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BOYS&-3 OP ID: SF AC-ORO CERTIFICATE OF LIABILITY INSURANCE DATE 08/31/122 Y016 08/316 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 CONTANAME:CT Kenneth D.Felten,LUTCF Brown & Brown Insurance-Vero - Vero Division In"cC No.E�tr772-231-2828 FAX No):772-231-4413 817 Beachland Blvd Vero Beach, FL 32963 ADDRESS: Kenneth D.Felten,LUTCF INSURERS AFFORDING COVERAGE NAICs _ INSURERA:*New Hampshire Ins.Co. 23841 INSURED Boys&Girls Club of INSURER B:*National Union Fire Ins Co PA 19445 Indian River County INSURER C:*FFVA Mutual Insurance Co* 10385 1729 17th Avenue - Vero Beach,FL 32960 INSURER D. _ --- INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 ADDL SUBR _ --- POLICY EFF PC LTR TYPEOFINSURANCE POLICYNUMBER MMID./" POC MM/DDY EXP LIMITS A X I COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR 01-LX-086482036-0/000 12/13/2015 12113/2016 PREMISES(Ea occurrence) S 1,000+00 MED EXP(Any one person) S 20,00 X Abuse/Molestation PERSONAL&ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,00 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,0 OTHER: Emp Berl. S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,0 Ea accident 00 A X ANY AUTO 01-CA-084609623-00/00 12/13/2015 12/13/2016 BODILY INJURY(Per parson) S ALLOWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNEDPROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) S X UMBRELLA UAB X OCCUR - EACH OCCURRENCE $ 4,000,00 B _EXCESS UAB ~CLAIMS-MADE 29-UD-016698721-0/000 12/13/2015 12/14/2016 AGGREGATE S 4,000,000 DED I X RETENTION 5 10000 g WORKERS COMPENSATION I PER TH- AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNEREXECUTIVE Y❑ WC840-0030781-2016A 09/1312016 09/13/2017 E.L.EACH ACCIDENT S 5N, OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,0 If yes.descnbe under --- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500r DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Locations: 1729&1725 17th Avenue,Vero Beach, FL; 1415 Friendship Ln, Sebastian, FL; 22 S Orange St, Fellsmere, FL as their interests may appear. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Indian River County ACCORDANCE WITH THE POLICY PROVISIONS. 1800 27th Avenue Vero Beach,FL 32960-3365 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD