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BOYS& -3
<br />OP ID: SF
<br />J4c RL� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYY1�
<br />09/29/2015
<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
<br />Brown & Brown Insurance - Vero
<br />Vero Division
<br />817 Beachland Blvd
<br />Vero Beach, FL 32963
<br />Kenneth D. Felten, LUTCF
<br />CONTACT
<br />NAME: Sandy Feys
<br />PHOE
<br />INC. No. Ext): 772-469-1512 FAX
<br />No): 772-231-4413
<br />E-MAIL sfey s bbvero.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A .*Arch Insurance Company*
<br />11150
<br />INSURED Boys & Girls Club of Indian
<br />River County, Inc.
<br />1729 17th Avenue
<br />Vero Beach, FL 32960
<br />INSURER B .*FFVA Mutual Insurance Co*
<br />10385
<br />INSURER C .
<br />NCPKG0191303
<br />INSURER D .
<br />12/13/2015
<br />INSURER E .
<br />$
<br />INSURER F .
<br />X
<br />COVERAGES
<br />CERTIFICATE NUMBER:
<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 />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />LIMITS
<br />A
<br />GENERAL
<br />LIABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />OCCUR
<br />NCPKG0191303
<br />12/13/2014
<br />12/13/2015
<br />EACH OCCURRENCE
<br />$
<br />1,000,000
<br />X
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$
<br />1,000,000
<br />CLAIMS -MADE
<br />X
<br />MED EXP (Any one person)
<br />$
<br />20,000
<br />X
<br />Professional Liab
<br />PERSONAL & ADV INJURY
<br />$
<br />1,000,000
<br />X
<br />Abuse/Molestation
<br />GENERAL AGGREGATE
<br />$
<br />3,000,000
<br />GEN'L AGGREGATE LIMIT
<br />APPLIES
<br />PER:
<br />PRODUCTS - COMP/OP AGG
<br />$
<br />3,000,000
<br />7 POLICY PEC
<br />LOC
<br />Emp Ben.
<br />$ 1,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED,SCHEDULED
<br />AUTOS
<br />HIRED AUTOS
<br />AUTOS
<br />NON -OWNED
<br />AUTOS
<br />I
<br />NCAUT0191303
<br />12/13/2014
<br />12/13/2015
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />1,000,000
<br />—1
<br />BODILY INJURY (Per person)
<br />$
<br />—
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />X
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT)
<br />$
<br />1
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />I X
<br />OCCUR
<br />CLAIMS -MADE
<br />NCFXS0191302
<br />12/13/2014
<br />12/13/2015
<br />EACH OCCURRENCE
<br />$
<br />4,000,000
<br />I
<br />AGGREGATE
<br />$
<br />4,000,000
<br />DED X RETENTION $ 10000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS
<br />Y / N
<br />N / A
<br />WC840-0030781-2015A
<br />09/13/2015
<br />09/13/2016
<br />I WCYTIM S I I ERT
<br />E.L. EACH ACCIDENT
<br />$
<br />500,000
<br />E.L. DISEASE • EA EMPLOYEE
<br />$
<br />500,000
<br />below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />500,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />Locations: 1729 17 Ave. & 1825 17 Ave, Vero Beach, FL
<br />1415 Friendship Ln, Sebastian, FL & 22 S. Orange Street, Fellsmere, FL
<br />ANCELLATION
<br />Indian River County
<br />1800 27th Avenue
<br />Vero Beach, FL 32960-3365
<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 />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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