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<br /> ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/WYY)
<br /> 4......------ 12/01/2016
<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
<br /> Brown&Brown Insurance-Vero
<br /> NAME: Sandy Feys
<br /> Vero Division (A/c No.Exn:772-469-1512 FAX
<br /> No):
<br /> 817 Beachland Blvd ADDRESS:sfeys@bbvero.com
<br /> Vero Beach, FL 32963
<br /> Kenneth D.Felten,LUTCF INSURER(S)AFFORDING COVERAGE NAIC II
<br /> INSURER A:Great American Ins Co of NY 22136
<br /> INSURED Boys&Girls Club of INSURER B:Great American Alliance InsCo 26832
<br /> Indian River County INSURERC:*FFVA Mutual Insurance Co* 10385
<br /> 1729 17th Avenue
<br /> Vero Beach,FL 32960 INSURERD:
<br /> INSURER E:
<br /> 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 I TYPE OF INSURANCE INSD WVD POLICY NUMBER I(MM DDY/YYYY)EFF I(MMIDDYIYYYYI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY _EACH OCCURRENCE S 1,000,000
<br /> CLAIMS-MADE X OCCUR PAC1580596 12/13/2016 12/13/2017 PREMISES(Eoccurrence)
<br /> c uo $ 1,000,000
<br /> PREMISES(Ea occurrence)
<br /> MED EXP(Any one person) $ 20,000
<br /> PERSONAL 8 ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> X POLICY 'ECOT- LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> OTHER: Emp Ben. $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> B X ANY AUTO CAP1580597 12/13/2016 12/13/2017 BODILY INJURY(Per person) S
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) S
<br /> AUTOS AUTOS
<br /> X X NON-0WNED PROPERTY a DAMAGE $
<br /> HIRED AUTOS AUTOS
<br /> S
<br /> X UMBRELLA LIAB XI OCCUR EACH OCCURRENCE I s 4,000,000
<br /> B EXCESS LIAB I CLAIMS-MADE UMB1580598 12/13/2016 12/14/2017 AGGREGATE $ 4,000,00a
<br /> DED X RETENTION 5 10000 5
<br /> WORKERS COMPENSATION I PERTUTE EI I 81" -
<br /> ANDEMPLOYERS'LIABILITY STA
<br /> YIN
<br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE WC840-0030781-2016A 09/13/2016 09/13/2017 E.L.EACH ACCIDENT 5 500,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 500,000
<br /> A Abuse/Molestation PAC1580596 12/13/2016 12/13/2017 Per Occ 1,000,000
<br /> A Professional Liab PAC1580596 12/13/2016 12/13/2017 Ann Agg 3,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Locations: 1729&1725 17th Avenue,Vero Beach, FL; 1415 Friendship Ln,
<br /> Sebastian, FL; 22 S Orange St, Fellsmere, FL
<br /> Certificate Holder is an additonal insured as their interests may appear
<br /> as required per written contract.
<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 /> Indian River County ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 1800 27th Avenue
<br /> Vero Beach,FL 32960-3365 AUTHORIZED REPRESENTATIVE
<br /> I
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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