COI Expires 12/08/2018 BOYS & -1. . . .OP ID: PR:
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A C c,R D' CERTIFICATE OF LIABILITY INSURANCE 09125/2018
THIS_ CERTIFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS, NO :RIGHTS UPON THE-CERTIFICATE HOLDER. THIS'
CERTIFICATE DOES NOT AFFIRMATIVELY ' .R NEGATIVE.? AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES: :
BELOW. THIS CERTIFICATE OF INSURAN. E DOES NOT CONSTITUTE. A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE' OR PRODUCER, AND THE, CERTIFICATE HOLDER. .
IMPORTANT: If the certificate holder is'an ADDITIONAL INSURED, the policy(ies) must he '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). • coNTACr.
PRODUCER 1 . NAME: Sharon Chesser _ •
Guifstream Insurance Group,lnc ON 964- 334 -1734 Fax
P.O. Box 8908 ! a c. N o, Ext): . ; (Alc, No): 954 = 53 7 0165 _
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Fort Lauderdale, FL 33310 -8908 i ADDRESS: sharonuifstreaminsurance.net . •
David Arch - E•MAj NArc -
IN SURER(S) AFFORDING COVERAGE
. - INSURER A : Nevv Hampshire Insurance Co t .
INSURED - Boys.& GirIs Clubs of the Keys`, iNSURER9: Insurance Company 113012
Area, Inc. INSURER C:Great.American Ins Co...
1400 United Street, SUIte,108 I .
Key West, FL 33040 INSURER D:
INSURER E :
I
' INSURER F : _ ,
COVERAGES CERTIFICATE NUMBER: . . ' . . . 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 DESCRI HEREIN IS SUBJECT TO ALL THE TERMS, •
EXCLUSIONS AND CONOITtONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. .
A O DL SU 3R: , POLICY EfF p POLICY EXP 1 LIMITS .
LTR T' INSURANCE . I NSD tWVD: 'POUCYNUMBER Mi
:(MDOlYYTO • IMM(CDIYYYY) -
A i X, COMMERCIALCENERAL t.UABILITY F I I . _ 1 a E+CH OCCURRENCE . 1 S 1,000,00
i ! �( , € ! 01LX0627968860 i 03/25/2018 03/25/2019 I FnES c S R s. ' - s 1,000;00 IL
i CIAIMVA.DE OCCUR
MED $ $XP (Arty one Person) I = 29,00 $-
}— 1 I PERSONAL S ADV INJURY S 1,000,001
■ 1 t �,1 i 1 GENERAL AGGREGATE tt S 3,000,00i 1 GEM. AGGREGATE LIMIT APPLIES PE"i,- I i I
i PRODUCTS - COi,iP,VP AGG j S 3
-f . ; POLICY j s � ; LC:, ! I i 1 1
. I 1 OTH _ Q ER: . . I ` . : : -S
i , 1 . i - t caa accident) 3 O4 EIS`( D SINGLE LIMIT A. 5
1 ,OQO,00
' AUTOMOBILEUABIUTY t�
A ; X I A�, AU 1 TO 1 01CA069968644 - 031 ! SODS Y INJURY (Per person) 1 s .
jj 1 AL L CP∎yNED . 1 I, G S ULED X { 1 1 i ; BODILY INJURY (Fir 2 cent) �. S _ .
k AUTOS /� , 1 PROPERTY DAMAGE ' c
vON ! tPerarztenn • • t -
t X 1 HREO AUTOS 1-5---c . C S 3J? {
X j,Comp-$500 o II 1 ,PIP .. i= - 10,00 r -
I UMBRELLA UAB 1 1 OCCUR 1 11 1 F ' EACH OCCURRENCE S
EX UAS CL�IAiS -MADE{ f j _ 1 i AGGREGATE -
. 9. I DEC i 1 RETENTION S i +'i I - I ER y 1. .517 , .
;WORKERS COMPENSATION' -` ' 1 i ? X I ST E I , ER
!AND' EMP] DYERS' LIAEIUTY Y f H ii - - . - • 1
B (ANY:P.ROPRIETc ?ARTNER/"cxECLT vE - - . I .NHFL0080172017 12!08/20171 12/0812018 ! E-L.,EACH ACCIDENT it 500,00'
l nCER/MEMEER EXCLUDED? Y N / A 1I
!(Mandatory In NH] . ` - I j EL. DISEASE • -A EMILOY _ g E c _ 500,00 �.
if yes, describe under - . ) . I i I i. .
(DESCRIPTION -OF OPERATIONS - 1Ow t 11 i - .. - ? I 4 EL. DISEASE • POLICY LIMIT : g • 500,00
A 4Crirne 1 iI 101LX0900114530 03/25/2018 03125/2019 ?EmpT 50,00'
A Abuse /Molestation li 101LX0900114530 ' 03/2612
3!25120181.03/25 /2019 Lim its $IMILJ5.3MI
il DESCRIPTION OF OPERATIONS 1 LOCATIONS $ VEHICLES (ACORD 101; Additional Remarks Schedule, 'may be attached it more space Is required] • •
D &O /EPLIFidueiaryry- Coverage: Carrier -Great American, Poi ##EPPE191918, Eff. •
• 8128117, Exp, 8128118, Limit 1,000,000, Retention $1,000 B PP sVED :Y •gin, -,
1 MINT -
DA -tISJi i11:r�
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WAIVER 1' S
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CERTIFICATE . 1 CANCELLATION
I MONCBCC
SHO ULD -ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
. . . . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN '
Morin* County Board Of County - ACCORDANCE WITH THE POLICY PROVISIONS.
. . Commissioners
111 12th Street„ St 408 1 AUTHORIZED REPRESENTATIVE f � •
Key West, F1: 33040 e,? -
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0 ACORD CORPORATION: All rights reserved.
ACORD 25 (2014/01) - Th ACORD name and logo are registered marks. of ACORD
. •