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Certificates of Insurance DATE(MMIDD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 04/20/2023 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT David Portuondo NAME: Brown&Brown of Florida,Inc. a/cNr o Ext: (305)714-4400 a/c,No): (305)714-4401 8825 NW 21 st Terrace E-MAIL David.Portuondo@bbrown.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Doral FL 33172 INSURERA: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: RetailFirst Insurance Company 10700 YMCA of South Florida Inc INSURER C: Philadelphia Indemnity Insurance Company 18058 900 SE 3rd Ave Suite 210 INSURER D: INSURER E: Fort Lauderdale FL 3331 6-1 11 8 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 Liab/23-24 WC REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 TYPE OF INSURANCEAUULbUBK POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDreme $ 1,000,000 MED EXP(Any one person) $ 5,000 A Y GL0000007092AT 03/31/2023 03/31/2024 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMITAPPLIES PERGENERAL AGGREGATE $ 3,000,000 POLICY ElPRO FX LOC PRODUCTS-COMP/OPAGG $ 3,000,000 JECT: Corporal Punishment $ Included AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y BA0000007090AT 03/31/2023 03/31/2024 BODI LY I NJ U RY(Pe r accide nt) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident Uninsured motorist $ 1,000,000 UMBRELLA LIAB X 10,000,000 OCCUR EACH OCCURRENCE $ A EXCESS LAB CLAIMS-MADE Y CMB0000008898AT 03/31/2023 03/31/2024 AGGREGATE $ 10,000,000 DED I X RETENTION $ 10,000 Personal&Advertising $ $10,000,000 X WORKERS COMPENSATION STATUTE EORH AND EMPLOYERS'LIABI LI TY Y/N 500'000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A 520-61182 O5/19/2023 O5/19/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Human Services Professional Liability Each Prof.Occurrence $1,000,000 A Human Services Abuse or Molestation PL0000007091AT 03/31/2023 03/31/2024 Each Abuse Conduct Lmt $1,000,000 Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Monroe County BOCC is listed as an additional insured with respects to the general liability and auto liability.Umbrella is follow form. All coverages are subject to the policy forms,terms and conditions within each policy. iK T 11 15.23 DATE_,__,--- —. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West FL 33040 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds YMCA of South Florida Additional Named Insured OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Brown&Brown of Florida,Inc. YMCA of South Florida Inc POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Remarks Aggregate Limit:$20,000,000 Certificate holder included as additional insured in accordance with all the policy terms,conditions,and exclusions and then only with respects to liability caused by the negligent acts or ommissions of the Named Insured. "Miami corporate office:790 NW 107Ave Miami FL 33172 ACORD 101 (2008/01) © 2008ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Employee Benefits EBLIA Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 1,000,000 1,000 Ref# Description Coverage Code Form No. Edition Date Medical payments MEDPM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 5,000 Ref# Description Coverage Code Form No. Edition Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 10,000 Ref# Description Coverage Code Form No. Edition Date Personal&Advertising Injury PIADV Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 10,000,000 Ref# Description Coverage Code Form No. Edition Date WC&Employer's liability WCEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$28,169.18 Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $160.00 Ref# Description Coverage Code Form No. Edition Date TERRIOSM COV TEROR Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $2,001.44 Ref# Description Coverage Code Form No. Edition Date Experience Mod Factor 1 EXP01 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $1.05 Ref# Description Coverage Code Form No. Edition Date Safety Program Cr SPCR Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$6,061.60 Ref# Description Coverage Code Form No. Edition Date Drug Free Credit DRUGF Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$14,850.93 OFADTLCV Copyright 2001,AMS Services,Inc. DATE(MMtDDIYYYY) AC40Rv CERTIFICATE OF LIABILITY INSURANCE tuf 12(2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER,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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT NAME. Michelle Wilson Brown&Brown Insurance Homestead Florida = Ext: (305)247-5121 FAX No (305)248-€543 1780 N Krome Avenue EMAIL mwilsont;Cilbbinsfl.corn ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL p Homestead FL 33030 INSURERA: Nationwide MIJtLIai insurance Conlpariy 23787 INSURED INSURER B United States Fire Insurance Company YMCA of South Florida,Inc INSURER c:900 SE 3rd Ave. INSURER D, INSURER E Ft.Lauderdale FL 33316 INSURER F: COVERAGES CERTIFICATE NUMBER: #1 of 2021 REVISION NUMBER: THIS IS T J CERTIf Y,rFtA'I'THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T)� NAMED ABOVE INSURED NAME ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC"f TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN-SR A POLICY Err POLICY EXP LTR TYPE OF INSURANCEgq .INN ,y ------------aaaPOUCY NUMBERaaaaaaaaaaaaaaa..a(#elMJClCa/YYYY jMtw1/DC7rY'Yvy._. _aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaLIMIT5 q gggqqqqqqqq x COMMERCIAL GENERAL LIABILITYp EACH OCCURRENCE $ 1,000,000 1 000,000 ci-Aici S-MADE �CkCG4lr'�a. i'P'd Ml;i f �U+.s'iuri�+a�i.;t HIED EXP(Any on.Dersoo) $...... 5,0130 ....... .................. A GL0000007092AT 03,131/2021 03131/2022 PERSONAL&ADV INJURY $ 1000000 GEN'LACGkEGATELtMIT APPLIES PER: Approved Risk Managementm GENERALAGCRECAIE. $ 3,000,000 PRo- 3,000,000 POLICY JECT � I.Oc P12C7i UCI COMP/OPAGG $ OTHER Corporal Punishment $ Included AUTOMOBILE LIABILITY 5-1 9-2021 C'OMWNED SINGLE LIMIT $ 1,000,000 Ea as�Ed�FlI X ANY AUTO BODILY INJURY fPe,pemwl $ A ONNED SCHEDULED BA00000007092AT 03131/2€>21 03/3112022 BOI)It.YIN.FUkYiPearzi,cc,d,,sntl $ AIJT(5S ONLY AUTOS H NON OWNED PROPERTY DAMAGE $ A11IFYED)S ONLY _ AUTOS ONL`f ,lptt M1 X UMBRELLA LIAR `'X OCCUR EACH OC'CURRENCE.. $ 10,000,009... A EXCESS LIAR CLAIMS MADE CMB0000008898AT 03131/2021 03131/2022 AGGREGATE $ 10,000,000 DED X RErENNOR$ tD $ WORKERS COMPENSATION X1 PER STATUTE ��. AND EMPLOYERS'LIABILITY Y/N _ .b r ANY 1=ROPR7ET(,,J�JIyARINrR,,EXECUT'IVE E t EACH ACC r $ af�i3OOO B ONFICE.RT�EPABEREXCLUDED" � NIA 40�£3-739141-8 OSi19/2C�20 08119l2021 (Mandatary in NH) E L DISEASE PA EMPLOYEE $ 500,00f3 tr yus dvsr,,flbe under 50('),007 CJE-SG`F2'1F'7ION OF t?F"E`G2M IONS below E L DISEASE POLICY LIMIT $ Professional/Abuse&Molestation Professional Occ I,000,000 A GL0000007092AT 0313l/2021 03/3112022 AbusaslMolestaton 1,0K000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Addluorral Remarks Schadute,.may be attached it mare space is required) Certificate holder Included as additional insured in acrx)rdance with all the Policy terins,conditions,and exclusions and then only with respects to liability caused by the negligent acts or oninT€scions of the Named Insured `Miami corporate ofI)ce:790 NW 107 Ave Miami FL 33172 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC Insurance Compliance ACCORDANCE WITH THE POLICY PROVISIONS, PO Box 100085-FX AUTHORIZED REPRESENTATIVE Duluth GA 30096 (O 19W2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Narned Insureds i ,I.,,�,t, ,,n A�,!,,"';, -,I ,�,I; ,,f h ,I I,,,,I,i. A,i`,. n `lo a u z d OFAPPINF(02Y2007) COPYRIGHT 2007,AMS SERVICES INC ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date WC&Employer's liability W C EL Limit 1 -1 Limit 2 Limiii..................... Deductible Amount-,-,- Deductible-Type Premium Rat#=Description Coverage Code Form No. Edition Date Premium discount PIDIS Limit I nut Limit 3 Deductible Amount Deductible Type Premium -$22,940.00 Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit I Limit 2 Limit 3 Deductible Amount Deductible Type Premium $160.00 Rat# Description Coverage Code Form No. Edition Date TERRIOSM COV TEROR Limit I Limit 2 Limit 3 Deductible Amount Deductible Type Premium I 1 $2,524.00 Description Coverage Code Form No. Edition )ate Experience Mod Factor 1 EXP01 ........................... Limit I Limit 2 Limit 3 Deductible Amount Deductible Type Premium $61,392,00 Ref# Description Coverage Code Form No. Edition Date Safety Program SAFTY Limit I Limit 2 Limit 3 Deductible Amount Deductible Type Premium . .............................. ......... ........ .................Ref DescriptionCoverage o e Edition Date Drug Free Credit DRUGF Limit I 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 7- -1- Rel# Description Coverage Code Form No. Edition Date Limit I Limit 2 Limit 3 Deductible Amount Deductible Type Premium Description Coverage Code Form No. Edition Date I............................................................................................ .........Limit I Limit 2 Limit 3 Deductible Amount.............................. Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit I Limit 2 Limit 3 Deductible Amount Deductible Type Premium .,Ref# Description Coverage Code Form No. [Edition Date .................................. Limit I Limit 2......................................... Limit 3----------------------- Deductible Amount Deductible Type Premium OFADTLC V Copyright 2001,ACAS Services,Inc. From: marias(i-Obmiaxom To: monroecountyfl; Michelle Wilson moo roecou n tyffiht)�E bix.com,tt)wilson(t-i).bbiiisfl.cotn CC: Subject: COI for Monroe County BBC C Date: 5/12/2021 10:41:59 AM Attachment(s): Good Afternoon, Attached please find Certificate of Insurance. Should you have any questions,feel free to contact me. Thank you. Mabel Arias Commercial Account Manager Associate 0(305)714-44001 D(305)714-4451 1 F (305)714-4401 Please note that we have moved to a temporary locationl Brown &Brown Miami Dade(NYSE: BRO) 1780 N Krorne Avenue Homestead, FL 33030 wvvw.bbinsurance.com From:Customer Service Sent: Tuesday, May 11, 2021 4:06 PM To: Michelle Wilson Subject: Monroe County Florida Certificate of Insurance Req [External] a its^ 1 _ 4 4"` I The attached notice is being sent to you on behalf of Monroe County Florida by Ebix RCS. Monroe County Florida has engaged with Ebix to manage insurance compliance verification on its behalf. You must be properly insured while doing business with Monroe County Florida and comply with insurance requirements. As of the date of this notice we have not received proper evidence of insurance coverage, Please review the attached notice as it includes the information needed for compliance.}and where to send your Certificate of Insurance. Vendor Instructions: The attached notice is being sent to you and your agent, if we have their email address on file. Agent Instructions: Please review the;attached notices as it includes the information needed for compliance. Please send your Certificate of Insurance via email to monroecountyfl@ebix.c:om; if you have any questions, please contact Ebix by calling(951) 925-1213; thank you for Your prompt attention to this matter. 1131X Ebix,lnc. I One Ebix way I Johns Creek, GA 30097 ( Web- Brown & Brown of Florida, Inc. - Miami Division, Protecting Your Business and Personal Assets is Our Business. Notice: Please remember that insurance coverage cannot be bound, amended or canceled by leaving an electronic or voice mail message. CONFIDENTIALITY NOTICE: The information contained in this communication, including attachments is privileged and confidential; it is intended only for the exclusive use of the addressee. If the reader is not the intended recipient, or the employee, or the agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited If you have received this communication in error please notify us by return email or telephone immediately, "Thank You. Insurance Compliance /w PO Box 100085-FX j; Duluth, GA 30096 May 11, 2021 Deference Number- FX00000312 Pin Number 12444584 Young Men's Christian Association of South Florida, Inc 900 SE 3rd Ave Ft Lauderdale, FL 33316 USA SUBJECT: CERTIFICATE OF INSURANCE REQUIREMENTS NOTIFICATION The terms of our agreement state that you must provide us with evidence of insurance coverage meeting our requirements while doing business with Monroe County Florida. According to our records, the evidence of your insurance coverage we received from Brown & Brown Insurance Homestead Florida, issued on 3/26/2021 requires your attention for the following reason(s): Deficiency Date Policy# *Workers Comp-Expiring Coverage. 