HomeMy WebLinkAboutCertificate of InsuranceACORD TIM CERTIFICATE OF LIABILITY INSURANCE I G08/O2/2017TI
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 endonemenL A statement on this certificate does not confer rights to the certificate holder in lieu Of
such endorsements .
PRODUCER
CONTACT Jon RlVera or Mae an Tyler
NAME: a
a�" ; (8131 eo2-asez aC Nn: (813) 223.3932
First Florida Insurance Brokers
100 South Ashley Drive, Suite 260
Tampa, FL 33602
BRAD.
ADDRESS: Jon mven�Rinebncom Or Maeoan TvlerOMosbrcom
PRODUCER
CUSTOMER ICS:
INSURERS AFFORDING COVERAGE NAICM
08/0112017
INSURED
INSURER A: FIT [Evanston Insurance Company]
INSURER e:
Treasure Coast Community Health, Inc.
2182 Ponce De Leon Circle
Vero Beach, FL 32960
INSURER c:
INSURERS:
INSURER E:
INSURERF:
:ATE
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTADING 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
TYPEOFINSURANCE
ADDU
INSR
SUBR
MIDMM/DneacromYTYrn
POLICY NUMBER
POLICY EFF
POLICY EXP
DNR"
A
GENERAL UABIOTY
% COMMERCUL GENERAL IIABIIRY
CWMsMADE ❑X OCCUR
OEN'L AGGREGATE LIMIT APPLIES PER:
% POLICY 7PROJECT 7 LOC
FITGL.38085-2017
Empl. Ben. Liale -Claims Made:
Each ClaimlGA $1,000,000
Retro Date 10109/2011
08/0112017
0610112018
EACH OCCURRENCE $1,000,000
OAMAOETO RENTED $300,000
PRENSE9 EnOaumnm
MEDEJ3TAnym0,eMn) $10,000
PERSONAL a ADV INJURY $1,000,000
GENEM A00REGATE $3,000,000
PRODUCTS-COMP/OP AOO $1,000,000
AUTOMOBILE
UABIL17Y
ANY AUTO
ALL VARIED AUTOS
BCHFAUIED AUTOS
HIRED AUTOS
NOHANNEDAUTM
COMBINED SINGLE UNIT
fee accident
BODILY INJURY (Per intron)
BODILY INJURY (Per Widenq
PROPERLY DAMAGE
xcWen
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CI -NMS -MADE
EACH OCCURRENCE
AGGREGATE
DEDUCTIBLE
RETEMION
WORKERS COMPENSATION YIN
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER,EXECUTI IE
OFFICEmMEMBER EXCLUDED?
IMenBelu1In Nle
II yee, des lbs MWer
DESCRIPTION OF OPERATIONS W.
WC STAT
JMn3 _HER
E.L EACH ACCIDENT
E.L DWEABE-EA EMPL
EL DISEASE -POLICY LIMIT
DESCRIPTOR OF OPERATIONShOCATIONSNENICLEA IAMACORD 101, MCNonW R—rk. SchMUH. Hmon spxa la rpulMl
To be used as evidence of insurance for the Health Fair.
C.ANCFI I. ATION
ACORD 25 (2009/09) ®1988-2009 ACORD CORPORATION. All rights reserved.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
City of Sebastian
WITH THE POLICY PROVISIONS.
1225 Main Street
AUTHORNED REPRESEWATNE
Sebastian, FL 32958
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ACORD 25 (2009/09) ®1988-2009 ACORD CORPORATION. All rights reserved.