmorks Sahndule, Ir moru apacu ls rvqulnd) 1729 17th Avenue, Vero BOACh, FL; 1925 17th Avenue, Vero Beach, PL; 1415 Friendship Tang, Sebastian, FL; 22 South Orange Street, Fuilamore,FL W Taao•cuTu AWKtJ UUMPUKAI IVN- AN rights reserved. ACORO 25 (2090105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Sebastian y 1225 Main Street THE. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROV191ON9. Sebastian, FI..32958 AUTkORIZIDREPRE<SLNTATIVI! W Taao•cuTu AWKtJ UUMPUKAI IVN- AN rights reserved. ACORO 25 (2090105) The ACORD name and logo are registered marks of ACORD hX Date /Time 08/09/2014 10,19 08109/2014 SAT 11:08 FAX 8,003 ®003/043 NOTEPAD. HOLDER CODE BOYS &•3 PAGE CNBURED'm NAM! Boye $ GIrIa Club of OP ID: SF DATE 12/06113 GL Qth4r Type Iris, - jloyao Benefits E&C $1000,000 Each Claim I i1,00Q,000 Aggregate alms Made Coverage) hakroactive Date 09113/04 BOYS & -3 OP ID: SF CERTIFICATE OF LIABILITY INSURANCE F DAT 12 /06D /YYYY) 12/06/13 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 Phone: 772 - 231 -2828 Vero Division Fax: 772- 231 -4413 CONTACT NAME; Sand Fe s PHONE .772 -469 -1512 I C No: No. E-MAIL ADDRESS: sfeys@bbvero.com 817 Beachland Blvd Vero Beach, FL 32963 NCPKGO191302 12/13/14 Kenneth D. Felten, LUTCF INSURERS AFFORDING COVERAGE NAIC # INSURERA: *Arch Insurance Company* 11150 $ 20,00 INSURED Boys & Girls Club of Indian River County, Inc. 1729 17th Avenue INSURER B : *Brid efield Employers Ins Co 10701 INSURER C GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC Vero Beach, FL 32960 INSURER D JEmp Ben. INSURER E: A AUTOMOBILE INSURE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP. 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 I TYPE OF INSURANCE ADDL SUBR P LICY UMB R POLICY EFF 12/13113 POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR X Prof Liability X NCPKGO191302 12/13/14 EACH OCCURRENCE $ 1,000,00 DAMAGE TO F?FNTE13 PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 20,00 PERSONAL &ADV INJURY $ 1,000,00 X Abuse /Molestation GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 3,000,00 JEmp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS NCAUT0191302 12113/13 12/13/14 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAR EXCESS LIAB X I OCCUR CLAIMS -MADE NCFXS0191302 12/13/13 12/13/14 EACH OCCURRENCE $ 4,000,00 X AGGREGATE $ 4,000,00 DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? __1 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 830-52976 09/13/13 09113114 X I WCSTATU- U-7-70TH- TORY LIMITS I I ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 1729 17th Avenue, Vero Beach, FL; 1825 17th Avenue, Vero Beach, FL; 1415 Friendship Lane, Sebastian, FL; 22 South Orange Street, Fellsmere,FL CERTIFICATE HOLDER CANCELLATION © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE L ESCRIBED POLICIES BE CANCELLED BEFORE The City of Sebastian y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1225 Main Street Sebastian, FL 32958 AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD BOYS & -3 OP ID: SF '4�CO -RO CERTIFICATE OF LIABILITY INSURANCE r AT 09 /18 /IYYYY) 09/18/13 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 Phone: 772 - 231 -2828 Brown & Brown Insurance - Vero Fax: 772 -231 -4413 Vero Division 817 Beachland Blvd Vero Beach, FL 32963 CONTACT NAME; Sandy Feys PHONE 772 -469 -1512 Fax A/C No Ext : A/C No): nI oRless: sfeys@bbvero.com NCPKGO191301 12/13112 Kenneth D. Felten, LUTCF INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: *Arch Insurance Company* 11150 MED EXP (Any one person) INSURED Boys & Girls Club of Indian River County, Inc. 1729 - 17th Avenue INSURER B: *Bridgefield Employers Ins Co 10701 INSURER C: Abuse /Molestation INSURER D: $ 3,000,000 Vero Beach, FL 32960 INSURER E : $ 3,000,000 Emp Ben. INSURER F: A AUTOMOBILE 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 POLICY NUMBER POLICY EFF MM /DDIYYYY POLICY EXP MM /DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR X NCPKGO191301 12/13112 12/13/13 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 20,000 PERSONAL & ADV INJURY $ 1,000,000 X Abuse /Molestation GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 3,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS NCAUT0191301 12/13/12 12/13/13 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ IR cdentDAMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NCUMB0191301 12113112 12/13/13 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED I X I RETENTION $ 10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 2095700 09/13/13 09113114 X I WC STATU- OTH- TORY LIMIT ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 300,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD