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HomeMy WebLinkAbout2013BOYS & -3 OP ID: SF `4�°RO CERTIFICATE OF LIABILITY INSURANCE DAT12 /13DIYYYY) 12/13/12 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: PHONE FAX A/c No Ext : A/C No): E -MAIL ADDRESS: NCPKGO191301 12/13/12 Kenneth D. Felten, LUTCF INSURERS 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: *RetailFirst Insurance Company 10700 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- RFVLa1nN NI IMRFR• 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMI D/ /YYYY MM/DDY /YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FK OCCUR X NCPKGO191301 12/13/12 12/13/13 EACH OCCURRENCE $ 1,000,000 DAMAGE T NTED 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 7 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 12/13112 12/13/13 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NCUMB0191301 12/13/12 12/13/13 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I X I RETENTION $ 10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y / N OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPT!ON OF OPERATIONS below NIA 52025864 09/13/12 09/13113 X WC STATU- OTH- E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CFRTIFICATF HAI nFR CANCFI I ATInM ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Sebastian 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 (2010105) The ACORD name and logo are registered marks of ACORD