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2017-037C19
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Last modified
10/26/2017 11:07:25 AM
Creation date
10/26/2017 11:07:24 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
03/21/2017
Control Number
2017-037C19
Agenda Item Number
8.C.
Entity Name
Gifford Youth Achievement Center, Inc.
Subject
Grant contract for After School Education
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�..41 GIFFO-1 OP ID: MY <br /> A��EY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 06/26/2017 <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(les) 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 /> NAMEMyriam Beige! <br /> Brown&Brown Insurance-Vero <br /> Vero Division PHOE(A/C.No.Ext): 28 FAX <br /> No):772-231-4413 <br /> 817 Beachland Blvd ADDRESS:mbeigel@bbvero.com <br /> Vero Beach, FL 32963 <br /> Dan Kross INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:National Casualty Company 11991 <br /> INSURED Gifford Youth Achievement INSURER B:Progressive Ins.Group 09412 <br /> Center,Inc. <br /> $875 43rd Ave INSURER C <br /> Vero Beach,FL 32967 INSURER D: <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 /> INS TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP <br /> INSD wvn POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR X KK0000002099350006/01/2017 06/01/2018 <br /> DAMAGE TO RENTED <br /> A X SAM PREMISES(Ea occurrence) $ 300,000 <br /> MED EXP(Any one person) S 5,000 <br /> PERSONAL&ADV INJURY $ • 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> POLICY 'ECOT- LOC PRODUCTS-COMP/OP AGG s 2,000,000 <br /> OTHER: SAM $ 1,000,000 <br /> AUTOMOBILE UABIUTY (EOa ac debt)INGLE LIMIT $ 1,000,000 <br /> B _ANY AUTO 01654457-5 06/01/2017 06/01/2018 BODILY INJURY(Per person) $ <br /> ALL OWNED X SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Per accident) $ <br /> .$ <br /> UMBRELLA LIAB -OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> • <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 /> • <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> Re:Children's Services Advisory Committee • <br /> Certificate holder is included as Additional Insured subject to policy <br /> provisions. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Indian River CountyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1800 27th Street <br /> Vero Beach, FL 32960 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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