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2003-253H
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2003-253H
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Last modified
11/22/2016 11:57:59 AM
Creation date
9/30/2015 6:47:47 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
09/23/2003
Control Number
2003-253H
Agenda Item Number
7.D.
Entity Name
Boys & Girls Club of IRC Inc.
Subject
Children's Home Society of Florida Independent Living Program
Children's Services Advisories Grant Contract
Archived Roll/Disk#
3207
Supplemental fields
SmeadsoftID
3409
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OP ID T o•Te MMA70IYTTYI <br /> CORD_ CERTIFICATE OF LIABILITY INSURANCE CHI - 3 02 / 26 / 03 <br /> pgODUCEP THIS CERTTMAT.E IE0 S 15SUASA MATTER OF INFORMATIO <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Greene -Rawl G Aa >Docidtas , Inc . HOLDER, THIS CERTIFICATE DOES <br /> NOT AMEND, EXTEND OR <br /> 1301 Riverplaee Blvd , Ste 2300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br /> Jacksonville FL 32207 NAIC N <br /> Phone : 904 - 398 -1234 Fax : 904 - 396 -'1432 INSURERS AFFORDING COVERAGE 407. 31 <br /> MINSURER w— ER n Old DaaLinion Insurance <br /> Childr�v01c Hoagie society of Staceyyy Phiillnlips1485 S . Park ran32792 , $ 1448im <br /> COVERAGES <br /> THE PouclEs of INSURANCE LISTED BELOW HAVE BEEN IsI TO THE INSURED NAMED ABOVE FOR THE PouGr PERIOD INOIa►TED. NOTWITH8rAN01 <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOC11lEN f WITH RESPECT TO VlFIIGH THIS CERIIFlCATE MAY 8E ISSUED OR <br /> POLIMAY EPERTAIN , THE INSURANCE <br /> AGGREGATE IUAITS AFFORDED BY THE HAVE BEE14 REDUCED RI ED HEREIN <br /> S bUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS Of SUCH <br /> N MAY <br /> POUCY NUNI66R pAT MIO r GATE M►OORY LIMITS <br /> LTR NwZFA TYPE OF INSURANCE EACH OCCURRENCE L <br /> OENERAL LIABILITY f <br /> PREMISES socanence <br /> r•,OMMERCIALGENERAL LIA61LITY <br /> C <br /> CNM9 MAGE 1 OCCUR I MED EX? (AfI PI <br /> f.f <br /> — { PERSONAADV INJURY <br /> GENfiRA0RMATE <br /> PROOVCPIOPff <br /> AGG If <br /> OetI AGGREOATE LIMIT APPLIES PER. <br /> pOLIOv <br /> TaiI'l LOC <br /> AVIOMOMLE UAbtLITY COM&NED3WOLE UM(T s 1 , 000 , 000 <br /> A X ANY AUTO BIG 10866 10 / 15 / 02 10 / xS / 03 <br /> IES ecclder+Q <br /> ALL OWNED AUTO$ BODILY t <br /> (Per Persoralonl <br /> i ,gCIIEDUL =0AVTO6 <br /> X MIRED AUTDS BODILY INJURY T <br /> X NDN-Owmm AUTOS <br /> X Ded $ 250 Coup HIpZD CAR PHY • DANAM PROPETTTY0AmAOE ' S <br /> X Ded $ 500 Coll $ 30 000 /DED $ 100 / $ 500 <br /> (Per �cda�1 <br /> AUTO ONLY - EA ACGDENT t <br /> OARAGE LIABILITY EA ACC I <br /> QTNERTMAN <br /> ANY AUTO AUTO ONLY: <br /> AGO s <br /> EACH OCCURRENCE f <br /> EXCFASIUMBRELLA UABIUTY AGOREOATE I <br /> 01 CU11M6 MADE <br /> S <br /> S <br /> OEDuCTIBLE I .. <br /> 11 RETCNTiON <br /> E <br /> WMD <br /> WORKERS COENUTION ANO TORY LIMITS <br /> EMPLOYLIRS LIABILITY EL EACH ACCIDENT >+ _ <br /> ANY PROP4IrTCRMAATNERrEXECUTIV6 E.L. DISEASE • EA EMPLOYE f <br /> OscICERIMEM@EA EXCLUOED7 <br /> It yyseo OxcAos uneer E.L. 016£AS6 POLICY LIMIT ! <br /> 9PEOAL PROVISIONS 0*f� <br /> OTHER <br /> A Property All Risk M3G10866 10 / 15 / 02 10 / 15 / 03 Building $ 26 , 570 , 290 <br /> Contents 96 , 854 716 <br /> OELCRIPTION OF OPEItATION41 LOCATIONS I VEMCLRS ► EXCLUSIONS ADDED BY Et10OR`EMENT ► SPECIAL PRpVISIONs <br /> RE : 4520 Selvitx Rd . , Fort Pierce , FL - TC <br /> Program - Mentoring by DCF <br /> CERTIFICATE HOLDER CANCELLATION <br /> DCFl -TC SHOULD ANY OF THE ABOVI! DEALICI6I <br /> CRISED PO9E CANCELLED BIORE EXPIRATION <br /> DATE THEAVOF • TME 18SUIN0 WI <br /> INSURER LL ENOEAVOR TO MAIL lO DAYS wp. RTTN <br /> Department of Children and NOTICE TO TIME CERTIFICATE HOLDER NAMED TO THE LLFT. BUT FAILURE TO 00 so SHALL <br /> ramil sea IMPOSQ NO OPLIGATKk► OR LIABILITY OF ART RIND UPON TNF TNIURFR, ITS AGENTS OR <br /> 337 N . 4th Street RE ESEN71VES. <br /> Fort Pierce FL 34450 AUT RuCI CNTATfVI <br /> moi] li <br /> ® AGGRO CORPORATION <br /> ACORD n (2001 /08) <br /> TOTAL P . 02 <br />
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