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2015-130E
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Last modified
3/30/2017 2:16:51 PM
Creation date
11/5/2015 11:16:36 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Grant
Approved Date
07/07/2015
Control Number
2015-130E
Agenda Item Number
8.I.
Entity Name
Indian River County Health Start Coalition
Subject
Children's Services Advisory Committee
Grant Contract
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AW o" CERTIFICATE OF LIABILITY INSURANCE <br />DATE (809/28//20152015YI) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER Phone: (772) 492-8187 Fax: (772) 492-8192 <br />INSURANCE PROFESSIONALS, LLC <br />87 ROYAL PALM POINTE <br />VERO BEACH FL 32960 <br />CONTACT Trusted Insurance Professionals, LLC <br />NAMTRUSTED <br />PHONE 492-8187FAX (772) 492-8192 <br />lac No. Exl): (772 ) INC. No): <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAZCA <br />INSURER A Underwriters at Lloyd's of London <br />LIABILITY <br />COMMERCIAL GENERAL <br />INSURED <br />INDIAN RIVER HEALTHY START COALITION, INC. <br />333 17TH STREET SUITE 2R <br />VERO BEACH FL 32960 <br />INSURER B <br />OCCUR <br />INSURERC <br />INSURER D. <br />11/04/14 <br />INSURER E <br />EACH OCCURRENCE <br />INSURER F <br />X <br />COVERAGES <br />CERTIFICATE NUMBER: 3775 <br />REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADD1. <br />MISR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/YYYY1 <br />LIMITS <br />A <br />GENERAL <br />LIABILITY <br />COMMERCIAL GENERAL <br />LIABILITY <br />OCCUR <br />ME0150540114 <br />11/04/14 <br />11/04/15 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />X <br />E TO RENTED <br />PRREM SES (Ea occureme) <br />$ 50,000 <br />CLAIMS -MADE <br />X <br />MED. EXP (Any one person) <br />$ 5,000 <br />PERSONAL 8 ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />GEN'L AGGREGATE <br />POLICYQ <br />LIMIT APPLIES PER: <br />LOC <br />PRODUCTS - COMP/OP AGG <br />$ 1,000,000 <br />$ <br />AUTOMOBILE <br />— <br />LIABILITY <br />ANY AUTO <br />ALL OWNED <br />AUTOS <br />HIRED AUTOS <br />—SCHEDULED <br />AUTOS <br />NON -OWNED <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />S <br />BODILY INJURY (Per person) <br />S <br />BODILY INJURY (Per accident) <br />S <br />_ <br />_AUTOS <br />PROPERTY DAMAGE <br />(per accident) <br />$ <br />5 <br />UMBRELLA LIAB <br />EXCESS UAB <br />1 <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />II yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />Y / N <br />N/ A <br />I WC <br />TOY LIMIATUOTH <br />TORY LIMITS ER <br />$ <br />E.L. EACH ACCIDENT <br />S <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />S <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space s required) <br />POLICY INCLUDES: HIRED NON OWNED AUTO LIABILITY $1,000,000, PROFESSIONAL LIABILITY $3,000,000, SEXUAL ABUSE/MISCONDUCT <br />$3,000,000 <br />CERTIFICATE HOLDER <br />Indian River County <br />Children's Services Advisory Committee <br />4675- 28th Ct. <br />Vero Beach, FL 32967 <br />Attention: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Jacqueline K. Savell <br />ACORD 25 (2010/05) <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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