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2017-037C4
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2017-037C4
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Last modified
10/25/2017 4:15:45 PM
Creation date
10/25/2017 4:13:29 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
03/21/2017
Control Number
2017-037C4
Agenda Item Number
8.C.
Entity Name
Daisy Bridgewater Hope Center
Subject
Grant contract for Daisy Hope Center Tutorial
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ACORD DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 09/25/2017 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTNAME:ACT Dan Myers <br /> Justine Rodgers Signature Insurance LLC talc No.Ext): (772)778-9970 FAX <br /> No): (772)365-0441 <br /> 2010 6th Avenue E-MAIL @ g <br /> ADDRESS: si cion natureinsurancevb.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Vero Beach FL 32960 INSURER A: WESTERN WORLD INSURANCE GROUP <br /> INSURED <br /> INSURER B <br /> Dasie Bridge Water Hope Center, Inc. INSURER C: <br /> P.O.BOX 701483 INSURER D: <br /> INSURER E: <br /> Wabasso FL 32970 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POUCY EFF POLICY EXPM/ LIMBS <br /> LTR 1MW WVD POLICY NUMBER (MM/DD/YYYY1 (MDD/YYYYI <br /> X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 <br /> GE TO <br /> CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A NPP8408718 02/23/2017 02/23/2018 PERSONAL a ADV INJURY $ 1,000,000 <br /> GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> X POLICY PRO- <br /> JECT LOC PRODUCTS-COMP/OP AGG $ INCLUDED IN AG <br /> OTHER: Employee Benefit Cvg. $ $1 Mil./$1 Mil Ag <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> $ <br /> UMBRELLA UAB — OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER 1 OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Sexual Molestation Ins. Each Claim $1000000 <br /> A NPP8408718 02/23/2017 02/23/2018 Cvg E.Agg. $1000000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> Tutoring School <br /> CERTIFICATE HOLDER CANCELLATION <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 /> County Commissioners of Indian River County <br /> 1801 27th St. AUTHORIZED REPRESENTATIVE <br /> Vero Beach FL 32960 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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