HomeMy WebLinkAbout2012RX Date /Time 03115/20112 08;30
03/15/2012 THU 9:28 FAX
CERTIFICATE OF LIABILITY INSURANCE
P.002
®002/002
OP ID oN
I 09J:20111
THISMORTIFIOATE",,I
CERTIFICATE DOES NOT' AFFIRMATNHLY OWNEOATIVELYAMEND, EXTEND OR ALTER" COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), A M
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
' e ee co Idiff 18 en AOOM a po ee mus : e e ores ; e9 4
the terme and conditions of the policy, certain policies may require an andomement, A statement on this oprtiticate does not go I ')Q�
Certificate holder In lieu of such endomementte).,
'PRODUCER
Brown s Broom Insurance — Vero
NA E:
IM
Vero Division
'LIMITS
2911 Cardinal Drive
Vero Beach FL 32963
Phone:112- 231 -2828 rax; 772- 2.31 -4413
INBUR S)AFFORDIN6CbvaRAOR
NAICI
4 , R V
IN8URERA: *Arch Insurance C,OLR ATE
��Hii a 6 Girls Club Of Indian
V7�2?rH
h FLt3L�� 0
INIUR s: •RecailFirot tawr.n c n
10700 ..
INJURER OR
,� 1j60,0.00.
INau1aR o I .
®�
WOUREa.E'I
OEN'L AGGREGATE LIMIT APPLIES PER: I
POLICY1 Z I L00
C 6MP1d ADO
INSURER I'll .17
�8 �' ” "' "•'
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COVERAGES CERTIFICATE NUMBER; REVISION NUMBER;
'i I CERTIFY T T P LicM OF INSURANCE LISTED BELOW VE BEEN ISSUFDTO THE INBUREDr NAMED ABOVE FOR THE POLICY PERIO '
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY DE ISSUED 00 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIDED HEREIN 16 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMIT6 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAyASrr
SHOULD ANY OF THE ABOVE DESCRIBED POLICee 88 CANCELLED BEFORE
TYP! F I N NSURANCE
y
�:
'
Hoye A Girls Club of Indian
POLl9T! UM8ER
IM
'LIMITS
IA I
GENERAL LIABILITY
„X, !COMMERCIAL OEN[R&UABILITY
ICLAIMSIAADE Xi OCCUR
•
1NCPKGO191300
09/13/11
�,
12/13/12 ;,p..yEJ,rJIq
;
ACM OOCURR� N, a
8 1 000 900
@��f10�, II�l,,DQQ
000
MRD !XP (Anyone ps son
*20,000
PERSONAL 6 AOV INJURY
,� 1j60,0.00.
QEN�FiALAaeREOATE
s 3•, 60(o)"'66
OEN'L AGGREGATE LIMIT APPLIES PER: I
POLICY1 Z I L00
C 6MP1d ADO
�i 066
�8 �' ” "' "•'
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f P,
AUTOMOmiLl CIA91lIT''
X. ANY AUTO
ALL OWNED AUTOS
.. ,SCHEDULED AUTOS
..HtRM AUTOD �
'NON•oWNEO AUTOS
j
'
I
NCAUT0191300
09/13/11
i
2/13/12
COMBINEDGINOLELIMR
(Er reeldanl)
111
;I , ObO., 000
BODILY I ' uaY (Prrpapll
tiODllV ff fear
;1'
PROPERTY DAMAGE
Par raeldsnll
.I. I`
,A 1,X
!
s !
iIIMeRELLAIIpe
;sXCa9eLIAe
;) I OCCUR i
; CLAIMS-MADE
'I
RCUMHOS913O0
G9/13/�l
12/19/12
EACH OCCURRENCE
X. 4�(SfSO�l000
AGGREGATE
s 4 00-0''000
DEDUCTIBLE 1
,g T);N MN. -• 19 000
1
X
.AND EMPLOVERM LIABILITY . •Y / N'
ANY PROPRIETORIPARTNERrEXECUTIy : - .
OFFICERWMDER EKCLUDE01
(Mefifisloly in
draarlbrNUnMr
.OEBCRIPTION OF OPERATIONS Wow
I A
I I
D9' 18 1
(
I
19 1
I
I
8 ,.
EI..EADHACGOENT
L, OalEA¢E . FA EMPLOYEE
:'1500 900
L. DISEASE •POLICYLIMrr
4 500 060
I
BCRrYI N Or OPEPATIONS I LOCATIONS IVEHIDLES (A N AOORO 101, Addlllonrl Rsmarke BahoduN, If mss spew N reoulrsd)
For Information Only
CERTIFIOATE HOLPJER CANCELLATION
' .1E. R .GRATION. I rlphts reserved. '
ACORb 25 (2009100) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICee 88 CANCELLED BEFORE
THB n IRATION oATE THEREOF, NOTICe WILL e! DELIVERED IN
Hoye A Girls Club of Indian
ACCORDANCE WITH THE POLICY PROWBIONB.
River County
FO Box 643068
UTHO I W -ROPA90INTATNE
Vero Beach FL 32964
' .1E. R .GRATION. I rlphts reserved. '
ACORb 25 (2009100) The ACORD name and logo are registered marks of ACORD