05119/2021 4087391418 Included on the back of this notice is information about our certificate requirements. Please contact your insurance agent or broker and ask them to provide us with a current Certificate of Insurance using one of the following methods: A. By uploading directly to our website httf 5 iiwww.obxcerts.corn using your reference number and pin number shown at the top right of this notice, B. By email to monroecountyflebix.com C. By fax to(770) 325-5717 After using one of these methods, please do not send us the certificate by mail. We should receive your Certificate of Insurance within 15 days of the date of this notice in order to avoid further notices and possible interruption of your activities with Monroe County Florida. If you have questions about this notice or the correct coverage required you may call us at(951)925-1213. Sincerely, Insurance Compliance Department Incomplete Coverage 1 [IC 1) CERTIFICATE OF LIABILITY INSURANCE Dale!MMtDD/YY THIS CIwR`TIFICATE 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 0,4 r 11 tr A r r r r �a.Aa � R" Q . O. dP Nlur � "E RQ ,, rQ 1 aER 7MPORTfi+NT If the certificate;holdo is an ADDITIONAL INSURED,the policy(i€sj must be rmdorsode If SUBROGATION IS WAIVED,subject to tact terms and conditions of Oro policy, kdiartaln Pc"licies may require an endorsement.A statement on this cmrtificaae does not confer rights to the certlfacate holder In I'reau of such endorsement(s}. PRODUCER Phone: CONTACT NAME: Flax: PHONE FAX Name&Address of Producer (AIC,No, Ext): (A/C, No) E-MAIL ADDRESS: PRODUCER CUSTOMER ID#IE: INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURER A:_AM Best Rating A-,-Or Better _ Fd INSURER B AM Best Rating pA Or Better OV, Name&Address cat Insured ii� 11�ET�C:...AM Best Rating A , Or Better pro 6 INSURER D: AM Best Rating A , Or Better vide COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. _`o THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 1'4AVs;BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER10 1,1DIC ATCD NOTWITHSTANDING ANY RECTt.ktRFMEN't',TERM OR CONDI TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESP FC T TC?WHICH THIS CERTIF ICATE MAY BE ISSUED OR MAY VERTAIN.T HF INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE IERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID N a T 1 ADDL'SUBR, OLICY EFF Pf7t IGY E X P PE Y OF INSURANCE POLICY NUMC3Er( IN'SR 1WVD DATE(I`JWJD`YY) (MMfDD/YYYY) LIMITS A GENERAL LIABILITY EACH O CURRENCE _.._.._ $1,000,000 ,X COMMERCIAL GENERAL LIABILITY °( DA GE TO RENTED CLAIMS MADE X OCCUR EMI SES(Ea occurrence) MED EXP(Any one Person) PERSONAL&ADV INJURY GENERAL AGG LIABILITY APPLIES PE Vf GENERAL AGGREGATE POLICY PROJECT LOC PRODUCTS-COMP/OP AGO 'AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1E}00000 X ANY AUTO HIRED AUTOS t d (Ea ar,Cwrferak) ALL OWNED AUTOS 00" BODILY INJURY (Per Ix-?mon) SC:HEI:TIJt.ED AtJTta BODILY INJURY (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE(Per accident) UMBRELLA LIAR OCCUR EXCESS LIAR DE " ryi m EACH OCCURRENCE CL ims DEDUCTIBLE. AGGREGATE RETENTION WORKERS COO _NSA ION AND X WC TATu1°C#�Y LIMITS OTHER EMPLOYER"S LI BILI TY N� ANY PROPRIETORIPARTNER/ E.L.EACH ACCIDENT $500,000 EXECUTIVE OFFICER-edl a `F IN 'EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000(Mandatory in NH) If yes,de si rbe under E,L.DISEASE-POLICY LIMIT $500,000 'DESCRIPTION OF OPERATIOlid below l Builders Risk: Real Replacement Value Proof Of Coverage DESCRIPTION OF OPERATIONS/LOCATIONS t VEHICLES (Attach ACORD 101„Additional Remarks Schedule,if more space is required) -Required Additional Insured Language for General Liability and Auto Liability Monroe County BOCC. -Workers Compensation: Must provide coverage for the following State(s): FL CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Insurance Compliance EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE R POLICY PROVISIONS. PO Box 100085-FX AUTHORIZED REPRESENTATIVE Duluth,GA 30096 Certificate Must be Signed y f[grict Please note that the certificate requirements appearing in this notice are for certificate tracking purposes only, and do not alter your insurance obligations under our agreement in any way. The certificate must include: Coverage must be placed with carrier rated not less than A-, and show complete insurance carrier names as it appears in AM Best Property & Casualty Guide (or include NAIC#or AMBest#). Binders are not acceptable. Required Certificate Holder Language: Monroe County BOCC. Additional Requirements: • Required Additional Insured Language for General Liability and Auto Liability Monroe County BOCC. • Workers Compensation: Must provide coverage for the following State(s): FL If appropriate, please complete the following section and return this form to the address shown on the front of this notice. Reference Number FX00000312 Young Men's Christian Association of South Florida, Inc My Company is no longer doing business with Monroe County Florida, Automobile-No company owned autos, Workers'Compensation- I certify that my company has no employees that fall within the jurisdiction of any state(s) Workers' Compensation Laws in which work is to be performed. Authorized Signature Date Printed Name Title Phone Number Contact Information If any of the Information shown below is a)missing or b) incorrect, please complete or correct It and return it along with your certificate. Your Email Address: ba0erburn@ymcasouthflorida,org Your Agent's Email Address: mwilson@bbinsfl.com Your Telephone Your Agent's Telephone#: (305)247-5121 Your Fax#: Your Agent's Fax#: (305)248-8543 A�® CERTIFICATE OF LIABILITY INSURANCE DATE A EJMMIDD2Q""' 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(tes)must have ADDITIONAL INSURED provisions or 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 endon3ement(B). PRODUCER CONTACT NAME Michelle Wilson Brown&Brown Insurance Homestead Florida PHONE Ext: (305)247-5121 A(AJX No: (305)248-8543 1780 N Krome Avenue ADDRESS: mwilson@bbinsfi.com INSURERS}AFFORDING COVERAGE NAIC N Homestead FL 33030 INSURER A: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: United States Fire Insurance Company YMCA of South Florida,Inc INSURER C: 900 SE 3rd Ave. INSURER 0: INSURER E: Ft.Lauderdale FL 33316 INSURER F: COVERAGES CERTIFICATE NUMBER: 2020 Master REVISION NUMBER: 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. LTR TYPE OF INSURANCE IN SO WWI) POLICY NUMBER MWD MWD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE DAMAGE TO RENTS117- �OCCUR PREMISES Meoccurrenoe S 1,000,000 VIED EXP(Any one S 5.000 A Y GL0000007092AT 03/31/2020 03/31/2021 PERSONAL&ADV INJURY S 1,000,000 GENLAGGREGATE LIMIT APPLIES PER P GENERALAGGREGATE S 3.000,000 POLICY jEa ❑Loc ROVED RISK MA AGEME T PRODUCTS-COMPIOPAGG S 3,000,000 OTHER t'f Corporal Punishment S Included AUTOM0131LE LIABILITY INED Ea IN LE LIMIT 5 1,000,000 ecddent X ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED Y BAOOOO0007092AT 03/31/2020 03/31/2021 BODILY INJURY(PeracddaM) S AUTOS ONLY AUTOS HIRED NON-OWNED PR PERTY DAMA E $ AUTOS ONLY AUTOS ONLY Per acddant S X UMBRELLA LIAR I X OCCUR EACH OCCURRENCE s 10,000,000 W A EXCESS LB CLAIMS-MADE CM80000008898AT 03/31/2020 03/31/2021 AGGREGATE 5 10,000,000 DIED I XRETENTIONS 0 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE Y NIA 408-738141-8 05/19/2020 45/19/2021 EL EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? IF)(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500.000 If Yes describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S 500.000 Professional/Abuse&Molestation Professional Occ 1,000,000 A GL0000007092AT 03/31/2020 03/31/2021 Abuse/Molestation 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms. conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West FL 3304D 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD It • Ate^RD CERTIFICATE OF LIABILITY INSURANCE DATE(h1M1001Yyyy) I 03/14/2019 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. ij IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED,the pollcy(Ies)must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT Michelle Wilson NAME: (305)248-8543 III Brown&Brown Insurance Homestead Florida PHONE (305)247-5121 FAX C (NC.N.EMI (AIC,No): 1780 N Krome Avenue E-MAIL : mwilson@bbinsfl.com A1 INSURER(S)AFFORDING COVERAGE NAIL 77 Homestead FL 33030 Nationwide Mutual Insurance Co 23787 INSURERA: INSURED • INSURER B: Associated Industries Insurance Company,Inc. 23140 YMCA of South Florida,Inc INSURERC: 900 SE 3rdAve. INSURER D: i• • INSURER E: I!Ft.Lauderdale FL 33318 INSURER F: COVERAGES CERTIFICATE NUMBER: 19 Master,18 WC REVISION NUMBER: : 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 SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLBUBR ', LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DDIYYYY) (MM/DDlYYYYYY) UMITS r X COMMERCIAL GENERAL LIABILITY 1,000,000 'X J� EACH OCCURRENCE $ CLAIMS-MADE I"1 OCCUR DRAMAGETS Ea w IE ante $ 1,000,000 MED EXP(Any one person) $ 5,000 !' A Y GL0000007092AT 03/31/2019 03/31/2020 1,000,000 PERSONALSADVINJURY $ GEMLAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 3,000,000 POLICY I l n d' JEC LOC R PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY • • COMBINED SINGLE LIMIT $ 1,000,000 • X ANY AUTO Eaacddent BODILY INJURY(Per person) $ I.A OWNED —SCHEDULED y BA0000007090AT 03/31/2019 03/31/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIREDTOS ONLY /� NON-OWNED PROPERTY DAMAGE AU AUTOS ONLY Per accident $ if Uninsured Motorists $ 1,000,000 X UMBRELLALIAB X OCCUR 10, , 000000 11 EACH OCCURRENCE $ A EXCESS LIAR CLAIMS-MADE CMB0000008898AT 03/31/2019 03/31/2020 $ 10,000,000 ` AGGREGATEii DED XI RETENTION$ 0 $ • WORKERS COMPENSATION PER OTH- ANO EMPLOYERS'LIABILITY Y!N STATUTE ER I' B ANY PROPRIETOR/PARTNER/EXECUDVE E.L EACH ACCIDENT 500,000 II OFFICERIMEMBER EXCLUDED? pi /A AWC1107185 05/19/2018 05/19/2019 $ t (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 Professional Liability/ Professional 1,000if ,000 A Abuse&Molestation PL0000007091AT 03/31/2019 03/312020 Abuse/Molestation 1,000,000 is DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) y I. Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject I. :.licy terms, p conditions,and exclusions. f IA t1 Y I' PW4AGEAEAT ✓ , 1 4 FBY DATE , r-i CERTIFICATE HOLDER WAIVER W/l Yr4S_ �' ! . CANCELLATION r ,. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE r. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1. 1100 Simonton Street AUTHORIZED REPRESENTATIVE ' Key West FL 33040 1 i '...''...:;#4. 1"wr.---"''''''#'3.4.11:..--"—"Z:°11111?'•1140‘.... .--••''''''' ., ©1988-2015 ACORD CORPORATION. All rights reserved. • ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A66 ®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 3/23/2018 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 endorsement(s). PRODUCER Brown &Brown of Florida, Inc. dba T.R. Jones & Co. 1780 N Krome Ave Homestead FL 33030 CONTACT Me Gee NAME: g Arcc °N N Ext: (305)247 -5121 {AID No): (305)248 -8543 E-MAIL ADDRESS: mgee @bbinsf1.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:United States Fire Insurance 21113 INSURED YMCA of Sough Florida, Inc 900 BE 3rd Ave. . Ft. Lauderdal FL 33316 INSURERB:Associated Industries Insurance Cc 23140 INSURERC: INSURER D: INSURER E: EACH OCCURRENCE INSURER F: A COVERAGES CERTIFICATE NUMBER:18 WC 18GL /BA /UM /Pro REVISION NUMBER: 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 INSD WVD POLICY NUMBER MM D D/YYYY ) (MM/DDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE EMI, SES� a oNcur ante $ 1,000,000 X MED EXP (Any one person) $ 5,000 Crime— $1,000,000 X 5068933767 3/31/2018 3/31/2019 PERSONAL & ADV INJURY $ 1,000,000 APP, ED ; BY DATE ftSK NAGEMEN' )" GEN'L AGGREGATE LIMIT APPLIES PER: X PRO- X POLICY PRO ❑ LOC OTHER: GENERAL AGGREGATE $ 3,000,000 �/ / PRODUCTS - COMP /OP AGG $ 1,000,000 Corporal Punishment $ Included AUTOMOBILE LIABILITY N/A YES COMBINED SINGLE LIMIT Ea accident $ 1 A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X 5068933767 3/31/2018 3/31/2019 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ R a PER cidentDAMAGE $ X HIRED AUTOS X NON -OWNED AUTOS - Uninsured motorist combined $ 1,000,000 t X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ AGGREGATE $ A EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ 5068933767 3/31/2018 3/31/2019 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE � OFFICER /MEMBER EXCLUDED? - (Mandatory in NH) N ! A AWC1107185 5/19/2018 5/19/2019 X PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ 500,000 $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below - E.L- - DISEASE-EAEMPLOYEH E.L. DISEASE - POLICY LIMIT J $ 500,000 A Professional Liability 5068933767 3/31/2018 3/31/2019 Per occurrence /aggregate $1,000,000 A Sexual Abuse /molestation 5068933767 3/31/2018 3/31/2019 Per occurrence /aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy teims, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014101) INS025 (201401) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key Wes j FL 33040 C G Thomas Jones Jr. /KN ACORD 25 (2014101) INS025 (201401) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref # Description Medical payments Coverage Code MEDPM Form No. Edition Date Limit 1 5,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description PIP -Basic Coverage Code PIP Form No. Edition Date Limit 1 10,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description WC & Employer's liability Coverage Code WCEL Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Premium discount Coverage Code PDIS Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium - $36,423.00 Ref # Description Expense constant Coverage Code EXCNT Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $160.00 Ref # Description Terrorism Coverage Coverage Code TERR Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $2,514.00 Ref # Description Experience Mod Factor 1 Coverage Code EXP01 Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium - $19,364.00 Ref # Description Drug Free Credit Coverage Code DRUGF Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium - $20,383.00 Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium lt D escription Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium r OFADTLCV Copyright 2001, AMS Services, Inc. ® ACOR ® AC� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 3/23/2018 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 endorsement(s). PRODUCER CONTACT Cher Rust NAME: ry Brown & Brown of Florida, Inc. a/c E xt: (305)247 -5121 Fvc No ( 305) 248 -8543 dba T.R. Jones & Co. E -MAIL crust @bbinsfl.com ADDRESS: 1780 N Krome Ave INSURER(S) AFFORDING COVERAGE NAIC 9 INSURERA:United States Fire Insurance 21113 Homestead FL 33030 INSURED INSURER B: CLAIMS -MADE OCCUR INSURER C: YMCA of South Florida, Inc INSURER D: 900 BE 3rd Ave. INSURER E: $ 1,000,000 X INSURER F: $ 5,000 Ft. Lauderdale FL 33316 COVERAGES CERTIFICATE NUMBER:17 WC 18GL /BA /UM /Pro REVISION NUMBER: 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 ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM /DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 X MED EXP (Any one person) $ 5,000 EmpDishonesty -$1, 000 , 000 X 506- 893376 -7 3/31/2018 3/31/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO ❑ LOC JECT PRODUCTS - COMP /OPAGG $ 1,000,000 Corporal Punishment $ Included OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X 506 - 893376 -7 3/31/2018 3/31/2019 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15 AGGREGATE $ 15,000,000 A EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ 582- 110033 -4 3/31/2018 3/31/2019 A - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory-in NH)- - N / A 408- 731211 -9 5/19/2017 5/19/2018 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE 5 _ 5 _ 0 _ 0 _ , __ 0 0 - 0 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500 000 A Professional Liability 506 - 893376 -7 3/31/2018 3/31/2019 Per ocdAgg $1,000,000 A Sexual Abuse /molestation 506 - 893376 -7 3/31/2018 3/31/2019 PerOcc/Agg $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. YPR ED *IG MENT WAIVER / L CC � d1 l� CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) IN S025 (201401) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key Wet, FL 33040 GL T Jones Jr . /CHERUS ACORD 25 (2014/01) IN S025 (201401) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORU® �� CERTIFICATE O� LIABILITY INSURANCE, DATE (MM/DD/YYYY) 5/12/2017 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 terns 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 endorsement(s). PRODUCER CONTACT Ch us NAME: ry 1 R Brown fi Brown of Florida, Inc. dba T.R. Jones 6 Co. _ PAH/ c t: (305)247 -5121 F A//C No: (305) 248 -8543 E -MAIL ADDRESS: crust @bbinsfl.com INSURER(S) AFFORDING COVERAGE NAIC # 1780 N Krome Ave INSURER S tates Fire Insurance 21113 Homestead FL 33 030 INSURED INSU B: YMCA Of South Florida, Inc INSURER C: _ 900 BE 3rd Ave. INSURE D: $ 1,000,000 INSU E: GENERAL AGGREGATE $ 3,000,000 INSURER F: $ 1,000,000 Ft. Lauderdale FL 33316 COVERAGES CERTIFICATE NUMBER:17 All Lines Master REVISION NUMBER: 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 J TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY E MM /DO/YYYY 1 POLICY EXP (MM/DD/YYYYi LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR X 506- 888296 -2 AP Y BY DATE 3/31 2017 ISK G 3/31/2018 MENT EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY D PRO ❑ LOC JEC7 OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 1,000,000 Corporal Punishment $ Included A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X WAIVER 506- 888296 -2 YES 3/31/2017 3/31/2018 MEIN D IN LE LIMIT E accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ X PROPERTY DAMAGE Per accident $ Uninsured motorist combined $ 1,000,000 A UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE 582- 107231 -7 3/31/2017 3/31/2018 EACH OCCURRENCE $ 15,000,000 X AGGREGATE $ 15,000,000 DED I X I RETENTION$ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY �, / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4087312119 5/19/2017 5/19/2018 PER TH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500 000 E.L. DISEASE - POLICY LIMIT $ 500,000 A 506 - 888296 -2 3/31/2017 3/31/2018 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. (305)292 -4487 Lewinski- Monique @monroecou The historic Gato Cigar Factory Monique Lewinski 1100 Simonton Street Suite 2 -268 Key West, F7� 33040 C .L_ ��M e✓i.l�t. 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 Jones Jr. /CHERUS ACORD 25 (2014101) INS025 (201401) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® DATE (MMIDD/YYYY) g�oRO CERTIFICATE OF LIA BILITY INSURANCE 3/27/2015 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 endorsement(s). CONTACT N1COtra PRODUCER N AME: _ -__ 3 Kath ) __ - -- - - -– Brown & Brown of Florida, Inc. DunuF 05 247 -5121 �Fnx -- rans,�aa - asas dba T.R. Jones & Co. 1780 N Krome Ave Homestead FL 33030 INSURED The Young Men's Christian Assn of South Florida 900 SE 3rd Ave. 3rd FL -_ -� - kn wsURERA:Zurich American Insurance Company i 16535 INSURER Insu Company INSUR .- IN D - IN E : __ Ft Lauderdale FL 33316 I INSURER F I COVERAGES CERTIFICATE NUMBER: 15 GL /BA /XS /WC /Prof REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXC LUSIO NS A ND CONDITIONS OF SUCH iNSR LTR TYPE OF INSURANCE � g COMMERCIAL GENERAL LIABILITY A '� _�'1 CLAIMS -MADE X OCCUR OF INSURANCE POLICIES. ADDL ttjqn X SUBR� wvD LISTED BELOW HAVE BEEN IS5UEU I U l Ht INaUt<tu TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED LIM SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - POLICY EFF POLICY EX POLICY NUMBER I MM /DD MMIDDNYYY PRA102649400 1 3/31/24 NMMCU rDwV — 1— 1 . �,, - WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRE $ 1,000,000 DAMAGE 70 RENTED P REMISES (Ea occurrenc $ 1,000,000 DEXP(Anyoneperson) $ 5,000 RSONAL 8 ADV INJU $ 1 0 00,000 X Bl Ad In _ G� EN'LAGGREGATE LIMIT AP PER: l PRO- ��_ POLICY _ X LOC [_ JECT OTHER: AUTOMOBILE LIABILITY NERAL AGGREGA $ 3,000,000 COMP/OP A GG O DUCTS - COM $ 1, rporal Punishment MBINED SINGLE LIMIT a ccident) $ Included $ 1,0001000 INJURY (Per person) $ lr ANY AUTODILY A - � SCHEDULED � ALL OWNED AUTOS NON -OWNED HIRED AU70S X AUTOS X ! PRA102649400I 3/31/2 DILY INJURY (Per accident) $ OPERTY DAA$ er a ccident)_ _ A X UMBRELLA LIAB �---+ I EXCESS LIAB X OCCUR I CLAIMS - MADE , AUC011328300 3/31/2015 I I 3/31/2016 EA CH OCCURRE $ 15, 000,000 AGG REGATE $ 15 0, 00 0__ �- - � _� DEC) X RETENTIONS 0 WORKERS COMPENSATION PER OTH- X STATUTE $ - E.L. EACH ACCIDENT B AND EMPLOYERS' LIABILITY iANY PROPRIETOR/PARTNER/EXECUTIVE . II OFFICER/MEMBER EXCLUDED? L -J (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A gp 0520 -42191 5/19/2015'' 5/19/2016 $ 500,000 E.L. DISEASE - EA EMPLOY _ $ 500,000 -- E.L. DISEASE - POLICY LIMIT $ 500,000 A Sexual Abuse PRA102649400 3/31/2015 1 3/31/2016 Occurrence $1,000,000 A Professional Liab PRA102649400 3/31/2015 3/31/2016 Occurrence $1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and excl R NEW BY P WAI I1= Monroe County Board of County Commissioners 1100 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 T Jones Jr. /CHERUS I�/1nn/1�A TIALI All �,.Mk recn..,nl'I ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) � �•� �.riv r LitC�t� 1 � K ACDRD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YY) PRODUCER 03/07/00 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ARTHUR J GALLAGHER -BOCA RATON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2255 GLADES RD SUITE 4 0 0 E ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Boca Raton, FL 33431 -7379 INSURED - — YMCA Of Greater Miami 175 SW 15th Road Miami, FL 33129 COVERAGES THE POI ICIER nF wai 113Ak1 = IN SURER A:Flreman s Fu Insurance INSU B: —. I NSURE R C: I NSURER D: INSURER E: 1w i nr irvsurstU 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 POLI AGG REGATE LIMITS SH OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY NUMBER A PO _ - -. - POLICY EFFECT P LLICYEXPIRATION -- - -- D T Y LIMITS I- _ X_NCOMMERCBALG MZG80748704 GENERAL LIABILITY 12/01/99 / 12 O1 /OO EACH OCC URRENCE $1 000 000__ _ -- —� - 1 CLAIMS MADE�� OCCUR FI DAMAGE (Any f ire $5 Q O O O - -+ `_ MED EXP (Any one person) $1 -- - - _- P ERSON AL &AD VINJURY ;$1� 0 0 0 OOO r - - - GEN'L AGGREGATE LIMIT APP PER: PRO G ENERAL AGGREGATE $3 , 0 0 0 ,00 0 PR ODUCTS- CO /0P AGG $� O O O , O O POLICYF I X LOC O - - — A I AUTOMOBILE LIABILITY IMZG80748704 12/01/99 12/01/00 1i ANY AUTO F ALL OWNED AUTOS _xi (Eaa cideD)SINGLELIMI $1, 000, 000 BOD person) (Per person) ) � SCHEDULED AUTOS _ X �, HIRED AUTOS - - - - -� - -- - -. - -- _ _ BODILY INJURY $ (Per accident) X NON- OWNEDAUTOS - -� PROPERTY DAMAGE I ( Per accident) GARAGE LIABILITY ANY AUTO r•n rrr q• i}, ;r $ - -- 1 0 SS LIABILI TM • ' l + �' AUTOONLY:NEAAEAI $ AGG � EAC OCC URR EN CE $ CCUR II - � CLAIMS MADE �/I -- — - L - - LGGREGATE $ - - � DEDUCTIBLE - -- RETENTION $ - - -- - — I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WCSTATU- DTH- TORY LIMIT E.L. EA CH ACCIDE $ E.L. DISEASE -EA 0.1PLOYEE, $ OTHER E.L.DISEASE- POLICYLIMI $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES /EXCLUSIONS AD DE BYE NDORSEMENT /SPECIALPROVISIONS Certificate Holder is listed as an Additional Insured with respects to Liability for Losses resulting solely from negligent operations of the YMCA with reguards to: Sports Program at Key Largo Community Park CERTIFICATE HOLDER aODmoNALINSURED•INSURERLETTER: CANCELLATION Monroe County Board of County SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, Commissioners THE ISSUING INSURER WILLENDEAVORTOMAIL DAYSWRITTEN 5100 College Road NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 72 Key West FL 3309tE IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. A ORIZED REPRESENTATIVE INITIAL INSURERS AFFORDING COVERAGE "` `" % " "' / J_ U = Z 4F 6 3 U 8 2 / M2 9 6 9 .1e AAB 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD2S- S(7/97)2 Of 2 #2968 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM /DD/YY) DATE (MM /DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ C GENERAL LIABILITY PRODUCTS - COMP /OP AGG $ CLAIMS MADE E OCCUR PERSONAL & ADV INJURY $ NER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ ANN [f AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS I L 1 �(� SCHEDULED AUTOS HIRED AUTOS VC NON -OWNED AUTOS FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ COMBINED SINGLE LIMIT $ BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) I DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS Monroe County B.O.C.C. Attn: Public Works 5100 College Rd. Key West, F1 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, T G COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTIC TO THE CE IFICATE HOLDER NAMED TO THE LEFT, DATE r BUT FAILURE TO MAIL SUCH SHAL OSE NO OBLIGATION OR LIABILITY INITI OF ANY KIND UPON THE ' �OTICE MP ,-175 A OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE °" — 24226 t PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL--- PARTNERS /EXECUTIVE OFFICERS ARE: EXCL 141800145429 5/07/99 5/07/00 _ - - X WC ST 0TH - TORY LIMIT ER EL EACH ACCIDENT $ 500000 EL DISEASE - POLICY LIMIT $ 500000 EL DISEASE - EA EMPLOYEE $ 500000 OTHER I DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS Monroe County B.O.C.C. Attn: Public Works 5100 College Rd. Key West, F1 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, T G COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTIC TO THE CE IFICATE HOLDER NAMED TO THE LEFT, DATE r BUT FAILURE TO MAIL SUCH SHAL OSE NO OBLIGATION OR LIABILITY INITI OF ANY KIND UPON THE ' �OTICE MP ,-175 A OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE °" — 24226 ACORD, CERTIFICATE OF LIABILITY INSURANCE 0 DATE 2/ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ARTHUR J GAiLAGHER - BOLA RATON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2255 GLADES RD SUITE 400E Boca Raton, FL 33431 -7379 INSURED YMCA Of Greater Miami 1320 S. Dixie Highway, Ste. 120 Coral Gables, FL 33146 INSURERS AFFORDING COVERAGE INSURER A: Fireman's Fund Insurance Company INSURERS: INSURER C: INSURER D: INSURER E: rnvFRA(.FS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLTY MM /DD �YE I MM/D /YY LIMITS A GENERAL LIABILITY MZG80792429 12/01/01 12/01/02 EACH - OCCURRENCE $1 000 000 -- —+— X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire), $ 5 0 , 000 CLAIMS MADE X OCCUR MED EXP(Anyone person) $10, 000 PERSONAL & ADV INJURY $1 , 000,000 GENERAL AGGREGATE s3 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: .PRODUCTS - COMP /OPAGG$2, 000, 000 POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO NAGEMENT (Ea accident) ALL OWNED AUTOS (� ql R� BODILY INJURY $ P I P I SCHEDULED AUTOS (Per person) L HIRED AUTOS BY - BODILY INJURY $ NON- OWNEDAUTOS pAIE (Per accident) WAIVER NIA PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY- EA ACCIDENT! $ ANY AUTO , ^ / ��✓ OTHER THAN EA ACC $ -� 1, ,,� �1�� AUTO ONLY: �� r AGG $ EXCESS LIABILITY EACH OCCURRENCE $ �� I• ` "T OCCUR CLAIMS MADE, AGGREGATE :$ j DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND O CSTATU- OTH- _TORYL.J.MIT$i__... -_ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT I $ - -___ E.L.DISEASE -EA EMPLOYEE! $ E.L. DISEASE - POLICYLIMIT" $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is listed as an Additional Insured with respects to Liability for Losses resulting solely from negligent operations of the YMCA with reguards to: any all programs held at Key Largo Community Park Monroe County Risk Management 5100 College Road Key West, FL 33040 AlY1Dn 9C._C 1710711 r.-P -) 1L0, nn cn /Ten o - )A SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF,THE ISSUING INSURER WILLENDEAVORTO MAI L3 0 DAYSWRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURE TODOSOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUIHORIZED REPRESENTATIVE T.TT AT � Arnon rnorW%MAT3nu Knee GUVERAGES THE POLICIES OF INSURANCE LISTED AELOW 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR TYPE OF INSURANCE POLICY NUMBER A I GENERAL LIABILITY IMZG80792429 X l COMMERCIAL GENE L IABILITY I I PO ATEf FECTIVE POLICY EXPIRATION LIMITS 112/01/01 : 12/01/02 EACH OCCURRENCE ($1 000 000 FIRE DAMAGE (Any one fire) $5 0 0 0 0 CLAIMS MADE; X 1 OCCUR I ME EXP (Any one person) $10 0 0 0 _ PERSONAL & ADV INJURY $1 1 0 0 O 1 0 0 0 j GENERAL AGGREGATE $ 3,000, 000 GEN AGGREGATE LIMIT APPLIESPER:' POLICY' PRO- LOC i PRODUCTS- COMP /OPAGGI S2, 000, 000 I I A AUT OMOBILE LIABILITY IMZG80792429 X ANY AUTO 1 12/01/01 1 12/01/02 , COMBINED SINGLE LIMIT (Ea accident) $1, 0 0 0, 0 0 0 X ALL OWNED AUTOS �X SCHEDULED AUTOS X HIRED AUTOS X ; NON -OWNED AUTOS j " C o ll. Ded $ 50 0 ICom Ded $ 2 5 0 `' _ BODILY INJURY i (Per person) i $ BODILY INJURY I (Per accident) i $ PROI pEgTY DAMAGE (Per accident) $ GARAGE LIABILITY_ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG I $ j EXC ESS LIABILITY _ OCCUR I CLAIMS MADE j _ EACH OCCURRENCE $ AGGREGATE S Is 'a� j I _ DEDUCTIBLE I s RETENTION S 1 WORKERS COMPENSATION AND WCSTAT OTHI i EMPLOYERS' LIABILITY I E.L. EACH ACCIDENT � I I E.L.DISEASE-EAEMPLOYE $ $ _ E.L.DISEASE- POLICYLIMI $ OTHER I I I DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is listed as an Additional Insured with respects to Liability for Losses resulting solely from negligent operations of the YMCA with reguards to: The Upper Keys Family YMCA operates a year round sports, afterschool & camp program @ the Key Largo Community Park @ (See Attached Descriptions) SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County B .O.C.C. DATETHEREOF, THE ISSUING INSURER WILLENDEAVORTOMAIL30 _DAYSWRrrEN Facilities Maintenance CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURETODOSOSHALL 3583 S. Roosevelt Blvd. MP NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITSAGENTS OR Key West, FL 33040 ? i� ' I REPRESENTATIVES. / A _ UMPR IZED REPRESENTATIVE // DESO' IIPTIONS (Continued from ` 'ge 1) 500 St. Croix Place, Key Largo, FL 33037. The pa k is a 7 acre park. The program at the park to include but not limited to: After School Program for 20 -50 Children ages 4 -12. Activities from homework to sports: Day .Camp Program (School Recess) for 30 -80 Children ages, 7:30A.M. - 6:OOP.M. activities include arts & crafts, sports, swimmimmg;Sports Program include a variety of sports during the year. Sports to Roller Hockey, Tennis, Basketball, Soccer, Lacross, Yoga, Flag Football, T -Ball the program is forages 4 and up. The time varies for each of the sports, but a YMCA Staff person is on site during the programs. S. AMS 2S.3 (07197) 3 of 3 #S10377/M9834 ' e :NPIP Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive Suite 1100 Miami FL 33131 PHONE 4305) 372 -9950 FAX - (305) 372 -1455 INSUR YMCA of Greater Miami 1320 S Dixie Hwy Suite 120 Coral Gables FL 331460000 USA �( INSURANCE DATE(MM/DD /W) 0 2 2 2/0 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A Transportation Insurance Co. COMPANY B COMPANY C COMPANY D 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 PAIDCLAIMS. POLICY EFFECTIVE POL ICY EXPI RATION C . O I TV PE OF INSURANCE I POLICY NUM BER I DATE(MM/DD/Yl') I DATE(MM/DD /YY) I LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY " CLAIMS MADE ❑ OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BY 7 -.1 aN� pA WAVER Nf A - -- -YES GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS /EXEC UT NE OFFICERSARE EXCL WC 2 22995031 WORKERS COMPENSATION Re: Management Key Largo Community Park GENERAL AGGREGATE PRODUCTS - COTAPiOP AGG PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE(Any one fire) MED EXP (Any one person) COMBINED SINGLE LIMIT BODILY INJURY ( Per person) BODILY INJURY (Per accident) • PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY EACH ACCIDENT EACH OCCUF AGGREGATE 05119101 05119102 TORY LIMITS ER EL EACH ACCIDENT EL DISEASE -POLICY LIMIT EL DISEASE -EA EMPLOYEI $500,000 $500,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Monroe County Risk Management EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 5100 College Road 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT Key West FL 33040 USA BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENT OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE — - - C -� Client • 133 Y i rim rULMC.7 Ut INSUKANC.t L15 tU 13ELOW 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 MCAOFG.mz c POLICI AGG REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YY) CLAIMS MADE X OCCUR�� -- — J _- ME D EXP (Any one person) $10 000 03/06/01 PRODUCER ARTHUR J GALLAGHER & CO THIS CERTIFICATE IS ISSUED AS A MATTER OF ONLY AND CONFERS NO RIGHTS UPON INFORMATION 2255 GLADES RD SUITE 4 0 0 E THE HOLDER. THIS CERTIFICATE DOES NOT AMEND, CERTIFICATE EXTEND OR Boca Raton, FL 33431 - 7379 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 561 995-6706 - - -- INSURERS AFFORDING COVERAGE INSURED YMCA Of Greater Miami I $ INSURER A: Fireman's F und Insurance Company INSURER B: BODILY INJURY 1320 S. Dixie Highway, Ste. 120 SCHEDULED AUTOS INSURER C: Coral Gables, FL 33146 $ INSURER D: rnnvro A n_r0 NON -OWNED AUTOS INSURER E: i rim rULMC.7 Ut INSUKANC.t L15 tU 13ELOW 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 POLICI AGG REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLT Y EFFECTIVE POLICY EXPIRATION LIMITS T TYPE OF INSURANCE POLICY NUMBER A GENERAL LIABILITY IMZG80771737 _. 1 12/ 0 1/00 :12/01/01 EACH OCCURREN 1, . $1 0 0 0, 0 0 0 X COMMERCIAL GENERAL LIABILITY FIRE D AM A GE Any one fire ( $5 O 00 � CLAIMS MADE X OCCUR�� -- — J _- ME D EXP (Any one person) $10 000 -- -- — -- - I PERSONAL 8 ADV INJURY $1 0 O 0 -_ - -- - - -- GERAL AGGREGATE $3 0 0 0 O O 0 GEN'LAGGREGATELIMITAPPLIESPER: DUCTS- COMP /OPAGG $2 000 , 000 POLICY JE LOC AUTOMOBILE LIABILITY / - �' COMBINED SINGLE LIMIT ,ANY AUTO (Ea accident) I $ J ALL OWNED AUTOS J ' \ BODILY INJURY SCHEDULED AUTOS V (Per person) $ _ � HIRED AUTOS n - - NON -OWNED AUTOS BODILY INJURY (Peraccident) $ - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY „ AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ $ 1 AUTO ONLY: qGG _EXCESS LIABILIT OCCUR � J CLAIMS MADE W EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ }- WORKERS COMPENSATION AND _ - -- - f EMPLOYERS' LIABILITY WCSTATU- OTH- _QBYLj [ EA ACCI DENT E . L. EASE EAEMPLOYEEi $ MAR 4 8 20Ol I ' OTHER .DISEASE - POLICYLIMI $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS AD DIE BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is listed as an Additional Insured with respects to Liability for Losses resulting solely from negligent operations of the YMCA with reguards to: The Upper Keys Family YMCA operates a year round sports, afterschool & camp program @ the Key Largo Community Park @ (See Attached Descriptions) Monroe County B.O.C.C. 3583 S. Roosevelt Blvd. Key West , FL 33040 ACORD25- S(7/97)1 of 3 #S5854/M5487 SHOU LD ANY OF THE ABOVE DESCRI BE D POLICIES BE CANCE LLE D BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL _0 DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KI N D UPON THE INSURER, ITS AGENTS OR D REPRESENTATIVE WLN © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ��.• -•ic vi J itJ007'f/l•1::)'t0 / DESCRIPTIONS (Continued from Page 1) 1 500 St. Croix Place, Key Largo, FL 33037. The park is a 14 acre park. The program at the park to include but not limited to: After School Program for 20 -50 Children ages 4 -12. Activities from homework to sports: Day Camp Program (School Recess) for 30 -80 Children ages, 7:30A.M. - 6:OOP.M. activities include arts & crafts, sports, swimmimmg;Sports Program include a variety of sports during the year. Sports to Roller Hockey, Tennis, Basketball, Soccer, Lacross, Yoga, Flag Football, T -Ball the program is forages 4 and up. The time varies for each of the sports, but a YMCA Staff person is on site during the programs. AMS 25.3 (07/97) 3 of 3 #55854/M5487 DATE (MMIDD /YY) A'C,0R CERTIFICATE OF LIABILITY INSURANCE 07/25/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ARTHUR J GALLAGHER - BOCA RATON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2255 GLADES RD SUITE 400E Boca Raton, FL 33431 -7379 INSURED YMCA Of Greater Miami 1320 S. Dixie Highway, Ste. 120 Coral Gables, FL 33146 INSURERS AFFORDING COVERAGE I Insura IN SURER B: INS URER C: I NSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS AIT M! / DATE M D GENERAL LIABILITY EACH OCCUR _ $ - - - -- — COMMERCIAL GENERAL LIABILITY FIRED - ---- A one fir $ CLAIMS MAD OCCUR E ME_D E X_P (Any o person) $ PERSO _& ADV I N J URY $ � �GEN'L GEN ERAL AGGREGATE $ _ AGGREGATE LIMIT APPLIESPER: – PRODUCTS - COMP / OPAGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY APP e y y A MAN E COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BY r E – -- -- ALL OWNED AUTOS BODILY INJURY Per n) $ -- SCHEDULED AUTOS DATE BODILY INJURY (Per accident) - -- — $ -- HIREDAUTOS NON- OWNEDAUTOS WAIVER N/A YES__ – PROPERTY DAMAGE $ I (Per accident) GARAGE LIABILITY AUTO ONLY_ EAACC IDENT $ ANY AUTO EA ACC OTHER ONLY. AUTO ONLY: $ C J AGG $ EXCESS LIABILIT�YI _EACH OCCU __ $ OCCUR CLAIMS MADE AGGREGATE $$ _ _ $ DEDUCTIBLE - - - -- -- RETENTION $ $ A WORKERS COMPENSATION AND WC255361988 05/19/02 05/19/03 X QRYAJMI ]o�- E. E ACC $ 5 0 0 , O O O EMPLOYERS' LIABILITY E.L.D EAEM P_ LO Y_EE $5 O O, 0 0 0 IE.L.DISEASE - POLICYLIMI $500, OTHER I i DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is listed as an Additional Insured with respects to Liability for Losses resulting solely from negligent operations of the YMCA with reguards to: The Upper Keys Family YMCA operates a year round sports, afterschool & camp program @ the Key Largo Community Park @ (See Attached Descriptions) Monroe County B.O.C.C. Public Works Division 1 100 Simonton Street Key West, FL 33040 -t -UnI I - n^ /RX1 nn-7n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERE OF,THE ISSUING INSURER WILL ENDEAVOR TO MAI L3 AD—. DAYS WRITTEN NCTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURE TODOSOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVE a nu © ACORD CORPORATION 1988 F _ DESCRIPTIONS (Continued from Page 1) 500 St. Croix Place, Key Largo, FL 33037. The park is a 14 acre park. The program at the park to include but not limited to: After School Program for 20 -50 Children ages 4 -12. Activities from homework to sports: Day Camp Program (School Recess) for 30 -80 Children ages, 7:30A.M. - 6:OOP.M. activities include arts & crafts, sports, swimmimmg;Sports Program include a variety of sports during the year. Sports to Roller Hockey, Tennis, Basketball, Soccer, Lacross, Yoga, Flag Football, T -Ball the program is forages 4 and up. The time varies for each of the sports, but a YMCA Staff person is on site during the programs. AMS25.3(07/9713 of 3 #S13939/M10973 ACORnTM CERTIFICATE OF LIABILITY INSURANCE 12112102 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ARTHUR J GALLAGHER & CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2255 GLADES RD SUITE 400E HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Boca Raton, FL 33431 - 7379 561 995 -6706 INSURERS AFFORDING COVERAGE INSURED - - INSURER A: Hartford Insurance Company YMCA Of Greater Miami INSURER B: 1320 S. Dixie Highway, Ste. 120 INSURER C: Coral Gables, FL 33146 .. INSURER D: _ INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - ATE M/ TIV ATE M / /YY -- - - - POLICY EFFECTIVE'PO INSRI EXPIRATION S T TYPE OF INSURANCE POLICY NUMBER LIMIT A GENERAL LIABILITY 83UENOB5231 '12/01/02 12/01/03 EACH OCCURRENCE $1,0 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $10 -_ -_ CLAIMS MADE X OCCUR 1 MED EXP (Anyone - person) $5,000 - PERSONAL & ADV INJURY � $1,000,000 GENERAL AG . $2,0 000 PRODUCTS- COMP /OPAGG. $2, PRO- GEN'L AGGREGATE LIMIT APPLIES PER: i POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON- OWNEDAUTOS (Per accident) $ -__ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ,�1 t,, AUTO ONLY- EA_ ACCIDENT'. $ ANY AUTO 1 MAN -EM -NT OTHER THAN EA ACC $ PPR(`, AUTO ONLY: AGG $ EXCESS LIABILITY By EACH OCCURRENCE $ OCCUR CLAIMS MADE tt n AGGREGATE $ DEDUCTIBLE WAIVER NIA /ES_ ---- - - - - DA v RETENTION $ $ WCSTATU - OTH-� WORKERS COMPENSATION AND TORY LIMIT$!_ ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ .... r E.L.DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Location(s): Key Largo Community Park Event(s): All Programs Date(s): December 1, 2002 - November 30, 2003 Certificate Holder is an Additional Insured as respects to the YMCA at the captioned location for the captioned dates, but only as respects to loss or damage arising out of negligent acts or omissions of the YMCA, its members, participants, guests, volunteer and employees. Monroe County Risk Management 5100 College Road Key West, FL 33040 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, THE ISSUING INSURER WILLENDEAVORTOMAIL DAYSWRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURE TO DOSOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR IZED REPRESENTATIVE A A e n Amon ( 1020 LLlenL : lij Y1v1UAU1 AC-0- .�� CERTIFICATE OF LIABILITY INSURANCE 12 /`07 /00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ARTHUR J GALLAGHER - BOCA RATON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2255 GLADES RD SUITE 400E Boca Raton, FL 33431 -7379 INSURED YMCA Of Greater Miami 175 SW 15th Road Miami, FL 33129 INSURERS AFFORDING COVERAGE !INSURER A: Fireman's F und Insurance Compan INSURER B: INSURER C: I INSURER D: INSURER E: COVERAGES 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. AG GREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DAT MMI CT Y POLICY EXPIRATION DATE MM/ / LIMITS • GENERAL LIABILITY '.. X COMMERCIAL GENERAL LIABILITYI, CLAIMS MADE OCCUR MZG80771737 12/01/00 12/01/01 EACH OCCURRENCE $1 QQQ QQQ FIRE DAMAGE (Any one fire) $5 Q , 000 MED EXP(Anyone pe rson) $10 000 '! PERSONAL & ADV INJURY $1, 000,000 li J 1 GENERAL AGGREGATE $3 , 0 00 000 GEN'L AGGREGATE LIMIT APPLIES PER - — _ ', PRODUCTS- COMP /OP AGG $2 L _ 000 Q Q Q O POLICY PRO- I LOC • AU TOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS MZG80771737 R E C E IV 12/01/00 D 12/01/01 COMBINED SINGLE LIMIT (Ea accident) $1 000, BODILY INJURY (Per person) $ � XX X1 BODILY INJURY (Per accident) $ HIRED AUTOS NON - OWNEDAUTOS n , DE , 200 X TX Coll. DED. $50 PROPERTY DAMAGE (Per accident) — $ Com . DED . $250 GARAGE LIABILITY AUTOONLY- EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESS LIABILITY OCCUR El CLAIMS MADEI DEDUCTIBLE , n y7E ( ", ;,�! -+- i i EACH OCCURRENCE $ AGGREGATE $ $ $ RETENTION $ WORKERS COMPENSATION AND F1e11 EMPLOYERS' LIABILITY t ` F4 �� • • . ,I �C� - - WCSTATU- OTH- T OHY_Ll E.L. EACH ACCIDENT $ - -- ' � F E.L.DISEASE -EA EMPLOYE E $ E.L.DISEASE - POLICYLIMI $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS AD DE BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is listed as an Additional Insured with respects to Liability for Losses resulting solely from negligent operations of the YMCA with reguards to: Sports Program at Key Largo Community Park Monroe County Board of County Commissioners 5100 College Road Key West, FL 33040 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR D REPRESENTATIVE ACnnnox /710711 - 4 f %0 /A/f7 ncn � T n Af; A^n I / ^nP nATI^a1 •Ann IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD25- S(7197)2 of 2 #S3082/M2969 ACORD CERTIFICATE OF LIABILITY INSURANCE ANDD/YYYY) ADD'L 06 /1 06/17/04 PRODUCER 1 - 561 - 995 - 6706 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. - Boca Raton ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2255 Glades Road Suite 400E HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GENERAL LIABILITY X C OM MERCIAL GENERAL LIABILITY CLAIMS MADE lxl OCCUR 83ENOB5231 Boca Raton, FL 33431 12/01/04 EACH OCCURRENCE $1,000,000 INSURERS AFFORDING COVERAGE NAIC # INSURED YMCA of Greater Miami INSURER A: Westchester Fire Ins Co 21121 INSURER B: Property & Cas Ins Co Of Hartford 34690 1200 NW 78th Avenue, Suite 200 INSURER C: Hartford Fire In Co 19682 INSURERD:Usf &G Specialty Ins Co 10182 Miami„ FL 33126 INSURER E: B C17VFROC.1-C 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS C X GENERAL LIABILITY X C OM MERCIAL GENERAL LIABILITY CLAIMS MADE lxl OCCUR 83ENOB5231 12/01/03 12/01/04 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Eaoccurence $ 100, 000 M ED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP /OPAGG $2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALLOWNEDAUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS Comp Ded 250 83UENOB5379 A F BY DATE — `° WAIVE R N/A 12/01/03 DEMENT _ __ �__ Y ES 12/01/04 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILYINJURY (Per person) $ X BODILY INJURY (Per accident) $ X X ( Perraccident) AMAGE X Coll Ded 500 GAR AGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS/UMBRELLALIABILITY X OCCUR FI CLAIMSMADE DEDUCTIBLE X RETENTION $ 10,000 CUW 7741030 ��_ ` 12/01/03 12/01/04 EACH OCCURRENCE $1,000,000 AGGREGATE $ 1,000,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE INC OFFICERIMEMBEREXCLUDED? EXCL Hyes, describe u nder S PEC IAL PROVISIONS below D216WO0118 05/19/04 05/19/05 X O E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is listed as additional insured as respects the YMCA of Greater Miami and all of it's branches but only as respects loss or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its members, participants, guests, volunteers and employees. County Board of County Commissioners Maria Slavik 1100 Simonton Street Rey West , FL 33040 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE 0 ACORD CORPORATION 1988 1885506 C C Powered ByCertificateSNown" ACORD DATE (MWDD/YYYY) . CERTIFICATE OF LIABILITY INSURANCE 06/23/04 PRODUCER 1 - 561 - 995 - 6706 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. - Boca Raton ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2255 Glades Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 400E Boca Raton, FL 33431 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Westchester Fire Ins CO 21121 YMCA of Greater Miami INSURER B: Property & Cas Ins Co Of Hartford 34690 1200 NW 78th Avenue, Suite 200 INSURER C: Hartford Fire In Co 19682 Miami„ FL 33126 INSURERD:Uef &G Specialty Ins Cc 10182 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R DD' INSR TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS C X GENERAL LIABILITY 83ENOB5231 12/01/03 12/01/04 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR DA TO RENT - PREMISES Eaoccurence $ 100,000 M ED EXP (Anyone person) $5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OPAGG $2.000,000 X POLICY PRO- LOC B AUTOMOBILE LIABILITY ANY AUTO 83UENOBS379 12/01/03 12/01/04 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALLOWNEDAUTOS SCHEDULEDAUTOS � -' " 14 A Et:. X BODILYINJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS - -- '� X Comp Ded 250 ATE '. __. _ _.- - X PROPERTY DAMAGE (Per accident) $ X Coll Ded 500 GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EA ACC AUTOONLY: AGG $ ANY AUTO ` C�. $ A EXCESS/UMBRELLALIABILITY CUW 7741030 12/01/03 12/01/04 EACH OCCURRENCE $1,000,000 X I OCCUR FI CLAIMSMADE AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ X RETENTION $ 10,000 * WORKERS WORKERS COMPENSATION AND EMPLOYERS'LIABPAR ANY PROPRIETOR/ PARTNER/EXECUTIVE INC 05/19/04 05/19/05 X WC OTH- T RY LIMITS R E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 OFFICERIMEMBEREXCLUDED? EXCL If yyes, describe under SPECIAL PROVISIONS below I E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is listed as additional insured as respects the YMCA of Greater Miami 1200 NW 78th Avenue, Suite 200, Miami, FL concerning all Grants and Contracts on file. but only as respects loss or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its members, participants, guests, volunteers and employees. 12 C � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County Risk Management DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Maria Slavik if NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1100 Simonton Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Rey West , FL 33040 AUTHORIZED REPRESENTATIVE USA �-- AUUKU 0 ACORD CORPORATION 1988 1898507 Powered ByCertificatesNown" l;VVtKA"tJ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DD' POLICYEFFECTIVE POLICY EXPIRATION POLICY NUMBER AT DATE 1MM/DD/YY) X GENERAL LIABILITY D216P00343 12/01/04 12/01/05 LIMITS EACH OCCURRENCE $1,000,000 RENTErD X COMMERCIAL GENERAL LIABILITY rB DAMAGE TO PREMISES Eaoccurence $ 100,000 CLAIMSMADE F---I OCCUR MED EXP (Any one person) PERSONAL &ADV INJURY $5,000 $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OPAGG $2,000,000 X I POLICY PRO- LOC 8 AUTOMOBILE LIABILITY D216AO0387 12/01/04 12/01/05 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO X ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS X BODI e URY $ HIREDAUTOS NON - OWNEDAUTOS Com ed 25 p }y �f ;' BY IDAT , n 1e �b1nn1 IVI�I --- 'r' X PROPERTY DAMAGE (Per accident) $ X X I Coll Ded 500 GARAGE LIABILITY ANY AUTO W� (��t.- d N /A ^� __,_. AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC AUTO ONLY: AGG $ $ A EXCESS /UMBRELLA LIABILITY CUW 7854450 12/01/04 12/01/05 EACHOCCURRENCE $1,000,000 AGGREGATE $ 1,000,000 X OCCUR El CLAIMS MADE $ $ DEDUCTIBLE _ G $ X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY D216W00118 05/19/04 05/19/05 X T O ER E.L. EACH ACCIDENT $500,000 ANY PROPRIETOR /PARTNER/EXECUTIVE INC OFFICER /MEMBER EXCLUDED? EXCL E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is listed as additional insured as respects the YMCA of Greater Miami 1200 NW 78th Ave Suite 200 Miami, FL 33126 and all of it's branches but only as respects loss or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its memebers, participants, guests, volunteers and employees. GtK I IFIL.A I G 117ULLJCR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Maria Slavik IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 Simonton Street West, FL 33126 USA REPRESENTATIVES. ,UTHORIZED REPRESENTATIVE ACORD 25 (200,108) stacbie •+�� '�� .. "^ �° 2499852 L (�- i Powered ByCertificatesNowT" ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 02/2 2 2 /0 5 / YY) PRODUCER 1 561 - 995 - 6706 Arthur J. Gallagher & co. -Boca Raton 2255 Glades Road THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HOLDER. TH S O CERTIFICATE DOES OTAM ND, A OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MAY PERTAIN, THE INSURANCE POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Suite 400E Boca Raton, FL 33431 INSURERS AFFORDING COVERAGE NAIC# INSURED YMCA of Greater Miami INSURER A: Westchester Surplus Lines Ins Co 10172 INSURER B: Discover Prop & Cas Ins Co 36463 INSURERC:Usf &G Specialty Ins Co 10182 1200 NW 78th Avenue, Suite 200 INSURER D: PERSONAL &ADV INJURY Miami„ FL 33126 GENERALAGGREGATE $ 2,000,000 INSURER E: PRODUCTS - COMP /OPAGG GUV LKAt3t3 INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE POLICIES OF TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DO' POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER LIMITS LT • X I GENERALLMIBILITY D216P00343 12/01/04 12/01/05 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA EN D PREMISES Eaoccurence $ 100,000 CLAIMSMADE lil OCCUR MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $2,000,000 X POLICY PRO- LOC • AUTOMOBILE LIABILITY D216AO0387 12/01/04 12/01/05 COMBINED SINGLE LIMIT $1, 000, 000 (Ea accident) ANY AUTO X ALLOWNEDAUTOS SCHEDULED AUTOS r APF' �`� I �- C K. klA GE ENT BODILY INJURY (Per person) $ BODILY INJURY $ X HIRED AUTOS "Y X X NON -OWNEDAUTOS Co mp De 250 " " "`- "'"° --' - j Q"ent) DAMAGE n "/ = a hi (Per accident) $ X Coll Ded 500 GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANY AUTO r $ AUTO ONLY: AGG A EXCESS /UMBRELLA LIABILITY CUW 7854450 12/01/04 12/01/05 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 X OCCUR FI CLAIMSMADE $ DEDUCTIBLE $ X RETENTION $ 10,000 C WORKERS COMPENSATION AND D216WO0118 05/19/04 05 /19/05 X T RY ER E.L. EACH ACCIDENT $500,000 EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE INC OFFICER/MEMBER EXCLUDED? EXCL E.L. DISEASE - EA EMPLOYEE $ 500, 000 E.L. DISEASE - POLICY LIMIT $500,000 Use describe under If es SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is listed as additional insured as respects the YMCA of Greater Miami 1200 NW 78th Ave Suite 200 Miami, FL 33126 and all of it's branches but only as respects lose or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its memebers, participants, guests, volunteers and employees. GhK 11t1GA I t MULL1tK 1 1 — County Board of County Commissioners Maria Slavik 1100 Simonton Street Key West, FL 33126 USA A1% ^0119C MMAI IAQ% atm rhi o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE 7 ACORD CORPORATION 1988 -- - -- J 2499852 CC ` Powered ByCertificatesNow- ACORD CERTIFICATE OF LIABILITY INSURANCE D ATE /DD/YYYY) OVE F R THE POLICY PERIOD INDICATED. NOTWITHSTANDING 0 4/05 4/05/06 PRODUCER 1 - 561 - 995 - 6706 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arthur J. Gallagher & Co. (Florida) 2255 GladeB Road Suite 4008 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Boca Raton, FL 33431 POLICYEFFECTNE POLICYEXPIRATION LIMITS B X GENERAL LIABILITY D216L00024 INSURERS AFFORDING COVERAGE NAIC # INSURED ^ YMCA of Greater Miami 9C Westches r Surplus Lines Ins Co 10172 MED EXP (Any one person) s5,000 :Discover Prop & Can Ins Co 36463 1200 NW 78th Avenue, Suite 200 INSURER C: GEN'L AGGREGATE LIMIT APPLIES PER: INSURER D: X POUCYL PRO- LOC Miami„ FL 33126 APR + AUTOMOBILE LIABILITY D216AO0705 VVVnmM"Cn THE POLICIES OF INSURANCE LISTED BELOW HAVE BEtN ASS OVE F R THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY C NTRACT OR CNOM; �� T WITH RESP CT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE P ICIES DESC r t18JECT TO AL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BE-.., INSR ADO'L POLICY NUMBER POLICYEFFECTNE POLICYEXPIRATION LIMITS B X GENERAL LIABILITY D216L00024 12/01/05 12/01/06 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccurence $100,000 CLAIMS MADE 7 OCCUR MED EXP (Any one person) s5,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POUCYL PRO- LOC B AUTOMOBILE LIABILITY D216AO0705 12/01/05 12/01/06 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS �. I.P. J ..., : (Per person) X HIRED AUTOS ' . BODILY INJURY $ X NON- OWNEDAUTOS °" - -- - - (Peraccident) - -i-1 O PROPERTY DAMAGE / .... $ (Per accident) GARAGE LIABILITY - °' ° °- °- '�- AUTO ONLY -EA ACCIDENT $ ANY AUTO 01 / /1 � I / OTHER THAN EA ACC $ $ V AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY 6220105301 12/01/05 12/01/06 EACH OCCURRENCE $1,000,000 X OCCUR 7 CLAIMSMADE AGGREGATE $ 1,000,000 DEDUCTIBLE X RETENTION $ 10, 000 $ WORKERS COMPENSATION AND c WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE INC E.L. DISEASE -EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? EXCL Use describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is listed as additional insured forGeneral Liability only as respects the YMCA of Greater Miami, 1200 NW 78th Ave, Suite 200, Miami, FL 33126 and all of it's branches but only as respects loss or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its members, participants, guests, volunteers and employees ** *Automobile coverage is Hired & Non -Owned Coverage along with Hired Automobile Physical Damage. The Coverage includes a $25,000 Physical Damage Limit, along with $250 for comp & $500 deductible for collision. * ** County Board of County Commissioners ( Maria Slavik 1100 Simonton Street Rey West , FL 33040 USA ACORD 252001/08) etacbie 4159048 , rvr1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE © ACORD CORPORATION 1988 row " "CertificatesNowTu IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) ACORD CERTIFICATE OF LIABILITY INSURANCE 1 D AD/YYYY) 066 /01 /01 /06 PRODUCER 1 -561- 995 -6706 Arthur J. Gallagher Risk Management Services Arthur J. Gallagher & Co. (Flom - -- 2255 Glades Road Suite ao Boca Ra PL 33431 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE - HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSAERS AFFORDING COVERAGE NAIC# INSURED YMCA of Greater Miami '� J U 1 4 J y I INSURER A: Westchester Surplus Linea Ins Co 10172 INSUR92 B:IIef &G Speci Ina Co 10182 1200 NW 78th Avenue, Suite 200 L INSUREIR, Di Prop & Cas Ins Co 36463 Miami,, FL 33126 � MONROE COUNTY INSUR D: DAMAGETO RENTED - PREMISES Ea occurence NSUR E: CLAIMS MADE OCCUR rnviceAIC. 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREG LIMI S H OW N MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR DD' - POLICY NUMBER POLICYEFFECTIVE POMCYEXPIRATION LIMIT S R C X GENERAL LIABILITY D216L00024 12/01/05 12/01/06 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED - PREMISES Ea occurence $ 100,000 CLAIMS MADE OCCUR MED EXP(Any anepersm) $5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE L IMIT APPLI ES PER. PRODUCTS- COMPIOPAGG $2,000,000 —— X POLICY PRO- LOC C AUTOMOBILE LIABILITY ANY AUTO D216AO0705 12/01/05 12/01/06 COMBINED SINGLE LIMIT (Ea acadenq $1,000,000 BODILY INJURY (Per Person) ALL OWNED AUTOS SCHEDULED AUTOS { ` ' ( / �1 1' �\ $ BODILY INJURY (Per an Want) $ X X HIRED AUTOS NON- OWNEDAUTOS .. )�.,.� I _ PROPERTY DAMAGE (Per accident $ GARAGE LIABILITY AUTO ONL - EAACCIOENT $. TH RTH EA $_ ANVAUTO $ ll-- UT AGO A EXCESSPJMBRELLAUABIUTY G220105301 12/01/05 12/01/06 E ACH OCCURRENCE 51,000,000 X OCCUR CLAIMS MADE AGGR 51,000,000 $ DEDUCTIBLE $ X RETENTION $ 10,000 B WORKERS COMPENSATION AND D216WO0612 05/19/06 05/19/07 X WC ORY'IMT OTH- EMPLOYERS' MABIUTY ANY PROPRIETOWPARTNERIEXECUTIVE INC E.L. EACH ACCIDENT $500,000 E.L. DISEASE -EA EMPLOYEE $500,000 OFFICERN EMBER EXCLUD ED? EXCL I(yyes,descnbe under 5P ECIAL PROVISIONS 1,60. E I. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROWSIONS Certificate holder is listed as additional insured for General Liability only as respects the YMCA of Greater Miami 1200 NW 78th Ave Suite 200 Miami FL 33126 and all its branches but only as respects lose or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its members, participants, guests, volunteers and employees. * *Automobile coverage is Hired and Non -Owned Coverage along with Hired Automobile Physical Damage. The coverage includes a $25,000 Physical damage Limit, along with $250 for comp and $500 deductible for collission. * ** County Board of County Commissioners is Slavik 0 Simonton Street West, FL 33126 ORD 25 (2001 �08) aimbel q 4425432 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER HALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHCRI2ED REPRESENTATIVE OACORD 1 L aL ACORD 1/06 CERTIFICATE OF LIABILITY INSURANCE GATE IM YYYV) 06/0 PRODUCER 1 -561- 995 -6706 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Manngement�servicee " D CONFERS NO RIGHTS UPON THE CERTIFICATE Arthur J. Gallagher a Co. (Florida) 1 1i -� "M 1rr HOLDE THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2255 Glades Road - ,._ ".i"' "1 - �_`A ALTER HE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 4008 Boca Raton, FL 33431 I INSURER AFFORDING COVERAGE NAIC# INSURED j I,.'i %'�INSU ERA: Wl 9tchooter Surplus Lines Ins Co 10172 YMCA of Greater Miami 1 - Ins Co 10182 1200 NW 78th Avenue, Suite 200 +_ m MSU FRB�D stover Prop Cam Ina Co 36463 FL 33126 h. ^.1�;JrrE RC;F F ±A1' V THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR DD' POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE LTR DATE (MMIDDNYI DATE MIMMONY1 C X GENERAL LIABILITY D216L00024 12/01/05 12/01/06 X COMMERCIAL GENERAL LIABILITY LIMITS EACH OCCURRENCE $1,000,000 DAMAGE TO - RENTED - PREMISES Ea a,cuence 5100,000 GlAIMS MADE O OCCUR MED EXP(My one person) $5,000 ...._ PERSONAL B ADV I NJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLI ES PER: PRODUCTS - COMPIOP AGG $2,000,000 X POLICY PRO- LOC C _AUTOMOBILE LIABILITY ANYAUTO D216A00705 12/01/05 12/01/06 COMBINED SINGLE LIMIT (Ea eccidenl) $1,000,000 BODILY INJU RY (Per person) $ _ ALLOWNEDAUTOS SCHEDULEDAUTOS -_ BO d amidenq ) X % HIRED AUTOS NO N -OWNED AUTOS -. s I- '( / I ZQ}J $ ac". DAMAGE acident) $ GARAGE LIABILITY \f ONLY -E ACCIDENT $ _AUTO OTHERTHAN _EAACC 4 ANYAUTO I` $ AUTO ONLY: AGG A I LIABILITY 6220105301 12/01/05 12/01/06 EACH OCC RRENCE $1,000, AG GREGATE $ 1 000, 000 k EXCESSIUMBRELIA OCCUR CLAIMS MADE S DETECTIBLE RETENTION $ 10,000 I D216WO0612 $ g EMPLOY S COMPENSATION ANO EMPLOYERS'LIABILITY ANYPROPRIETORIPARTN OUTIVE INC OFFICERIMEMBER EXCLUOE07 EXCL. 1 I 05/19/06 " M T; •u 05/19/07 ST % WCSTATU- — E.L.EACH ACCIDENT � 500,000 8 � E.L. DISEASE - EA EMPLOYEE $500,0 E1. DISEASE - POLICY LIMIT If yes, describe under SPECIAL PROVISIONS below 1 1�,(� � $500,000 I OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Certificate holder is listed as additional insured for General Liability only as respects the YMCA of Greater Miami 1200 NW 78th Ave Suite 200 Miami FL 33126 and all its branches but only as respects loss or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its members, participants, guests, volunteers and employees. • *Automobile coverage is Hired and Non -Owned Coverage along with Hired Automobile Physical Damage. The coverage includes a $25,000 Physical damage Limit, along with $250 for comp and $500 deductible for collission. * ** oe County Board of County Commissioners a Slavik Simonton Street West, FL 33126 USA )RD 25 (20`81108) aimbel 4425432 C C SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR 1988 ACORD CERTIFICATE ATE OF LIABILI INSURANCE DATE 13 IS MYY) 1/13/06 PRODUCER Arthur J. Gallagher Rink Arthur J. Gallagher & Co. 2255 Glades Road Suite 400E Boca Raton, FL 33431 of Greater Miami 11200 NW 78th Avenue, Suite 200 (Miami„ FL 33126 -- RE — DEC 2 7 _uuu I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE DOCUMENT WITH RESPECT TO WHICH MONROE COUNTY Vd IS AFFORDING COVERAGE Dsf &G Specialty Ins Co niscover Pron & Cas Ins Co NAIC # 10182 36463 COVERAGES INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICYEFFECTNE POUCYEXPIRATION INSR DO' LIMITS POLICY NUMBER 1, 1111111111 D217L00013 12/01/06 12001 /07 EACH OCCURRENCE $2.000,000 • GENERAL LIABILITY D AG REN 100,000 $ X COMMERCIAL GENERAL LIABILITY PREMISES Ea urenm MED EXP(Any one Person) $5,000 CLAIMSMADL- 1XI OCCUR PERSONAL &ADV INJURY $1,000,000 GENERALAGGREGATE $4,000,000 PRODUCTS -COMPIOPAGG $2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY PRO- LOC • AUTOMOSILE LIABILIT Y D217AO0112 12/01/06 12/01/07 COMBINED SINGLE LIMIT $1,000,000 (Ea acaden0 ANYAUTO ALLOWNEDAUTOS BODILY INJ DRY $ y . 61 -. (Per Person) SCHEDULEDAUTOS / X HIREDAUTOS — t (.X- BODILY INJURY $ X NON- OWNEDAUTOS 1�� _- - -- (Peramident) D AMAGE PROPE (Per accident) ident) § AUTO ONLY - EAACCIDENT $ GARAGE LIABILITY ANY AUTO I //(� / (ILf n J a, OTHERTHAN EAACC ONLY: $ v y VOL AUTO AGG $ EACHOCCURRENCE $ EXCESMMBRELLALIASILITY ( 1• I1 $ OCCUR C] CLAIMSMADE - l AGGREGATE G E DEDUCTIBLE RETENTION $ D216WO0612 05/19/06 05/19/07 X WCSTATU- :m A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L.EACH ACCIDENT §500,000 ANY PROPRIETOR/PARTNERIEXECUTIVE INC - E.L. DISEASE - EA EMPLOYEE $500,000 OFFICERWEMBER EXCLUDED? EXCL - Ifyes,descd5eunder E.L. DISEASE- POUCYUMIT $500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is listed as additional insured for General Liability only as respects the YMCA of Greater Miami 1200 NW 78th Ave, Suite 200 Miami, FL. 33126 and its branches but only as respects lose or damage arising out of the YMCA of Greater Miami, its members, participants, guests, volunteers and negligent acts or omi.esions of employees. ** *Automobile coverage is Hired and Non -Owned Coverage along with Hired Automobile Physical Damage. The Coverage includes a $25,000 Physical Damage Limit, along with $250 for comp and $500 deductible for collision. * ** County Board of County Commissioners Maria Slavik 1100 Simonton Street Key West, FL 33126 GSA 12001 /081 aimbel SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED 1988 �l1JJ VY _C' IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD CERTIFICATE OF LIABILITY INSURANCE GATE 15/08 /YYYY dODUCER HI O1 /15/08 � - 1- 3os- 59a -6oeo TS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION i,ithur J. Gallagher Risk Management Services, Inc. HOLDER. C O THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8200 N.N. 41st Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Miami, FL 33166 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:New Hampshire Ins Co 23841 YMCA of Greater Miami, Inc . ... RCRR.Florida Hospitality Mut Ins Co 10699 1200 NW 78 Avenue Suite 200 Miami, FL 33126 INSURER C: INSURER D: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE I LIABILITY 01 -LX- 6264095 -0 12/01/07 12/01/08 EACH OCCURRENCE $1,000,000 MERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 100,000 CLAIMSMADE OCCUR MED E %P (Any one person) $5,000 PERSONAL INJURY $ 1,000,000 GENERALAGGREGATE $ 3,000,000 GREGATE LIMIT APPLIES PER: PRODUCTS- $1,000,000 CY PRO- £OC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ILE LIABILITY F 01 -LX- 6264095 -0 12/01/07 12/01/08 COMBINED SINGLE LIMIT E. accident) $1,000,000 AUTHORIZED REPRESENTATIVE Key West, FL 33126 USA AUTO OWNEDAUTOS BODILY INJURY (Perperson) $ EDULEDAUTOS D AUTOS L ,_ " B er accient) (Per accident) $ - OWNEDAUTOS {� 16 � PROPERTY DAMAGE (Per accident) $ GARAGELIABILITY AUTO ONLY - EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC AUTO ONLY: AGG $ $ 'A EXCESSUMBRELLA LIABILITY X OCCUR CLAIMS MADE 01 -UD- 0773910 -0 12/01/07 - 12/01/08 EACH OCCURRENCE $1,000,000 AGGREGATE $ 1,000,000 17E] $ DEDUCTIBLE X WC STATU- DTH- $ H RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 306 -10333 l 05/19/07 05/19/08 E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 ANY PROPRIETOWPARTNEWEXECUTIVE OFFICEWMEMBER EXCLUDED? _ E.L. DISEASE - POLICY LIMIT $500,000 If yes. tlescribe antler SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The certiificate holder shall be an additional insured in accordance with all the terms, conditions, and limitations of Certificate Holder is listed as Additional Insured for General Liability only as respects the YMCA of Greater Niami 1200 NN 78th Ave, Suite 200 Miami, FL. 33126 and its branches but only as respects loss or damage arising out of negligent acts or omissions of the YMCA of Greater Miami, its members, participants, guests, volunteers and employees. ** *Automobile Coverage is Hired and Non -Owned Coverage along with Hired Automobile Physical Damage. The Coverage includes a $25,000 Physical Damage Limit along with 250 for comP and 500 deductible for collision. * ** GCXIIrII,NIn nVLVCn - - - -- -' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County Hoard of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 Simonton Street REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Key West, FL 33126 USA ACORD P (2001/08) msenimia �} 7991435 ACORD. CE RTIFICATE OF LIABILITY INSURANCE D 111/ 5/08 /25 /0)8NYYY) 'PRODUCER 1- 305 - 592 -6080 Arthur J. Gallagher Risk Management Services, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8200 N.N. 41st Street Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I INSURORS AFFORDING COVERAGE NAIC # Miami, PL 33166 Ceci Ford I Y l r 4 I �, l- (� INSURED YMCA of Greater Miami, Inc - - -_. ._.. �........_ _ INSURER : NH{Q HAMPSHIRE INS CO 23841 INSURER :Florida Hospitality Nut Ins Cc 10699 1200 NN 78 Avenue Suite 200 �7 G.;CG F L ✓ SURER SURER6 Miami, PL 33126 INSURER t '- - COVERAGES THE POLICIES OF INSURANCE LISTED BELOtN'HAtl�Tp THE tNBURED NA ED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 11001 POLICY EFFECTIVE POLICY EXPIRATION DATE (MMT)D/YYi POLICY NUMBER LIMITS A X GENERAL LIABILITY 01 -LX- 6264095 -1 12/01/08 12/01/09 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES En occurenoe $ 100,000 CLAIMS MADE 7X OCCUR MED EXP(My one person) $5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 3,000,000 G ENI AGGREGATE LIMI T APPLIES PER: PRODUCTS. COMP/OPAGG $1,000,000 POLICY D PRO LOG A AUTOMOBILE LIABILITY 01-LX- 6264095 -1 12/01/08 12/01/09 ANVAUTO Ea acoideDSINGLE LIMIT $110001000 ALL OWNED AUTOS " BODILY INJURY SCHEDULED AUTOS _ I � � (Pe( person) $ X HIRED AUTOS . -' BODILY INJURY X NON -OWNEDAUTOS (Pwacciaent) $ PROPERTY DAMAGE $ _ -- _- -- (Peramident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANVAUTO OTHER THAN EAACC $ AUTOONLV: AGO $ A X r ESSAIMBRELLALIMBILITY 01 -SID- 0773910 -1 12/01/08 12/0� �1/09 EACH OCCURRENCE $2 ,000,000 OCCUR CLAIMS MADE AGGREGATE T2,000,000 DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND WC306- 0010333 -2008 05/19/08 05/19/09 X WC STATU- G RI- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? It yes, tlescribe unAer E.L. DISEASE -EA EMPLOYEE $500,000 SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS The Certificate Holder Shall be an additional insured in accordance with all the terms, conditions, and limitations of the policy and then oul, I . with respect to liability caused by the negligent acts or omissions of the Named Insured. Form 81994 05 -03. nay CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County Risk Management DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1100 Simonton Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Hey Nest, PL 33040 AUTHORIZED REPRESENTATIVE 1 ` USA T ACORD 25 (2001/08) ravimia 10395073 ®ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE /DD/YYYY) MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 05/18/09 8 PRODUCER 1- 305- 592 -6080 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE POLICY EFFECTIVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8200 N.W. 41st Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 GENERAL LIABILITY 01 - LX - 6264095 - 1 Miami, FL 33166 12/01/09 EACH OCCURRENCE Ceci_ _ INSURERS AFFORDING COVERAGE NAIC # INSURED YMCA of Greater Miami, Inc INSURER A: NEW HAMPSHIRE INS CO 23841 INSURER B: ZENITH INS CO 13269 $ 100 1200 NW 78 Avenue Suite 200 INSURER C: INSURER D: CLAIMS MADE I I---I OCCUR Miami, FL 33126 INSURER E: PERSONAL BADVINJURY COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A X GENERAL LIABILITY 01 - LX - 6264095 - 1 12/01/08 12/01/09 EACH OCCURRENCE $1,000,000 X COMh1ERCIF.L GENERAL LIABILITY PRE1WiSES(Eaoccurence ) $ 100 MED EXP (Any one person) $5,000 CLAIMS MADE I I---I OCCUR PERSONAL BADVINJURY $ 1,000,000 GENERALAGGREGATE $3,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 POLICY PROs LOC A AUTOMOBILE LIABILITY ANY AUTO 01 -LX- 6264095 -1 12/01/08 12/01/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ 000 ' 06 PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUT ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY. AGG A X EXCESS /UMBRELLALIA131LITY 01 - UD - 0773910 - 1 12/01/08 12/01/09 EACH O CCURRENCE 2, $ 000,000 X OCCUR El CLAIMS MADE AGGREGATE $ 2,000,000 $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PRGPkiE i ORlPARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? If yes, describe under Z070286201 05/19/09 05/19/10 1 OTH- _ TORY LIMITS R _ E. EAC ACC _ _ E.L DISEASE - EA EMPLO _ $500,000 $ $500,000 E.L. DISEASE - POLICY LIMIT -- $500,000 SPECIAL PROVISIONS below • OTHER � f • DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The Certificate Holder shall be an additional insured in accordance with all the terms, conditions, and limitations of the policy and then only with respect to liability caused by the negligent acts or omissions of the Named Insured. Form 81994 05 -03. CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners 1100 Simonton Street Key West, F,, w 3 _ 30040 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE P%%,V w 4o kZUV IJUD) UraimJLa ©ACORD CORPORATION 1988 11935557 ✓R� CERTIFICATE OF LIABILITY INSURANCE ;;�;;ia; '" PRODUCER 1 - 305 - 592 -6080 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8200 N.W. 41st Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Miami, FL 33166 Ceci Ford INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: NEW HAMPSHIRE INS CO 23841 YMCA of Greater Miami INSURER B: ZENITH INS CO 13269 1200 NW 78 Avenue INSURER C: Suite 200 Miami, FL 33126 INSURER D: I INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A X GENERAL LIABILITY 01 LX- 0062640952 12/01/09 12/01/10 EACH OCCU RRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5 000 CLAIMS MADE F PERSONAL & ADV INJURY $ 1 GENERAL AGGREGATE $3,000,000 PRODUCTS - COMP /OP AGG $ 1 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY PRO-- LOC A AUTOMOBILE LIABILITY ANY AUTO 01 -LX- 0062640952 12/01/09 12/01/10 COMBINED SINGLE LIMIT (Ea accident) $ 1, 0 0 0, 0 0 0 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X X HIRED AUTOS NON -OWNED AUTOS t BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ f GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A X EXCESS / UMBRELLA LIABILITY X OCCUR FICLAIMS MADE 01- UD0007739102 12/01/09 12/01/10 EACH OCCURRENCE $ 5, 000, 000 AGGREGATE $ 5 $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below 2070286201 05/19/09 - 05/19/10 X WC STATU- OTH- TORY LIM TS FEE R E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYE $ 500 , 000 E.L. DISEASE - POLICY LIMIT $ 500 r 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The Certificate Holder shall be an additional insured in accordance with all the terms, conditions, and limitations of the policy and then only with respect to liability caused by the negligent acts or omissions of the Named Insured. Form 81994 05 -03. vF__rN I blur% i r_ nvLUCr% LoANUGLLH I IUN Monroe County Board of County Commissioners 11100 Simonton Street Key West, FL 33040 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE , /'AL umu Lo (LUV`! /Ui) manjumia 1356$55 c. c ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ---� � LC"R� CERTIFICATE DATE (MM /DD/YYYY) OFLIABILITY 08/19/2010 PRODUCER 1 - 305 - 592 - 6080 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management =d Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE . THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8200 N.W. 41st Street R l ALTER T E COVERAGE AFFORDED BY THE POLICIES Suite 200 S BELOW. V Miami, FL 33166 - Ceci Ford INS RERS FFORDING COVERAGE NAIC # INSURED �f W YMCA of Greater Miami AUG 2 �}ry� INSU ER A: HAMPSHIRE INS CO 23841 1200 NW 78 Avenue '} L( � INSU ER B: Z NITH INS CO 13269 Suite 200 INSU ER C: Miami, FL 33126 MONROE COUNTY INSURER D: RK) K MANACE�'4F INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS4RD D' L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DDn0(YY) -DATE (MM/DDPOM) LIMITS NSRQ TYPE OF INSURANCE A GENERAL LIABILITY 01 —LX 0062640952 12/01/09 12/01/10 EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS MADE F x - � OCCUR MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3, 0 0 0, 0 0 0 PRODUCTS - COMP /OP AGG $ 1 POLICY PRO _ LOC A AUTOMOBILE LIABILITY 01 - LX- 0062640952 12/01/09 12/01/10 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1 0 0 0, 0 0 0 ALL OWNED AUTOS SCHEDULE[) AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS / UMBRELLA LIABILITY O1- UD0007739102 12/01/09 12/01/10 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE RETENTION $ B WORKERS COMPENSATION $ (at AND EMPLOYERS' LIABILITY 2070286202 1 05/19/10 05/19/11 �( WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N --LER- OFFICER/MEMBER EXCLUDED? ❑ E.L. EACH ACCIDENT $ 500,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - EA EMPLOYE $500,000 SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The Certificate Holder shall be an additional insured for General Liability as per Form 81995 (2/09) and form CA0001 (3/06) Re: Management - Key Largo Community Park / ) auto as per CERTIFICATE HOLDER. - - -•- ., iv - aa y =or premium non payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1100 Simonton Street. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Key West, FL 33040 / AUTHORIZED REPRESENTATIVE L: G ACORD 25 (2009 /01) brengamia © 1988 -2009 ACORD CORPORATION. All rights reserved. 17076897 The ACORD name and logo are registered marks of ACORD Arthur J. Gallagher Risk Management Services, Inc. 8200 N.W. 41st Street Suite 200 Miami, FL 33166 USA Monroe County Board of County Commissioners 1100 Simonton Street Key West, FL 33040 USA 5:10:360 IIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII �� This document was brought to you by Ebix /CertificatesNow and Arthur J. Gallagher Risk Management Services, Inc. in Miami, FL. If you have questions regarding the content of this document, please contact the Producer /Agent listed on the certificate of insurance. The data included in this notice and in the attached document is confidential to Ebix /CertificatesNow and Arthur J. Gallagher Risk Management Services, Inc. This certificate replaces CN Id: 16934450 cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. 1:4 Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 A CC >R �' s CERTIFICATE OF LIABILITY INSURANCE DATE (MM 01/05/2011 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 endorseme PRODUCER - 561 -99 CONTACT NAME: Cynthia L. Preston Arthur J. Gallagher Risk Management .ervices, Inc. PHONE E :561- 998 -6810 F AX No 561 -995-6708 E-MAIL ADDRESS: CYn thiaPrestont$a jg• _ com 2255 Glades Road PRODUCE YMCAOFGRBATBR Suite 400E Boca Raton, FL 33431 0 tea# 2M PRODUCTS - COMP /OP AGG INSURERS AFFORDING COVERAGE NAIC # $ • INSURED LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS NSW HAMPSHIRE INS CO 23841 YMCA of Greater Miami MOWN LIN URERB ZENITH INS CO 13269 730 NW 107 Avenue Suite 200 RISK MANAGEM BODILY INJURY (Per person) $ INSURER D: $ Miami, FL 33172 PROPERTY DAMAGE (Per accident) $ X INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 19220930 REVISION NUMBER: 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 POLICY EFF POLICY EXP POLICY NUMBER MM /DD/YY MM/DD/W LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [] OCCUR OILX006264095 12/01/1 12/01/11 EACH OCCURRENCE $ 1,000,000 D A T NT ED PREMISES Ea occurrence $ 100, 000 MED EXP (Any one penmen) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP /OP AGG $ 1,000,000 $ • AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS OILXOO 264 f � ' I --COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ • X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE OlUD0007739102 12/01/1 12/01/11 EACH OCCURRENCE $ 5, 000, 000 AGGREGATE $ 5, 000, 000 DEDUCTIBLE RETENTION $ 10 $ X $ • WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A Z070286201 I 05/19/1 Lt 05/19/11 I X WCSTATU- OTH- E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) The certificate holder shall be an additional insured in accordance with all the terms, conditions, and limitations of the policy and then only with respect to liability caused by the negligent acts or omissions of the Named Insured -as per Blanket Additional Insured form 81995 (2/09). Re: Management - Key :Largo Community Park C e- •. (: Nti ox.-'n Q. L Monroe County Board of County Commissioners 1100 Simonton Street Key West, FL 33040 USA 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 aimbel © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 19220930 ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 a.m. forms a part of Policy No. 01LX006)264095 by New Hampshire Ins. Co. issued to YMCA of Greater Miami BLANKET ADDITIONAL INSURED PROVISION \. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. SECTION II - WHO IS AN INSURED is amended advertising injury" arising out of the sole to include as an insured any person or negligence of the additional insured. organization whom you are required to add as an 4. A person or organization's status as an additional insured to this policy under a written additional insured ends when your operations contract, agreement or permit: for that additional insured are completed. 1. Currently in effect or which will become effective! during the term of the policy; and C. The insurance provided to the additional insured does not apply to "bodily injury", "property 2. Executed prior to the "occurrence" which damage ", or "personal and advertising injury" results in "bodily injury" or "property damage" arising out of an architect's, engineer's or under Coverage A, or the offense which surveyor's rendering or failure to render any results in "personal and advertising injury" professional services including: under Coverage B. 1. The preparing, approving or failing to prepare B. The insurance provided to this additional insured or approve, maps, shop drawings, opinions, is limited as follows: reports, surveys, field orders, change orders 1. That person or organization is an additional or drawings and specifications; and insured only with respect to liability: 2. Supervisory, inspection, architectural or a. Arising out of premises you own, rent, engineering activities. lease or occupy; or D. Coverage provided by this endorsement is excess b. Caused by your ongoing operations over any other valid and collectible insurance performed for that additional insured as available to the additional insured whether specified in the written contract, primary, excess, contingent or on any other basis. agreement or permit. When this insurance is excess, we will have no 2. The limits of insurance applicable to the duty under COVERAGE A. BODILY INJURY AND additional insured are those specified in the PROPERTY DAMAGE LIABILITY or contract, agreement, permit or in the COVERAGE B. PERSONAL AND ADVERTISING Declarations of this policy, whichever are less. INJURY LIABILITY to defend the additional These limits of insurance are inclusive of and insured against any suit" if any other insurer has not in addition to the Limits of Insurance a duty to defend the additional insured against shown in the Declarations. that "suit ". If no other insurer defends, we may undertake to do so, but we will be entitled to the 3. Coverage is not provided for "bodily injury", additional insured's rights against all those other "property damage ", or "personal and insurers. All other terms and conditions of the policy remain the same. Authorized Signature 81995 (2/09) CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIY 12/7/201 THIS CERTIFICATE 18 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 CERTIFIC HO LDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. It SUBROGATION IS WAIVED, subject to Ow 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 endors PRODUCER Brown A Brown of Florida, Inc. dba T.R. Jones & Co. 1780 N Rrome Ave Homestead FL 33030 NONT AJ , eCT Kathy Nicotra PHONE (305) 247 -5121 FAX .(305)248 -8343 M^a ,knicotra@bbhomestead.con INBU AFFORDING COVERAGE NAIC 8 INSURER A:Philadel hia Indemnity Ins Co 18058 INSURED The Young Men's Christian Assoc of Greater 730 NW 107 Ave Ste. 200 Miami FL 33172 INSURER B AstailFirst Insurance Company 10700 INSURER C:Philadel hia Indemnity Ins Co 18058 INSURER 0: INSURER E INSURER $ 1, COVERAGES CERTIFICATE NUMBER -2011 Master REVISION NUMBER: 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 POLICY EFF F EXP ACCORDANCE WITH THE POLICY PROVISIONS. TYPE OF INSURANCE AUTHORIZED REPRESENTATIVE - POLICY NUMBER Hamilton Jones /CRECIO LIMPIB GENERAL LIABILITY EACH OCCURRENCE $ 1, DAMAGE TO RENTED S 1,000,000 R COMMERCIAL GENERAL LIASIUTY A 7 CLA(MS4AADE ® OCCUR 9799825 2/1/2011 2/1/2012 MEDEXP one arson S 20,000 PERSONAL 3 ADV INJURY S 1,000,000 S - IT GENERAL AGGREGATE S 3,000,000 qq�! "Gem t GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 3,000,000 AJ �— R POLICY PRO' LOC �+ tt $ AUTOMOBILE LIABILITY COMBINED sedden S 1,000,000 A ANY AUTO �� ED S LED PK799925 12/1/2011 2/1/2012 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMN E P $ R HIRED AUTOS X NON -OWNED AUTOS $ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000,000 R AGGREGATE S 5,000,000 A EXCESS Ld1B CLAMS -MADE DED I X I RETENTIONS 10,OOC $ PHU 365932 12/1/2011 2/1/2012 B WORKERS COMPENSATION AND EMPLOYERS• LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (MandsIM In NH) NIA 520 052625 /19/2012 /19/2013 X WC STATU- O - E.L. EACH ACCIDENT $ 500 000 E.L DISEASE - EA EMPLOY4 $ 500,000 Ifyes describe under DESCRIPTION OF OPERATIONS below F.L. DISEASE - POLICY LIMB I $ 500,000 C Directors & Officers PKSD735536 /15/2012 /15/2013 Dkeclors&OMcar,Wbl(Ity $5,000,000 D&O Dad $25,000 EPL Da $15,000 Employmenl Practices Lleb9( $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AtIsch ACORD 101, AddHlorlsl Remarks Sahsdule, If mare space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010!05) I1LSn25 rmmmm m 01988 -2010 ACORD CORPORATION. All rights reserved. Tha af:npn name onA Innn aro r iaturerl marire of arson SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commission ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street Rey West, FL 33040 AUTHORIZED REPRESENTATIVE J GC. Hamilton Jones /CRECIO ACORD 25 (2010!05) I1LSn25 rmmmm m 01988 -2010 ACORD CORPORATION. All rights reserved. Tha af:npn name onA Innn aro r iaturerl marire of arson r4CC?R" CERTIFICATE OF LIABILITY INSURANCE i2i5i2o1� 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 CER R. IMPORTANT: If the certificate holder is an ADDITI NAL INS It s endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain poli es may r ent. A st tement on this certificate does not confer rights to the certificate holder in lieu of such endorsement (s). PRODUCER CONTACT Kathy cotra C NAME: y FAX Brown & Brown of Florida, Inc. DEC — p (30 ) 247 -5121 AIC Nol (305) 248 -8543 dba T.R. Jones & Co. -MAIL .knico ra @bbhomestead.com 1780 N Krome Ave SURE S AFFORDING COVERAGE NAIC u Homestead FL 33030 A:Phi del hia Indemnity Ins Co 18058 INSURED 1First Insurance Company 10700 YMCA of Greater Miami, DBA: The Young Men's INSURER C:Philadel hia Indemnity Ins Cc 18058 Christian Assoc of Greater Miami Inc . INSURER D : 730 NW 107 Ave Ste. 200 I NSURER E: Miami FL 33172 INSURER F: CAVFRAr;FS CERTIFICATE NIIIiARFR•12 MASTER QCV1CInW IJI IIIIQCI7• 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. I NSR TYPE OF INSURANCE A DL UBR POLICY NUMBER MM DDY EFF MM DD W LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 A CLAIMS -MADE FX1 OCCUR PHPK951504 12/1/2012 12/1/2013 MED EXP (Any one person) $ 5,000 PERSONAL SADVINJURY $ 1,000,000 X Abuse /Molestation:$1Mil X Employee Benefits:$1Mil GENERAL AGGREGATE $ 3,000,000 AP PRO IVM ANAT Ex '41 D •xx ( � GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3 ,000,000 Prof essional Liability $ 1,000,000 POLICY PR0 X LOC W T AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ' 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS HPK951504 12/1/2012 12/1/2013 X PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ A EXCESS LIAB CLAIMS -MADE DED I X I R TENTION$ 10, OOC $ PHUB403932 12/1/2012 12/1/2013 B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ 500 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 20 -42191 5/19/2012 5/19/2013 E.L. DISEASE - EA EMPLOYE $ 500 If y describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMB $ 500,000 C Directors & Officers PHSD735538 4/15/2012 4/15/2013 Limit: 5,000,000 Deductible: $25,000 4/15/2012 4/15/2013 Employment Practices Limit: 5 ,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. CFRTIFICATF mini nFR cenlecl 1 ATInk1 AC:UKD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissione ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West, FL 33040 CG Hamilton Jones /HUECK T— AC:UKD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD ' V CERTIFICATE OF LIABILITY INSURANCE 5/17/2013 I 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 endorsement(s). PRODUCER Brown & Brown of Florida, Inc. dba T.R. Jones & Co. 1780 N Krome Ave Homestead FL 33030 CONTACT Kathy icotr NAME: Y a PHONE (305) 247 -5121 FAX (305)248 -8543 JC. EMAIL ,knicotra @bbhomestead.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Phil adel hia Indemnity Ins Co 18058 INSURED YMCA of Greater Miami, DBA: The Young Men's Christian Assoc of Greater Miami, Inc. 730 NW 107 Ave Ste. 200 Miami FL 33172 INSURER B: Re ta i 1F i rst Insurance Company 10700 INSURER C:Philadelphia Indemnity Ins Co 18058 INSURERD: INSURER E: $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR COVERAGES CERTIFICATE NUMBER: 12 MASTER REVISION NUMBER: 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. I LiR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR X PHPX951504 12/1/2012 2/1/2013 DAMAGE 0 RENTED PREMISES Ea occurrence) $ 1,000,000 MED EXP (Anyone person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 X Abuse /Molestation:$1Mil X Employee Benefits:$1Mil GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 POLICY PRO X LOC JErT Professional Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) 1 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HPK951504 12/1/2012 2/1/2013 BODILY INJURY (Per accident) $ PeOaxd ' DAMAGE $ X N HIRED AUTOS X UT O WNED X UMBRELLA LIAB X OCCUR X EACH OCCURRENCE $ 5,000,000 AGGREGATE $ A EXCESS LIAB CLAIMS -MADE � HUB403932 DIED X RETENTION 10,00 $ 12/1/2012 2/1/2013 B WORKERS COMPENSATION FWC STATU- OTH- TORY AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORMARTNER(EXECUTIVE — 1 E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 520 -42191 5/19/2013 /19/2014 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 C Directors & Officers PHSD827698 4/15/2013 /15/2014 Limit 5,000,000 Deductible: $25 ,000 /15/2013 /15/2014 Employment Practices Limit: 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. BY AGEMEM ;,/, D - 4 f Vi ll — 2 ,? J CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 (201005).01 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissions ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE K ey West/ FL 33040 v C - Hamilton Jones /HUECK T 1 ACORD 25 (2010/05) INS025 (201005).01 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACC °® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/4/2013 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 terns 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 endorsement(s). PRODUCER CONTACT Kathy Nlcotra NAME: Brown & Brown of Florida In c. PHONE (305) 247 -5121 FAX 1 N AIC. (305)243 -8543 dba T.R. Jones & Co. EMAIL .knicotra @bbhomestead.com 1780 N Krome Ave INSURERS AFFORDING COVERAGE NAIC # Homestead FL 33030 INSURER A:Philadelphia ndemnity Ins CO 18058 INSURED YMCA of Greater Miami, Inc. INSURERB Insuranc Co mpanV 10700 730 N.W. 107 Avenue, Suite 200 E: Miami FL 33172 1 INSURER F: /rnvoo Af2CC t CGTICIf`ATC WI IILACCD•CT.1 nn R5=VISInk1 NI IMRPR• 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 AD DL U POLICY NUMBER POLICY EFF MM POLICY EXP M LIMITS Commissioners GENERAL LIABILITY 1100 Simonton Street AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY Hamilton Jones /KN DAMAGE TO RENTET PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 20,000 A CLAIMS - MADE � OCCUR X HPK1105893 12/1/2013 2/1/2014 PERSONAL &ADVINJURY $ 1,000,000 • Abuse & Molestation • Corporal Punishment GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 $ X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS X HPK1105893 12/1/2013 2/1/2014 BODILY INJURY (Per accident) $ Pe (P R O P ERTY DAMAGE $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 RDIE x AGGREGATE $ A XCESS LIAB CLAIMS -MADE RETENTION $ HUB442191 12/1/2013 2/1/2014 B WORKERS COMPENSATION WC STATUS OTH- ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? (Mandatory in NH) NIA 520 -42191 5/19/2014 /19/2015 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below A D &O /EPLI PHSD34714 4/15/2014 /15/2015 D &O 5,000,000 EPLI 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. c AP A lC. WAIVE N/A V I i 'AINA03 30SNOW CERTIFICATE HOLDER """ CANCELLATION ACORD 25 (2010105) v lUtit$ -ZU'IU At;UKL) vultrUKAI IUn. Ali ngnis reserves. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE } � 1 :9 WV 91 AVW h1ol THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissioners 080338 80J 0311A 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West, FL 33040 Hamilton Jones /KN ACORD 25 (2010105) v lUtit$ -ZU'IU At;UKL) vultrUKAI IUn. Ali ngnis reserves. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD ACOR& CERTIFICATE OF LIABILITY INSURANCE D2 /17IDD/YYYY) 12/17/2014 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 endorsement(s). PRODUCER Brown & Brown of Florida, Inc. dba T.R. Jones & Co. 1780 N Krome Ave Homestead FL 33030 CONTACT N AME: Y Kath Ni CO tra PHONE (305247_5121 ( A/C, No: (305) 248 -8543 E -MAIL kn±cotra@bbinsfl.com INSURERS AFFORDING COVERAGE NAIC # IN SURER A:Philadel hia Indemnity Ins Cc 18058 INSURED YMCA of Greater Miami 730 NW 107 Ave Ste. 200 M1 ami FL 33172 INSURERB:RetailFirst Insurance Company 10700 INSURER C : INSURERD: INSURER E: $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY GUVERAGES CERTIFICATENUMBFR,14 GL. Prof. D &O,EPL. BA. Umb RFVICI0NMIIMRFR- 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. 1 �7R TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM /DDYIYYYY MM /DDMfYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS -MADE � OCCUR X HPK1264219 12/1/2014 2/1/2015 ME EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 X Abuse & Molestation X Corporal Punishment GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY CO aBINED SINGLE LIMIT $ 1 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED X HPK1264219 12/1/2014 2/1/2015 BODILY INJURY $ AUTOS AUTOS (Per accident) X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 X I AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ PHUB482158 12/1/2014 2/1/2015 B WORKERS COMPENSATION WC STATU OTH- - I AND EMPLOYERS' LIABILITY YIN T ER E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA 520 -42191 /19/2014 /19/2015 E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,000 A PHSD934714 /15/2014 /15/2015 D &O 5,000,000 D & O /EPLI EPLI 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. A GIMENT DA R N /A 1 3 '813 Monroe County Board of Count Commissioners ? ,1:8 NV GZ 330 bIOZ 1100 Simonton Street Key West, FL 33040, R 80J 03111 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 Jones Jr. /VERINC / ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD AC"R "' CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 3/29/2016 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 endorsement(s). PRODUCER Brown & Brown of Florida, Inc. dba T.R. Jones & Co. CONTACT Cheryl Rust PHONE (305)247 -5121 FAX (305)248 - 8543 A/C No Ex t): A/C No E - MAIL AD DRESS: c rust @bbinsfl.com 1780 N Krome Ave Homestead FL 33030 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:United States Fire Insurance 21113 INSURED YMCA of South Florida, Inc INSURER B :RetailF Lrst Insurance Comp 10700 INSURER C: 900 SE 3rd Ave. IN SURER D: EACH OCCURRENCE $ 1,000,000 INSUR E. , Ft. Lauderdale FL 33316 INSURER F A 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. L IMITS SHOWN MAY HA VE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBRj — - LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY E XP D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMA E RENTED PREMISES Ea occurrence $ 1,000,000 A CLAIMS -MADE ❑R OCCUR MEDEXP (Ar one person) $ 5,000 X 506- 884531 -5 3/31/2016 3/31/2017 PERSONAL & ADV INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X ❑ PRO - POLICY LOC JECT i PRODUCTS - COMP /OP AGG $ 1,000,000 Corporal Punishment $ In OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMI Ea accident $ 1,000,000 A X ANY AUTO BODILY INJURY (Par person) $ A O SCHEDULED AUTOS AUTOS X 506- 884531 -5 3/31/2016 3/31/2017 BODILY ) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident $ Uninsured motorist combined $ 1,000,000 UMBRELLA LA X OCCUR EACH EACH OCCURRENCE $ 15,000,000 X AGGREGATE $ 15 A EXCESS LIA DED X RETENTION$ 0 $ 5821049016 3/31/2016 3/31/2017 WORKERS COMPENSATION OTH- AND EMPLOYERS' LIABILITY Y / N I I STATUTE I I ER E. L. EACH ACCIDENT - $ 500 ANY PROPRIETOR /P.ARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? N / A E.L DISEASE -EA EMPLOYE $ 50 0,000 B (Mandatory in NH) 0520 -42191 5/19/2015 5/19/2016 K yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 500,000 A ProfessiC'- o 1 ilit �b Y c_ 506- 864531 -5 3/31/2016 3/31/2017 Occurrence $1,000,000 A Sexual A�Se 506- 884531 -5 3/31/2016 3/31/2017 Occurrence $1,000,000 DESCRIPTION OF ORRATI S/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CertificatQ.,holder inc as additional insured as respects general liability where required by written contract. C . form;i>s subject to policy terms, conditions, and exclusions. LL_ — . L - � � Lu Cr_. - }G o v wo ,i ' CC CEKIIFICAIE HOLDER CANCELLATION Monroe County Board of County Commissioners 1100 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 T Jones Jr. /CHERUSy ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 ��