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COI Expires 05/29/2015® ' ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 4/17/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER NTA T Michael D Holleman Work Comp Associates, Inc. HO (A/ / NE C, o, Ert): (561) 863 -9581 ac, No): (561) 881 -9745 P.O. Box 33297 A mail @WorkCompAssoc.com INSURERS AFFORDING COVERAGE NAIC # Palm Beach Gardens, FL 33420 -3297 INSURER A: RetailFirst Insurance Company 10700 $ INSURED Boys & Girls Club of the Keys Area Inc. 1400 United Street, Suite 108 INSURER B: INSURER C: INSURER D: PERSONAL & ADV INJURY INSURER E: Key West, FL 33040 -3400 1 INSURER F: $ COVERAGES CERTIFICATE NUMBER: RFVLaInN NI IIURI=R- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MWDD LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR EACH OCCURRENCE _15TMAGE $ TO RENTED $ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO SCHEDULED ALL OWNED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BINED SINGLE LIMIT Ea accident $ 0DILY INJURY Per person) _ $ 3OD6WS Pepccident) $ Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS- EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICOMEMBER EXCLUDED? y (Mandatory in NH) If yes, describe under - - --- DESCRIPTION OF OPERATIONS below n/a N 0520446780000 5/29/2014 5/29/2015 X I WC STATU OTH TORYLIMITS ER E.L. EACH ACCIDENT $ 1 00,000 E.L. DISEASE - EA EMPLOYEE rt $ 100000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 4AA � . a Monroe County Board of County Commissioners 110 Simonton Street Key West, FL 33040- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORA A%.UKU AD 12U11.11/U51 I ne AUUKD name ana logo are r egistered marks of AGORD