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2017-037C3
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Last modified
10/25/2017 4:09:45 PM
Creation date
10/25/2017 4:09:44 PM
Metadata
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Template:
Official Documents
Official Document Type
Contract
Approved Date
03/21/2017
Control Number
2017-037C3
Agenda Item Number
8.C.
Entity Name
Youth Guidance
Subject
Grant contract for mentoring academy
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Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> �.../-- 8/24/2017 <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 CONTACT Tammy Waddington <br /> S. T. Good Insurance, Inc. PHONE (772)287-3625 FAX (772)287-3516 <br /> (A/C,No.Ext): (A/C,No): <br /> 2501 SE Aviation Way E-MAIL twaddin ton@the ooda enc <br /> ADDRESS: g g g ycom <br /> Suite H INSURER(S)AFFORDING COVERAGE NAIC# <br /> Stuart FL 34996 INSURERAFederated National Insurance <br /> INSURED - <br /> INSURER B:Frank Winston Crum Ins Co. , <br /> Woodright Construction Corp INSURERC: <br /> 2605 51st Avenue INSURERD: - <br /> INSURER E: <br /> Vero Beach FL 32966 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1641826051 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 /> ITR TYPE OF INSURANCE NSD ADDL SWVD POLICY NUMBER (MM/DDUBR Y/YYYY) (EFF MM/DD//YYYYY) <br /> LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS MADE OCCUR DAMAGE TO RENTED 100,000 <br /> PREMISES(Ea occurrence) $ <br /> GL-0506013527-00 3/28/2016 3/28/2017 MEDEXP(Anyoneperson) $ 5,000 <br /> PERSONAL 8 ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ N/A <br /> - <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ N/A <br /> ALL OWNED SCHEDULED N/A N/A N/A BODILY INJURY(Per accident) $ N/A <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS _ AUTOS (Per accident) $ N/A <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ N/A <br /> EXCESS LIAB CLAIMS-MADE N/A N/A N/A AGGREGATE $ N/A <br /> DED RETENTION$ $ <br /> B WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEFWCW10320900 8/7/2017 8/7/2018 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> (772)770-5333 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Indian River County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> • 1028 20th Place ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Vero Beach, FL 32960 <br /> AUTHORIZED REPRESENTATIVE <br /> S Good, III/DANYEL - _ -----.C.7—____.,., c� �z,c_< <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> INS025 owl 4011 <br />
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