HomeMy WebLinkAbout2011JE�?,W OP ID AT CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD /YYYY)
TYPE OF INSURANCE
03/30/33
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:
BROWN &: BROWN - VERO OFFICE
PHONE
A/C No Ext : (A/C, No):
ADDRESS:
2911 CARDINAL DRIVE
PRODUCER TO
CUSTOMER ID #: BOYS & – 3
VERO BEACH FL 32963
INSURER(S) AFFORDING COVERAGE
NAIC #
$ 15,000
INSURED
INSURERA: PHILADELPHIA INSURANCE COMPANY
23850
Boys & Girls Club of
Indian River County, Inc.
PO BOX 643068
INSURER B: FLORIDA RETAIL FEDERATION
PRODUCTS - COMP /OP AGG
INSURERC:
Vero Beach FL 32964 -3068
D:
AUTOMOBILE
X
-INSURER
INSURER E:
[INSURER F:
109/13/10
09/13/11
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.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MM /DDIYYYY)
(MM /DD /YYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
—�
X
PHPK624446
09/13/10
09/13/11
EACH OCCURRENCE
$ 1,000,000
PREMISES(Eaoccurrence)
$ 300,000
MED EXP (Any one person)
$ 15,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 3,000,000
GEML AGGREGATE LIMIT APPLIES PER:
X POLICY PRO LOC
JECT
PRODUCTS - COMP /OP AGG
$ 3,000,000
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
PHPK624446
109/13/10
09/13/11
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
A
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
PHUB321423
09/13/10
09/13/11
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
X
DEDUCTIBLE
RETENTION $ 10,000
$
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/FXECUTIVE[::]
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
/ A
52025864
09/13/10
09/13/11
X TORY LIMITS I I ER
E.L. EACH ACCIDENT
$ 50 0 , 0 0 0
E.L. DISEASE - EA EMPLOYE
$500,000
I E.L. DISEASE - POLICY LIMIT
$500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1017 Additional Remarks Schedule, If more space is required)
Certificate Holder is included as Additional Insured with respects to
General Liability.
CERTIFICATE HOLDER CANCELLATION
Yf988 -ZUU9 AGURU CORPORA I wn. Au rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
The City Of Sebastian
AUTHORIZED REPRESENTATIVE
1225 Main Street
Sebastian FL 32958
Yf988 -ZUU9 AGURU CORPORA I wn. Au rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD