CERTIFICATE OF LIABILITY INSURANCE - School District of

CERTIFICATE OF LIABILITY

INSURANCE

Table of Contents

1310 Congress Partners, LLC

Abacoa Property Owners’ Assembly, Inc.

Abacoa Town Center Master POA

Aberdeen Golf & Country Club

Abocoa Condominium Assoc.

Academy of Health Science and Pre-Medicine

Advent Lutheran Church/School

Aleman & Associates, LLC and SMG

Allen & Arts

American Academy of Dermatology

American Heritage – Delray Beach

Applebees

Arbern Investors IV, LP

Atlanta Independent School District

Atlantic Community High School

Avis Budget Group, Inc.

Bank of America, N.A.

Belle Glade Board of County Commissioners

Benoist Farms Elementary School

Best Buy

Bethel Assembly of God

Big Brothers Big Sisters of PBC

Big Lots

Boca Ballet Theatre

Boca Lago Country Club, Inc.

Boca Mission, LP

Boca Museum of Art @ Mizner Park

Boca Raton Board of City Council

Boca Raton Resort & Club

Boca Raton Wine & Food Festival

Boca Woods Country Club Association, Inc.

Boynton Beach BOCC

Boynton Beach Mall

Boys & Girls Club of PBC

Brevard Community College

Broadmoor Apartments Associates

Broward County Parks and Rec

Broward County Public Schools

Broward Paper & Packaging

Bureau of Land Management

Burlington Coat Factory

Casanova Custom Tile & Marble, LLC

CB Richard Ellis Investment Property Group

Center for Spiritual Living

Cheney Brothers, Inc.

Children’s Services Council of Palm Beach

Chris Evert Charities, Inc.

City Council of Greenacres; City of Greenacres

City of Belle Glade

City of Boca Raton

City of Boynton Beach Recreation & Parks, Denson

City of Boynton Beach Recreation Department

City of Delray Beach

City of Lake Worth

City of Palm Beach Gardens Risk Mgmt

City of Riviera Beach Parks and Recreation

City of Riviera Beach Parks and Recreation Dept.

City of Riviera Beach

City of St. Petersburg

City of West Palm Beach and Board of Supervisors of

West Palm Beach Golf Club

City of West Palm Beach

City Place Community Development

Clarke Holdings Corporation

Clifford O. Taylor/Kirklane Elementary

Colonial High School

Cosmopolitan AME Church

Cross Match Technologies, Inc.

Custom World, Inc.

CVS Pharmacy

Dayton Ballet Association

Delray Beach Board of City Commissioners

Delray Beach BOCC

Department of Army, JROTC Program

Department of Juvenile Justice, Project MIND

Department of Juvenile Justice, Delinquency

Prevention Program

Department of Juvenile Justice, School Accountability

Boards

Department of the Army, c/o Forest Hill High School

Department of Transportation

Devos Blum Family YMCA of Boynton Beach

Diocese of Palm Beach

District Office of Vocational Rehabilitation

Dolly Hand Cultural Arts Center

Drum Corps International

Early Learning Coalition of Palm Beach County, Inc.

Eastern Florida State College

Everglades Youth Camp

Family Central Inc.

Famoso, Inc. DBA: Manpower

FAU Athletics

Firehouse Subs

First Baptist Church of Boca Raton

First Baptist Church of Orlando

First Methodist Church of Oviedo

First United Methodist Church of Jupiter

Florida Atlantic Board of Trustees

Florida Charter Schools Conference

Florida Children’s Forum

Florida Citrus Sports

Florida Coca-Cola Bottling Company

Florida Community College

Florida Department of Agriculture and Consumer

Services

Florida Department of Education

Florida Department of Transportation c/o DBI Services

Florida Expo / Aleman & Associates

Florida High School Athletic Association

Florida Institute of Technology

Florida Power & Light Co.

Florida Southern

Follett Bookstore

Fullerton Civic Light Opera Co., Inc.

Gateway Performing Arts

GBYSA / Boca United FC

George Snow Scholarship Foundation Inc.

George Snow Scholarship Fund Inc.

Georgia State University

Gibbs High School

Girls Scouts of Southeast Florida, Inc.

Global Rental Company, Inc.

Gold Coast Christian Camp

Good Shepherd United Methodist Church

Grace Covenant Presbyterian Church

Grandview Preparatory School

Greater Boca Raton Beach & Park District

Greater Boca Raton Beach & Park District – James A.

Rutherford Community Center

Greenacres Community Center

Greenacres Learning Center

Grosh Scenic Rentals, Inc.

Gulfstream Council

Gulfstream Race Track

Gwinnett County Board of Commissioners

Hardee County School District

Harid Conservatory

Haverhill Town Council

Health Care District of Palm Beach County

Hillsborough County Public Schools

Holy Spirit Catholic Church

Home Depot

Hyatt Place

Hypoluxo Town Council

Indian River County School District

Indian Trail Improvement District

IPC Operations, LLC

Janoura Partners, LLC DBA Sims Creek Plaza

JC Penney’s

JCB Enterprises, Ltd.

Joann Fabrics

John C Bills Enterprises LTD

Johnathan’s Landing Golf Club

Johnathan Dickinson State Park

Juno Beach Town Council

Jupiter Christian School

Jupiter Community Center

Jupiter High School Government Association

Jupiter Inlet Colony Town Council

Jupiter Lanes Bowling Alley

Jupiter Medical Center, Inc. and Pavilion

Jupiter Town Council

Kelly Tractor

Keystone – Florida Property Holding Corp.

K-Mart

Kravis Center

Lake Clarke Shores Town Council

Lake County School Board

Lake Park Town Commission

Lake Worth BOCC

Lantana Homes HOA

Lantana Town Council

LBS South, LLC/Jacksonville Facility

Lutheran Services Florida, Inc.

Lynn University

Macy’s Department Store #757-town Ctr.

Maddox – Joines, Inc. dba Sunshine Golf Carts

Main State Musical Theatre Costume Rental

Maltz Jupiter Theatre

Mangonia Park Town Council

Mar-a-Lago Club

Mariela Castillo

Marjon Specialty Foods, Inc.

MBIA Insurance

Menin Development Companies

Miller Legg

Mission Bay Shopping Center

Mobile Gas

Mobile Mini, Inc. – Fort Pierce, FL

Mobile Mini, Inc. – Tempe, ZA

Modular Space Corporation

Neff Rental

North Broward Preparatory School

Northern Palm Beach County Improvement District

Northwest College

Nova Southeastern University – Fort Lauderdale

Nova Southeastern University – Palm Beach Gardens

O.B. Festival Events, LLC

Oakstone Academy Palm Beach Corporation

Ocean Ridge Town Commission

Office of Family & Community Outreach

Old Navy

Olympic Heights Community High School

Orange County Public Schools

OXXO Care Cleaners

Pahokee City Commission

Pahokee Middle Senior High School

Palladium Management Company

Palm Beach Atlantic College

Palm Beach Atlantic University

Palm Beach County Board of County Com. – Summer

Palm Beach County Board of County Com. - Head Start

Palm Beach County Board of County Com. – Film &

Television Commission

Palm Beach County Board of County Com. – Film &

Television Commission

Palm Beach County Board of County Com. – Prop &

Real Estate Mgmt Div

Palm Beach County BOCC, Risk Management Dept

Palm Beach County Convention Center

Palm Beach County Health Dept, Environmental Health

& Engineer

Palm Beach County Health Dept, Lairsey/Childcare

Licensing

Palm Beach County Health Dept, Child Care Facility

Palm Beach County Health Dept, Div of Finance and

Accounting

Palm Beach County Parks & Recreation

Palm Beach County Youth Services Department

Palm Beach County

Palm Beach County Southwinds Golf Course

Palm Beach County Parks and Recreation – BB Swan

Palm Beach County Youth Services Department

Palm Beach County Convention Center

Palm Beach County BOCC, Div of Human Services

Palm Beach County

Palm Beach Gardens Aquatic Complex

Palm Beach Gardens City Council

Palm Beach Institute for Contemporary Art

Palm Beach Mall Holdings, LLC

Palm Beach Mall Holdings, LLC; PBM Developer, LLC

Palm Beach Maritime Museum

Palm Beach Outlets & UG2

Palm Beach Shores Town Commission

Palm Beach State College

Palm Beach State College and its District Board of

Trustees

PBSC and its District Board of Trustees

Palm Springs Village Council

Park Avenue BBQ and Grille

Park Vista High School

Penske Truck Leasing Co., L.P. – Reading, PA

PGA National Resort & Spa

Pinellas County School Board

Pleasant City Multicultural Center

Port of Palm Beach District

Promenade Mobil

PSI Services

Publix @Village Commons

Publix Store #1384

Publix Super Market

Quantum Foundation

Ramco-Gershenson Properties, LP

Ramco-Gershenson, Inc., Attn: Isabel E. Feldman

Refugee Programs Administration

Regency Party Rentals

Ridgecreast YMCA

Riviera Beach Marina Event Center

Rosen Shingle Creek

Royal Inn

Royal Palm Beach Hess

Royal Palm Beach Village Council

Royal Palm Beach Chick-Fil-A

Royal Palm Exxon

Ryder Truck Rental, Inc.

San Diego County Office of Education

Sandypines

Saxon Archives Palm Beach, Inc.

School Board of DeSoto County

School Board of Pinellas County

School District of Manatee County

School District of Philadelphia

SeaWorld Parks & Entertainment, Inc.

Self Storage

Shadowwood Square, Ltd. & Terranova Corp

Shape Students Changing the World

Single School Culture Initiatives

Sloan's

Solid Waste Authority

Soroptimist International of Stuart

Sound Advise Amphitheater

South Bay City Commission

South Florida Fair and Palm Beach County Expositions,

South Florida Water Management District

South Palm Beach Town Commission

Southeastern University

Spring Lake Partners

St. Andrews School

St. Leo University

St. Luke’s UMC

St. Vincents Ferrer Catholic Church

Stanbery Development

State of Florida Division of Drivers Licenses

Statewide Mutual Aid Program

Steven R. Morgan, Principal Avison Young

StrawberryCrest High School

Sun State International Truck, LLC

Suncoast High School

SunFest of Palm Beach County, Inc.

Sunset Cove Amphitheater

Sunshine Golf Car

Sweet Tomatoes

Sysco Southeast Florida, LLC

T.J. Maxx

Tampa Armature Works

TD Equipment Finance, Inc.

Temple Beth El

Tennis Club of the Palm Beaches

Tequesta Village Council

The Alliance for Community Enrichment at The Borland

Center

The Ballpark of the Palm Beaches

The Benjamin School

The Boca Raton Bridge

The Breakers Hotel

The City of Boca Raton

The City of Boca Raton, The Greater Boca Raton

Beach & Park Dist

The First Academy, Attn: Ginger Millsaps

The First Academy, FHSAA Board of Directors

The Flagler Museum

The Florida Department of Children and Families

Refugee Service Program

The Harriet Himmal Gilman Theater

The Home Depot

The Kings Academy

The Mall at Wellington Green and The Taubman

Company Limited Partnership

The National Memorial Day Parade

The Resort at Singer Island

The School District of Pinellas County

The Scripps Research Institute

The Society of The Four Arts

Therapeutic Recreation Complex

Thomas Jefferson High School

Tiburon Corp.

TJ Maxx; The TJX Companies Inc.

TJX Companies, Inc.

Town Center Mall at Boca Raton

Town of Jupiter

Town of Lake Park

Town of Lantana – 500 Greynolds Cir

Town of Lantana – 510 West Pine

United Way of Palm Beach County Conference

Unity School

University of Central Florida

University of South Florida

US Armory

VC1, LLC

Versa Property Management, LLC

Village Academy Early Head Start

Village of Royal Palm Beach

Village of Wellington – 11700 Pierson Rd

Village of Wellington – 1279 W. Forest Hills Blvd

Village of Wellington, Amce Improvement Dist

Weight Watchers North America, Inc.

Wellington Regional Medical Center

West Orange High School

West Palm Beach BOCC

Whole Food Market – Austin, TX

Whole Food Market – Wellington, FL

Wireless Systems Group, Inc.

Workforce Alliance Contracts Unit

YMCA of South Palm Beach County

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER

ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

CANCELLATION

DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE

LOCJECTPRO-

POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $DAMAGE TO RENTEDEACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSRLTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF(MM/DD/YYYY)

POLICY EXP(MM/DD/YYYY) LIMITS

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe underDESCRIPTION OF OPERATIONS below

(Mandatory in NH)OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

HIRED AUTOSNON-OWNED

AUTOS AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE $

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSURED

PHONE(A/C, No, Ext):

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.

INS025 (201401)

3/19/2018

The Beacon Group, Inc.

6001 Broken Sound Pkwy.,N.W.

Suite 500

Boca Raton FL 33487-2730

(561)994-9994 (561)997-7087

School Board of Palm Beach County

3370 Forest Hill Blvd.

Suite A-103

West Palm Beach FL 33406

School Board of Palm Beach

Master 18/19A

X Also applies to Child

Abuse and Molestation

SUBJECT TO INSURER A: 07/01/2018 07/01/2019

FLA STATUTE 768.28

*200,000 PER PERSON

*300,000 PER OCCURRENCE

200,000

Excluded

300,000

Included

A SUBJECT TO INSURER A: 07/01/2018 07/01/2019

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.

D Dresback, CPCU, ARM

1310 Congress Partners, LLC Attn: Shelly 5201 Village Blvd. West Palm Beach, FL 33407

(561)687-1903

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Abacoa Property Owners' Assembly, Inc. 1200 University Blvd. Suite 102 Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Abacoa Town Center Master Property Owners Association, Inc/ c/o Versa Property Management 661 University Blvd. Suite 200 Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Aberdeen Golf & Country Club Attn: Sean Lutwin 8251 Aberdeen Drive Boynton Beach, FL 33437

(561)493-6854

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Abocoa Condominium Assoc. Attn: Terri 4798 Central Blvd. Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Academy of Health Science & Pre-Medicine Jensen Beach High School 2875 NW Goldenrod Road Jensen Beach, FL 34957

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Advent Lutheran Church/School Attn: Kevin Wrenne 5001 NE 4th Avenue Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Aleman & Associates, LLc and SMG (Puerto Rico Convention Center) Janet Freyre 1000 Convention Blvd. San Juan, PR 00907

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Allen & Arts Attn: Paul Allen 215 South County Road Bellport, NY 11713

(163)128-6425

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

American Academy of Dermatology 930 E. Woodfield Road Schaumburg, IL 60173

(561)775-7249

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

American Heritage - Delray Beach 6200 Linton Blvd. Delray Beach, FL 33484

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Applebees 1570 W. Boynton Beach Blvd. Boynton Beach, FL 33436

applebeesboynton@dohertyin

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Arbern Investors IV, LP & Stoltz Management of FL Inc 301 Yamato Road,Suite 3101 Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Atlanta Independent School District 1631 LaFrance Street NE Atlanta, GA 30307

cpennyman@atlanta.k12.ga.u

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Atlantic Community High School Attn: JROTC (LTL Rodriguez) 2445 West Atlantic Avenue Delray Beach, FL 33445

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Avis Budget Group, Inc. and it's Subsidia 4500 S 129 E Avenue, Suite 100 P.O.Box 690360 Tulsa, OK 74169-0360

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Bank of America, NA, its affiliates, successer, and assigns as their interest may appear P.O. Box 4431 Atlanta, GA 30302-4431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Belle Glade Board of County Commissioners 110 SW Avenue E Belle Glade, FL 33430

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Benoist Farms Elementary School Lisa Martin Confidential Secretary to the Principal 1765 Benoist Farms Road West Palm Beach, FL 33411

(561)383-9750

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Best Buy Jennifer Laiahsang 20540 State Road 7 Boca Raton, FL 33498

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Bethel Assembly of God 4320 South Congress Avenue Lake Worth, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Big Brothers Big Sisters of Palm Beach Co 1707 Kirk Road West Palm Beach, FL 33406

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Big Lots Ricardo McDonald, Manager 1930 N. Military Trail West Palm Beach, FL 33409

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Ballet Theatre 7630 NW 6th Avenue Boca Raton, FL 33487

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Lago Country Club, Inc. Attn: Steve O'Neil 8665 Juego Way Boca Raton, FL 33433

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Mission, LP 31500 Northwestern Highway Suite 300 Farmington Hills, MI 48334

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Museum of Art @ Misner Park 401 Plaza Real Boca Raton, FL 33432

(561)391-6410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Raton Board of City Council 201 West Palmetto Park Road Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Raton Resort & Club 501 East Camino Real Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Raton Wine & Food Festival BocaRaton.com 40 SE 3th Street Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boca Woods Country Club Association,Inc. Boca Woods Property Owners Association, I 10471 Boca Woods Lane Boca Raton, FL 33428

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boynton Beach BOCC 100 E. Boynton Beach Blvd. Boynton Beach, FL 33435

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boynton Beach Mall 801 N. Congress Avenue Suite 295 Boynton Beach, FL 33426

(561)736-7907

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Boys & Girls Club of PBC 800 Northpoint Pkwy #204 West Palm Beach, FL 33430

(561)992-8637

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Brevard Community College 1519 Clearlake Blvd. Cocoa Beach, FL 32922

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Broadmoor Apartments Associates, Ltd Partnership,A South Carolina Ltd. Partner c/o Apartment Investment & Management Com 4582 South Ulster Street PKWY Suite 1100 Denver, CO 80237

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Broward County Parks and Recreation 950 NW 38th Street Oakland Park, FL 33309

deborah.nash-utterback@pal

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Broward County Public Schools 600 S. E. Third Avenue Fort Lauderdale, FL 33301

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Broward Paper & Packaging Jack McVey 1201 NE 45th Street Fort Lauderdale, FL 33334

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Bureau of Land Management Department of Interior c/o Peter DeWitt 600 State Road 707 Unit B Jupiter, FL 33469-3516

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Job Training Site.

Burlington Coat Factory 2601 Okeechobee Blvd. West Palm Beach, FL 33409

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Burlington Coat Factory Village Shoppes on 441 10101 Southern Blvd Royal Palm Beach, FL 33411

storemgr.811@burlingtonsto

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Burlington Coat Factory 9839 Military Trail Boynton Beach, FL

store.580@burlingtonstores

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Casanova Custom Tile & Marble, LLC Attn: William Sarro 5896 Trip Hammer Road Greenacres, FL 33467

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

CB Richard Ellis Investment Property Grou Richard Tarquinio 5355 Town Center Road Suite #701 Boca Raton, FL 33486

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Center for Spiritual Living (previously known as Science of Mind) 2 S. W. 12th Avenue Boca Raton, FL 33486

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Cheney Brothers, Inc. Lisa cc: Cheryl Combord @ 561-338-1440 1 Cheney Way Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Children's Services Council of Palm Beach 2300 HIgh Ridge Road Boynton Beach, FL 33426

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Chris Evert Charities, Inc. 7200 W. Camino Real Suite 310 Boca Raton, FL 33433

lindsey@chrisevert.org

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City Council of Greenacres City of Greenacres 5985 Tenth Avenue, North Greenacres, FL 33463

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Belle Glade Attn: Lomax Harrelle, City Manager 110 Dr. Martin Luther King Jr. Blvd. Belle Glade, FL 33430

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Boca Raton 201 West Palmetto Park Road Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Boynton Beach Recreation & Parks, Denson Pool 225 N. W. 12th Avenue Boynton Beach, FL 33435

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Boynton Beach Recreation Department Wally Majors PO Box 310 Boynton Beach, FL 33425

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Delray Beach 100 NW 1st Avenue Delray Beach, FL 33444

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Lake Worth 1900 2nd Avenue North Lake Worth, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Palm Beach Gardens High School Homecoming 10/20/2-17

City of Palm Beach Gardens 10500 N. Military trail Palm Beach Gardens, FL 33410

rfutch@pbgfl.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Riviera Beach Parks and Recreatio Lindsay Davis Center 1555 W 28th Street Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Dates October 23, 2017 - January 16, 2018

City of Riviera Beach Parks & Recreation Department 1621 West Blue Heron Blvd. Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of Riviera Beach 600 West Blue Herron Blvd. Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of St. Petersburg 1400 19th Street North Bldg. A St. Petersburg, FL 33713

(727)893-7343 delisha.woods@stpete.org

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City of West Palm Beach and Board of Supervisors of West Palm Beach Golf Club 200 2nd Street PO Box 3366 West Palm Beach, FL 33402

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability. Dreher Park;date: 11/20/16

City of West Palm Beach 401 Clematis Street West Palm BeachF

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

City Place Community Development District 700 Rosemary Avenue West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Clarke Holdings Corporation c/o Century 21 Academy of Learning Attn: William Cummings 2215 Military Trail West Palm Beach, FL 33409

(561)689-0342

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Clifford O. Taylor/Kirklane Elementary 4200 Purdy Lane Palm Springs, FL 33462

cybil.askew@palmbeachschoo

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Colonial High School Attn: Julie Sanford 6100 Oleandor Drive Orlando, FL 32807

Julie.sanford@ocps.net

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability. Event Date: 10/28/2017 8AM - 5PM

Cosmopolitan AME Church 170 Vine Street Atlatna, GA

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Cross Match Technologies, Inc Nate Bray 3950 RCA Blvd. Suite 5001 Palm Beach Gardens, FL 33410

(561)828-2307

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Custom World, Inc. 950 South Federal Highway Deefield Beach, FL 33441

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

CVS Pharmacy Store #7891 8954 Lantana Road Lake Worth, FL 33467

(561)434-7688

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Dayton Ballet Association 140 N. Main Street Dayton, OH 45402

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Delray Beach Board of City Commissioners 100 N.W First Avenue Delray Beach, FL 33444

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Delray Beach BOCC 100 NW 1st Avenue Delray Beach, FL 33444

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Department of Army, JROTC Program, Atlant Comm. High School, Dwyer Comm. High Sch Forest Hills Comm. HighSchool & Jupiter C High School,Seminole Ridge HS 2455 W. Atlantic Ave. Delray Beach, FL 33445

(561)330-8902

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Department of Juvenile Justice Project MIND 1160 Avenue N Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Department of Juvenile Justice Delinquency Prevention Program 2215 S 25 Street Ft.Pierce, FL 34947

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Department of Juvenile Justice School Accountability Boards- Restorative Justice 2215 S. 25th Street Ft. Pierce, FL 34947

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Department of the Army c/o Forest Hill High School JROTC 6901 Parker Avenue West Palm Beach, FL 33405

(561)540-3048

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability

Department of Transportation 9700 Forest Hill Blvd. West Palm Beach, FL 33413

(561)431-4231

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Devos Blum Family YMCA of Boynton Beach 9600 S. Military Trail Boynton Beach, FL 33436

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Diocese of Palm Beach Gerald M. Barbarito Bishop Pope John Paul II High School 4001 North Military Trail Boca Raton, FL 33431-4302

(561)314-2101

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

District Office of Vocational Rehabilitat 2550 West Oakland Park Blvd. Fort Lauderdale, FL 33311

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Dolly Hand Cultural Arts Center 1977 College Drive Belle Glade, FL 33430

(561)993-1162

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Drum Corps International Attn: Sue Kuehnhold 110 W. Washington Street Suite C Indianapolis, IN 46204

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Early Learning Coalition of Palm Beach Co 2300 High Ridge Road Suite 115 Boynton Beach, FL 33426

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Eastern Florida State College 3865 North Wickham Road Melbourne, FL 32935

shulmanj@easternflorida.ed

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Everglades Youth Camp 12100 Seminole Pratt Whitney Road West Palm Beach, FL 33412

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Family Central Inc. Early Learning Coalition Mr. Barry Miller 3111 South Dixie Highway Suite 222 West Palm Beach, FL 33405

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Permit 2013-F-496-0041-93290

Famoso, Inc. dba Manpower 11211 Prosperity Farms Road C-120 Palm Beach Gardens, FL 33410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

RE: Boca Raton Community High School Baseball Team

FAU Athletics Attn: Joshua Fryd 777 Glades Rd. Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Permit #2017-F-496-038-93230

FDOT Palm Beach Operations Center 7900 Forest Hill Blvd. West Palm Beach, FL 33413

rosie.evert@dot.state.fl.u

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

FHSAA 1801 NW 80th Blvd. Gainesville, FL 32606

(352)244-5050

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Firehouse Subs 975 Gateway Blvd. #113 Boynton Beach, FL 33426

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

First Baptist Church of Boca Raton 2550 NW Yamato Road Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

First Baptist Church of Orlando 3000 South John Young Pkwy Orlando, FL 32805

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

First Methodist Church of Oviedo 263 King Street Oviedo, FL 32765

Cynthia_Wood@ncci.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

First United Medthodist Church of Jupiter 815 E. Indiantown Road Jupiter, FL 33477

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Atlantic Board of Trustees, the Florida Board of Governors, the State of Florida & their respective officers, agen volunteers & employees 777 Glades Road Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Date: 11/1-1/17

Florida Charter Schools Conference 325 W. Gaines Street, Rm 1044 Tallahassee, FL

planner@charterschoolconfe

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Children's Forum cc: Mary Ussery @ 561-963-3852 Kathy Carver 2807 Remington Green Circle Tallahassee, FL 32308

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Citrus Sports Attn: Ms. Robyn Graves One Citrus Bowl Place Orlando, FL 32805

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Coca-Cola Bottling Company Attn: Michael Frith 6553 Garden Road Riviera Beach, FL 33404

(561)881-7708

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Community College North Campus 11901 Beach Blvd. Jacksonville, FL 33246

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Department of Agriculture and Consumer Services Division of Licensing Post Office Box 6687 Tallahassee, FL 32314-6687

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Department of Education Bureau of Public School Options 325 W. Gaines Street Tallahassee, FL 32399

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Department of Transportation c/i DBI Services Corp. 2728 State Road 15 Belle Glade, FL 33430

(561)993-9000

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Expo/Aleman & Associates. LLC and SMG (Puerto Rico Convention Center) (See attached for named continuation) Attn: Janet Freyre 100 Convention Blvd San Juan, PR 00907

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida High School Athletic Association 1801 NW 80th Boulevard Gainesville, FL 32606-9176

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Institute of Technology Attn: Ryan Vanderwielen 150 W. University Blvd Melbourne, FL 32902

(321)984-8529

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Power & Light Co. Eduardo Garcia, Relocation Coordinator PO Box 14000 (TLE-JB) Juno Beach, FL 33408

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Florida Southern Attn: Mr. Swank 111 Lake Hollingworth Dr. Lakeland, FL 33801

(863)680-4122

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Follett Bookstore Attn: Shawn Olds 4200 Congress Avenue Lake Worth, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Fullerton Civic Light Opera Co., Inc. Attn: Larry Knigge 218 W. Commonwealth Avenue Fullerton, CA 92832

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Gateway Preforming Arts PO Box 5 215 South Country Road Bellport, NY 11713

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Dates: Mon-Fri, from 10/23/17 thru 1/30/18 3:15-5:30pm

GBYSA/Boca United FC 11890 Flotilla Place Boca Raton, FL 33428

(561)961-0864 gbysa_admin@gbysa.org

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

George Snow Scholarship Foundation, Inc. Rexann Jones, Treasurer 201 Plaza Real Suite 201 Boca Raton, FL 33432

(561)392-0804

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

George Snow Scholarship Fund Inc. 1860 North Dixie Highway Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Event Date: 10/28/2017 - 8AM to 12PM

Georgia State University Hass Howell Building ,Suite 721 75 Poplar Street Atlanta, GA 30303

bands@GSU.edu

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liabilityDates: 11/21/214-11/22/2014

Gibbs High School 850 34th Street, S St. Petersburg, FL 33712

(727)893-5452

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Girls Scouts of Southeast Florida, Inc. 1224 West Indiantown Road Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Global Rental Company, Inc. 33 Inverness Center Parkway Birmingham, AL 35242

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Gold Coast Christian Camp Crystal-Manager 7495 Park Lane Road Lake Worth, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Good Shepherd United Methodist Church 2341 S. MIlitary Trail West Palm Beach, FL 33415-7543

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Grace Covenant Presbyterian Church 1655 Peel Avenue Orlando, FL 32806

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Grandview Preparatory School Kathleen Prindle 336 NW Spanish River Blvd. Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Greater Boca Raton Beach & Park District 150 Crawford Blvd. Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Greater Boca Raton Beach & Park District James A. Rutherford Community Center 2000 NW 51st Street Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Greenacres Community Center 501 Swain Blvd. Greenacres, FL 33463

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Greenacres Learning Center Attn: Ziara 3950 S. 57 Avenue Greenacres, FL 33463

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Grosh Scenic Rentals, Inc. Monica Martinez 4114 Sunset Blvd. PO Box 29579 Hollywood, CA 90029

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Gulfstream Council Boy Scouts of America 8835 N. Military Trail Palm Beach Gardens, FL 33410-6329

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Gulfstream Race Track Robbi Auerback 901 S. Federal Highway Hallandale, FL 33009-7199

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability. Park Vista Marching Band practice @ Cemetary Field, 211 Cemetary Street, Norcross, GA 30071 Dte" 10/27/17

Gwinnett County Board of Commissioners 75 Langley Drive Lawrenceville, GA 30046

keith.strong@gwinnettcount

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Hardee County School District Attn: Robert Shayman 1009 North 6th Avenue Wauchula, FL 33873

(863)773-0069

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Harid Conservatory 2285 Potomac Road Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Haverhill Town Council 4585 Charlotte Street Haverhill, FL 33417

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Health Care District of Palm Beach County 2601 10th Avenue North Suite 100 Palm Springs, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Hillsborough County Public Schools 901 E. Kennedy Blvd. Tampa, FL 33062

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Holy Spirit Catholic Church 1000 Lantana Road Lantana, FL 33462

(561)585-8482

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Home Depot Store 6313 5750 Jog Road Lake Worth, FL 33463

(561)432-8236 BRANDI_GARIN@homedepot.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Hyatt Place Marcel P. Girard, General Manager 295 Lakeview Avenue West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Hypoluxo Town Council 7010 S. US 1 Haverhill, FL 33462-5493

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Indian RIver County School District AttnPam Romero 1990 25th Street Vero Beach, FL 32960

(561)493-6835

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Indian Trail Improvement District Timothy Wojnar 13476 61st Street, North West Palm Beach, FL 33412

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

IPC Operations, LLC 3667 120th Avenue South Wellington, FL 33414

(561)784-3993

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Janoura Partners LLC dba Sims Creek Plaza 6827 W. Commercial Blvd. Tamarac, FL 33319

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

JC Penneys Manager: Lisa Escalante District Manager - Prince Mims 10308 W. Forest Hill Blvd. Wellington, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Delete on renewal

JCB Enterprises, Ltd 3910 RCA Blvd. Suite #1015 Palm Beach Gardens, FL 33410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Dates: 10/30/17 - 6/9/2018

Joann Fabrics Attn: Bobby Mano 940 South State Road 7 Wellington,, FL 33414

S1862@joann.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

John C Bills Enterprises LTD John C Bills Properties LLC 3910 RCA Blvd. Suite #1015 Palm Beach Gardens, FL 33410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Johnathan's Landing Golf Club Human Resources Dept. 185 E. Indiantown Road #128 Jupiter, FL 33477

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jonathan Dickinson State Park Attn: Mark Nelson, Park Manager 16450 SE Federal Highway Hobe Sound, FL 33455

(561)744-7604

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Juno Beach Town Council 340 Ocean Drive Juno Beach, FL 33408

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jupiter Christian School 700 S. Delaware Blvd. Jupiter, FL 33458

(561)744-7921

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jupiter Community Center Attn: Janet Metz 210 Military Trail Jupiter, FL 33458

(561)745-2559

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jupiter High School Government Associatio Attn: Jeanmarie McCann 500 North Military Trail Jupiter, FL 33458

jeanmarie.mccann@palmbeach

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jupiter Inlet Colony Town Council 1 Colony Road Jupiter, FL 33469

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jupiter Lanes Bowling Alley Attn: Doug Moore 350 Maplewood Drive Jupiter, FL 33458

(561)744-7978

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jupiter Medical Center, Inc. and Jupiter Medical Center Pavilion, Inc. Attn: Susan Kenerson Contracts Coordinator/Buyer 1210 S. Old Dixie Highway Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Jupiter Town Council 210 Military Trail Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Kelly Tractor 5460 Okeechobee Blvd. West Palm Beach, FL 33417

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Keystone-Florida Property Holding Corp. dba The Galleria at Fort Lauderdale Kravco Simon Company Attn: Denis Alfano 2414 East Sunrise Blvd. Fort Lauderdale, FL 33304

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

KFC 14470 South Military Trail Delray Beach, FL 33484

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

K-Mart Donita Oberge 1401 Palmetto Park Road Boca Raton, FL 33486

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Kravis Center 701 Okeechobee Blvd. West Palm Beach, FL 33401

(561)833-3901

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lake Clarke Shores Town Council 1701 Barbados Road Lake Clarke Shores, FL 33406

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lake County School Board Curriculum Department Attn: April Weaver 201 West Burleigh Blvd. Tavares, FL 32778

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lake Park Town Commission 535 Park Avenue Lake Park, FL 33403

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lake Worth BOCC 7 N. Dixie Highway Lake Worth, FL 33460

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lantana Homes HOA Indian Pines Estates 5750 Edgecliff Avenue Lake Worth, FL 33463

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lantana Town Council 500 Greynolds Circle Lantana, FL 33462

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

LBS South, LLC/Jacksonville Facility 10628 General Avenue Jacksonville, FL 33320

(904)800-2204 dchesney@lbssouth.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lutheran Services Florida, Inc. 3627A W. Waters Avenue Tampa, FL 33614

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Lynn University 3601 N. Military Trail Boca Raton, FL 33431

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Macy's Department Store #757-Town Ctr Mal c/o Macy's Coral Spring Attn: Norman Murphy Director of Operations 9263 W. Atlantic Blvd. Coral Springs, FL 33071

(954)345-3311

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Dates of attendance or event: September 15, 2017- September 18, 2017

Maddox-Joines, Inc. dba Sunshine Golf Carts Michala DeRosier, Assistant Manager 9740 West Atlantic Avenue Delray Beach, FL 33466

(561)499-9865

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Main State Musical Theatre Costume Rental 14 Maine Street Suite 216 Brunswick, ME 04011

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Maltz Jupiter Theatre David Harris - General Manager 1001 E. Indiantown Road Jupiter, FL 33477

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Mangonia Park Town Council 1755 E. Tiffany Drive Mangonia Park, FL 33407

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Mar-a-Lago Club 1100 South Ocean Blvd. Palm Beach, FL 33480

(561)738-2794

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Mariela Castillo Director of Special Events St. Baldrick's Foundation 1443 E, Washington Blvd. #650 Pasadena, CA 91104-2650

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Marjon Specialty Foods, Inc 3508 Sydney Road Plant City, FL 33566

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

MBIA Insurance 113 King Street Armonk, NY 10504

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Menin Development Companies Downtown at the Gardens Attn: Julie Mullen-Kaminski 11701 Lake Victoria Gardens Av Ste 2203 Palm Beach Gardens, FL 33410

(561)282-5001

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Miller Legg Attn: Mark Brandenburg 2005 Vista Parkway Suite 100 West Palm Beach, FL 33411-2719

(561)689-8108

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Mission Bay Shopping Center, LLC c/o Schmier & Feurring Properties, Inc. Attn:: Lauren Leitkowski 7777 Glades Road Suite 310 Boca Raton, FL 33434

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Mobile Gas Karen Eslory 3000 Jog Road Greenacres, FL 33467

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Mobile Mini, Inc 500 Rock Road North Fort Pierce, FL 34945

(480)894-6433

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Mobile Mini, Inc 7420 South Kyrene Road Suite 101 Tempe, AZ 85283

(480)894-6433

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Modular Space Corporation 1200 West Swedesfort Road Berwyn, PA 19087

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Neff Rental 1860 MLK Jr. Blvd Riviera Beach, FL 33417

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

North Broward Preparatory School Mike Ostrowski 7600 Lyons Road Coconut Creek, FL 33073

(954)247-0136 ostrowskim@nbps.org

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Northern Palm Beach County Improvement District 359 Hiatt Drive Palm Beach Gardens, FL 33418

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Northwest College Summer Conferences Kristie R. Sullivan 231 West 6th Street Popwell, WY 82435

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Nova Southeastern Univeristy 3301 College Avenue Fort Lauderdale, FL 33314

flaviai@nova.edu

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Nova Southeastern University Attn: Jana Debow 3970 RCA Boulevard Suite 7000 Palm Beach Gardens, FL 33410

(561)622-6472

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

O.B.Festival Events, LLC;The Orange Bowl mittee,Inc.;South Florida Stadium,LLC;Mia Dolphins Ltd.;Fin Associates,llc; South Florida Football Assoc.,LLC 14360 NW 77th Court Miami Lakes, FL 33016

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Oakstone Academy Palm Beach Corporation 345 South Military Trail West Palm Beach, FL 33415

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Ocean Ridge Town Commission 6450 N. Ocean Blvd. Ocaen Ridge, FL 33435

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Office of Family & Community Outreach 325 W. Gaines Street Suite 544 Tallahassee, FL 32399-0400

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Old Navy Attn: Sandy Singh 840 State Road 7 Wellington, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Olympic Heights Community High School 20101 Lyons Road Boca Raton, FL 33434

dave.clark@palmbeachschool

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Orange County Public Schools Attn: Roy Peters 445 West Amelia Street Orlando, FL 32801

(407)816-5633

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

OXXO Care Cleaners Attn: Jesus Duran 11081 Southern Blvd. Royual Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Pahokee City Commission 171 N. Lake Avenue Pahokee, FL 33476

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Pahokee Middle Senior High School 900 Larrimore Road Pahokee, DE 33476

jose.riverariver@palmbeach

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palladium Management Company 700 Rosemary Avenue West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Atlantic College Theater Department 901 South Flagler Drive West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Atlantic University 910 S. Dixie Highway West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Board of County Com- missioners Community Services Department Division of Human Services Summer Camp Scholarship Program 810 Datura Street West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Board of County Commiss c/o Yvonne Walker Head Start 50 South Military Trail Suite 203 West Palm Beach, FL 33415

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Board of County Commissioners and The Palm Beach County Film and Televison Commission 1555 Palm Beach Lakes Blvd. Suite 900 West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Board of County Commissioners and the Palm Beach County & Film & Television Commission 2195 Southern Blvd, Suite 520 West Palm Beach, FL 33406

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Board of County Commissioners c/o Property&Real Estate Management Divis Attn: Director 2633 Vista Parkway West Palm Beach, FL 33441-5605

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County BOCC Risk Management Department Attn: Dick Cohen 160 Australian Avenue Suite 401 West Palm Beach, FL 33406

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Convention Center Ms. K. Hayek 650 Okeechobee Blvd. West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Health Department Environmental Health & Engineer Barbara Hoggard 345 South Congress Avenue Delray Beach, FL 33445

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Health Department Lairsey/Childcare Licensing PO Box 1332 Belle Glade, FL 33430

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Village Academy Early Head Start 400 SW 12th AveDelray Beach, FL 33444

Palm Beach County Health Department Child Care Facility Board PO BOX 29 West Palm Beach, FL 33402

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Health Dept. Division of Finance and Accounting 800 Clematis Street West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Parks & Recreation 2700 6th Avenue South Lake Worth, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Youth Services Dept. Palm Beach County Commissioners,a Politic Subdivision of the St. of Florida It's em 50 S. Military Trail,Suite 203 West Palm Beach, FL 33415

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County 100 Australian Avenue West Palm Beach, FL 33406

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Southwinds Golf Course 19577 Lyons Road Boca Raton, FL 33434

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Parks & Recreation BB Swan 2700 6th Avenue South Lake Worth, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Youth Services Department 50 S. Military Trail Suite 203 West Palm Beach, FL 33415

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Convention Center 650 Okeechobee Blvd. West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach County Board of County Commissioners Community Services Department Division of Human Services 810 Datura Street West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Acct: PLC2498Pahokee Middle School -Palm Beach County - Youth Services - Summer Camp

Palm Beach County c/o Insurance Tracking Services. Inc. P. O. Box 20270 Long Beach, CA 90801

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Gardens Aquatic Complex 4404 Burns Road Palm Beach Gardens, FL 33410

(561)366-6550

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Gardens City Council 10500 N. Military Trail Palm Beach Gardens, FL 33410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Institute for Contemporary Art 601 Lake Ave Lake Worth, FL 33460-3810

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Mall Holdings, LLC 1751 Palm Beach Lakes Blvd. Suite E121 West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Mall Holdings, LLC; PBM Developer,LLC; Lubert-Adler Group;NED PBM LLC; (See attached for remainder of name) 1801 Palm Beach Lakes Blvd. West Palm Beach, FL 33401

lrojas@nedevelopment.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Maritime Museum 6500 Peanut Island Drive Peanut Island Riviera Beach, FL 33407

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Outlets & UG2 1721 Palm Beach Lakes Blvd. Suite E121 West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach Shores Town Commission 247 Edwards Lane Palm Beach Shores, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach State College 1977 College Drive Belle Glade, FL 33430

(561)649-6028

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach State College 3160 PGA Blvd. Palm Beach Gardens, FL 33410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach State College and its District Board of Trustees 3160 PGA Blvd. West Palm Beach, FL 33410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Beach State College and its District Board of Trustees 4200 Congress Ave Lake Worth, FL 33461

(561)993-1162

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Palm Springs Village Council 226 Cypress Lane Palm Springs, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Park Avenue BBQ and Grille John Ernst cc: Nancy Courtney @ 561-792-8106 13897 Wellington Trace Wellington, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Park Vista High School 7900 Jog Road Lake Worth, FL 33467

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Penske Truck Leasing Co., L.P. Attn: Rental Department Route 10, Green Hills P. O. Box 391 Reading, PA 19603

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

PGA National Resort & Spa Jane S. Broderick / Director of Golf 400 Avenue of the Champions Palm Beach Gardens, FL 33418

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Pinellas County School Board 301 4th Street, S. W. Largo, FL 33770

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Pleasant City Multicultural Center Gloria Williams 501 21st Street West Palm Beach, FL 33407

(561)835-7110

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Port of Palm Beach District 4 East Port Road Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Promanade Mobil Tim Bowman 9890 Alt. AIA Palm Beach Gardens, FL 33410

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

PSI Services 777 Mariners Island Blvd. Suite 200 San Mateo, CA 94404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Publix @ Village Commons 831 VIllage Blvd. West Palm Beach, FL 33409

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Publix Store # 1384 Attn: Millie Deneus CSM & Nico Natale A 214 N Dixie Highway Lake Worth, FL 33460-3362

nico33461@gmail.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Publix Super Market 1589 W. Lantana Road West Palm Beach, FL 33462

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Quantum Foundation 2701 N. Australian Avenue Suite 200 West Palm Beach, FL 33407

(561)832-5794

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Ramco-Gershenson Properties, LP Ramco-Gershenson, Inc. 31500 Northwestern Highway Suite 300 Farminton Hill, MI 48334

(248)592-6435

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Ramco-Gershenson, Inc. Attn: Isabel E. Feldman Property Manager 951 Yamato Road Suite 100 Boca Raton, FL 33431

(866)405-3542

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Refugee Programs Administration George Lewis 1317 Winewood Blvd. Tallahassee, FL 32399

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Regency Party Rentals 5900 N. Australian Avenue Suite 3 West Palm Beach, FL 33407

Tammy@Regencyparty.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Ridgecreast YMCA Shannon Wynn 1801 119th St. N Largo, FL 33778

swynn@suncoastymca.org

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

4/27/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Riviera Beach Marina Event Center 190 E. 13th Street Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Riviera Beach Marina Village Event Center 600 W. Blue Heron Blvd. Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Rosen Shingle Creek Lisa Burrowws,Conference Center Sales Man 9939 Universal Blvd. Orlando, FL 32819

(407)996-9935

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Royal Inn 675 Royal Palm Beach Blvd. Royal Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Royal Palm Beach Hess 11711 Okeechobee Blvd. Royal Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Royal Palm Beach Village Council 1050 Royal Palm Beach Blvd. Royal Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Royal Palm Chick Fil A Brian Barnes, Manager 206 State Road 7 West Palm Beach, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Royal Palm Exxon 1201 Royal Palm Beach Blvd. Royal Palm Beach, FL

(561)795-9498

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Ryder Truck Rental, Inc. and Ryder Truck & Affiliates 6000 Windward Parkway Alpharetta, GA 30005

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

San Diego County Office of Education Attn: Barbara Burns 5404 Napa Street San Diego, CA 92110

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Sandypines 111301 S. E. Tequesta Terrace Tequesta, FL 33469

mailto:karlbarbatschi@uhsi

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Saxon Archives Palm Beach, Inc. Attn: Dwight Saxon 1500 Ave R Suite 100 Riviera Beach, FL 33404

(561)882-9911 dsaxon@saxonarchives.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

School Board of DeSoto County 830 LaSolona Avenue Arcadia, FL 34266

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

School Board of Pinellas County Attn: Real Estate Department 11111 S. Belcher Rd. Largo, FL 33773

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

School District of Manatee County 215 Manatee Avenue West Bradenton, FL 34205

(941)708-8698

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

School District of Philadelphia Office of Risk Management 4400 North Broad Street Philadelphia, PA 19130

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

4/12/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Seaworld Parks & Entertainment, Inc. c/o Insurance Compliance PO Box 12010-B2 Hemet, CA 92546-8010

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Self Storage 1930 Lantana Road Lantana, FL 33462

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Shadowwood Square, Ltd. and Terranova Cor C/o CertFocus P. O. Box 140528 Kansas City, MO 64114

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Shape Students Changing The World Attn: Ilene Miller 2875 NE 191st Street Suite 400 Aventura, FL 33180

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

gail.verrigni@palmbeachsch

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Sloan's 700 S. Rosemay Avenue #A38 (City Place) West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Solid Waste Authority Pamela Vann 7501 North Jog Road West Palm Beach, FL 33412

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Soroptimist International of Stuart Attn:Sherry Guffin P.O.Box 2250 Stuart, FL 34995

(772)781-8631

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Sound Advise Ampitheater 601-7 Salisbury Way West Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

South Bay City Commission 333 SW 2nd Street South Bay, FL 33493

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

South Florida Fair & Palm Beach County Expositions, Inc 9067 Southern Blvd P.O.Box 210367 West Palm Beach, FL 33421-0367

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

South Florida Water Management District 3301 Gun Club Road West Palm Beach, FL 33406

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

South Palm Beach Town Commission 3577 S. Ocean Blvd. South Palm Beach, FL 33480

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Southeastern University 1000 Longfellow Blvd. Lakeland, FL 33801

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Spring Lake Partners 2455 East Sunrise Blvd. Arcade I Fort Lauderdale, FL 33304

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

St. Andrews School David Ahearn 3500 Jog Road Boca Raton, FL 33434

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

St. Leo University Mr. Fran Reidy 33701 State Road 52 Saint Leo, FL 33574

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

St. Luke's UMC Dede Duncan Director of Events & Office Administratio 4851 S. Apopka Vineland Road Orlando, FL 32819

(407)876-4991

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

St. Vincents Ferrer Catholic Church 840 George Bush Blvd. Delray Beach, FL

(561)276-8068

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Stanbery Development, Coconut Creek Development,C.B. Richard Ellis Attention: Bill Horowitz 4443 Lyons Road Suite 212 Coconut Creek, FL 33073

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

State of Florida Division of Drivers Licenses 703 Waterview Drive Palm Springs, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Statewide Mutual Aid Program Division of Emergency Management 2555 Shumard Oak Blvd. Tallahassee, FL 32399

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Steven R. Morgan, Principal Avison Young 30 Ivan Allen Jr. Blvd Suite 900 Atlanta, GA 30308

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

StrawberryCrest High School 4691 Gallagher Road Dover, FL 33527

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Sun State International Truck, LLC 6020 Adamo Drive Tampa, FL 33619

donna.white@sunstateintl.c

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Suncoast High School 1717 AVE S Riviera Beach, FL 33404

Kelli.Erianne@palmbeachsch

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

SunFest of Palm Beach County, Inc. 525 Clematis Street West Palm Beach, FL 33401

(561)659-3567 brittany@sunfest.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Sunset Cove Amphitheater 20405 Amphitheater Circle Boca Raton, FL 33498

lawrence.shane@palmbeachsc

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability. Cavalcade of Bands Sept 23, 2017

Sunshine Golf Car 9740 W. Atlantic Avenue Delray Beach, FL 33446

(561)852-6618

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Sweet Tomatoes 1100 Congress Avenue Boynton Beach, FL 33426

dmurphy@gardenfreshcorp.co

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability Band event at Santaluces Community High

Sysco Southeast Florida, LLC 1999 Dr. Martin Luther King Jr Riviera Beach, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

T. J. Maxx 388 N. Congress Avenue Boynton Beach, FL 33426

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Tampa Armature Works 440 S. 78th Street Tampa, FL 33619

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

TD Equipment Finance, Inc. 1006 Astoria Boulevard Cherry Hill, NJ 08034

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

TD Equipment Finance, Inc. 1006 Astoria Boulevard Cherry Hill, NJ 08034

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Temple Beth El Mrs. Barrish 2815 N. Flagler Drive West Palm Beach, FL 33407

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Tennis Club of the Palm Beaches Bob Allen, Head Professional 2800 Haverhill Road West Palm Beach, FL 33415

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Tequesta Village Council 357 Tequesta Drive Tequesta, FL 33469

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Alliance for Community Enrichment at The Borland Center Attn: Gary Finley, Executive Director 4889 PGA Blvd. Palm Beach Gardens, FL 33418

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Ballpark of the Palm Beaches 5444 Haverhill Road West Palm Beach, FL 33407

zhermayer@prosportscaterin

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Benjamin School 11000 Ellison Wilson Rd North Palm Beach, FL 33408

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Boca Raton Bridge, LLC Attn: Joe Kopeika 999 East Camino Real Boca Raton, FL 33432

362-0492

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Breakers Hotel Attn: Kevin Johnson 1 South County Road Palm Bech, FL 33480

(561)659-8452

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The City of Boca Raton 201 West Palmetto Park Rd Boca Raton, FL 33432-3730

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The City of Boca Raton 201 W. Palmetto Park Road Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The City of Boca Raton The Greater Boca Raton Beach & Park Distr Palm Beach County Mr. Buddy Parks, CPRP 2000 NW 51st Street Boca Raton, FL 33432

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The First Academy Attn: Ginger Millsaps 2667 Bruton Blvd. Orlando, FL 32805

(407)206-8724

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The First Academy Darrell Don Athletic Director&Head Varsity Baseball C FHSAA Board of Directors 2667 Bruton Road Orlando, FL 32805

(407)206-8724

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Flagler Museum 1 Whitehall Way Palm Beach, FL 33480

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Florida Department of Children and Families Refugee Service Program Andrea Gordon: Contract Manager 401 NW 2nd Avenue Suite N-812 Miami, FL 33128

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Harriet Himmal Gilman Theater Palladium Management LLC Continental Performances Inc. 700 South Rosemary Avenue Suite 200 West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Home Depot Attn: Kevin Morrison 6800 Okeechobee Road West Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Kings Academy Jeffrey M. Loveland 8401 Belvedere Road West Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Mall at Wellington Green and The Taubman Company Limited Partnership Dorian Zimmer 10300 W. Forest Hills Blvd. Suite 2000 Wellington, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

4/11/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The National Memorial Day Parade c/o American Veterans Center 1100 North Glebe Road Suite 910 Arlington, VA 22201

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Resort at Singer Island Attn: Laura Short 3800 N. Ocean Drive Singer Island, FL 33404

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The School District of Pinellas County 301 4th Street, S. W. Largo, FL 33770

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Scripps Research Institute, Scripps Florida 130 Scripps Way Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

The Society of The Four Arts 2 Four Arts Plaza West Palm Beach, FL 33480

(561)655-7233

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Therapeutic Recreation Complex 2728 Lake Worth Road Lake Worth, FL 33461

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Thomas Jefferson High School 4401 W. Cypress St. Tampa, FL 33607

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Tiburon Corp. 15 Senecca Trail Harrison, NY 10525

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

TJ Maxx The TJX Companies, Inc. 8903 Glades Road Bldg. F Boca Raton, FL 33434

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

TJX Companies Inc 770 Cochituate Road Farmington, MA 01701

(317)324-3039

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Performance Dates 12/08 to 12/15

Town Center Mall at Boca Raton Attn: Sean Carroll 6000 Glades Road Suite 200 Boca Raton, FL 33431-7208

(561)338-0891 scarroll@simon.com

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Town of Jupiter 500 Military Trail Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Town of Lake Park 535 Park Avenue Lake Park, FL 33493

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Town of Lantana 500 Greynolds Circle Lake Worth, FL 33462

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Town of Lantana 510 West Pine Lantana, FL 33462

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

United Way of Palm Beach County Conferenc 2600 Quantum Blvd. Boynton Beach, FL 33426

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Unity School 101 N. W. 22 Street Delray Beach, FL 33444

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

University of Central Florida Department of Athletics PO Box 163555 Orlando, FL 32816-3555

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

University of South Florida Sun Dome Inc., Global Spectrum LP, (see attached for name completion) Attn: Michael Woods Baxter 4202 East Fowler Avenue Tampa, FL 33620

mwbaxter@usf.edu

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

US Armory Sgt. Tom Fragale 3193 Gun Club Road West Palm Beach, FL 33406

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

VC1, LLC c/o Gregory J. Rider 1024 Monroe Drive Atlanta, GA 30306

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Versa Property Management, LLC 661 University Blvd. Suite 200 Jupiter, FL 33458

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

This certificate supercedes and voids all previous certificates. The School Board of Palm Beach County isself insured under the laws of the State of Florida for the above limits for tort liability.Dates of attendance or event: 07.01.2017-06.30.2018

Village Academy Early Head aStart 400 S. W. 12th Avenue Delray Beach, FL 33444

cheryl.williams.2@palmbeac

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Village of Royal Palm Beach 1050 Royal Palm Beach Blvd. Royal Palm Beach, FL 33411

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Village of Wellington Attn: Ryan Hagopian 11700 Pierson Rd. Wellington, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Village of Wellington 1279 W. Forest Hills Blvd. Suite 23 Wellington, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Village of Wellington Amce Improvement District 14000 Greenbriar Blvd. Wellington, FL 33414

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Weight Watchers North America Incorporate 675 Ave of the Americas New York, NY 10010

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Wellington Regional Medical Center Brenda Atkins 10101 Forest Hill Blvd. West Palm Beach, FL 33414

(561)798-8622

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

West Orange High School 1625 S. Beulah Road Winter Garden, FL 34787

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

West Palm Beach Board of City Commissione City of West Palm Beach PO Box 3366 West Palm Beach, FL 33402-3366

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Whole Food Market and its subsidiaries 550 Bowie Street Austin, TX 78703

(561)904-4001

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Whole Food Market Linda Belinsky 2635 S. State Road 7 Wellington, FL 33414

(561)904-4001

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Wireless Systems Group Inc Attn: Holland Ryan 4708 Brook Drive West Palm Beach, FL 33417

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

Workforce Alliance Contracts Unit 315 South Dixie Highway Suite 102 West Palm Beach, FL 33401

CERTIFICATE HOLDER

ACORD 25 (2014/01)

CANCELLATION

DATE (MM/DD/YYYY)

LOCJECTPRO-

POLICY

OCCURCLAIMS-MADE

GENERAL AGGREGATE $

$RETENTIONDED

CLAIMS-MADE

AGGREGATE $

EXCESS LIAB

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

PROPERTY DAMAGE $

INSDADDL

WVDSUBR

(Ea accident)

(Per accident)

OTHER:

INSURED

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INS025 (201401)

3/19/2018

Suite 500

(561)994-9994 (561)997-7087

Suite A-103

Master 18/19A

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

Excluded

300,000

Included

FLA STATUTE 768.28

*200,000 PER PERSON

200,000

300,000

Included

FLA STATUTE 768.28

YMCA of South Palm Beach County 6631 Palmetto Circle South Boca Raton, FL 33433

clawrence@ymcaspbc.org

CERTIFICATE OF LIABILITY INSURANCE - School District of

Documents

CERTIFICATE OF EMPLOYERS' LIABILITY INSURANCEmbtechniques.com/pdf/2019 EL Certificate - MB... · CERTIFICATE OF EMPLOYERS' LIABILITY INSURANCE Where required by regulation 5 of the

Whittlesea Letter Template · Web viewquot ation for each item in your project Certificate of public liability insurance, professional indemnity insurance or relevant business insurance

Business Insurance: Restaurant Liability Insurance

CERTIFICATE OF LIABILITY INSURANCEsethiinternational.ca/packet.pdf · CERTIFICATE OF LIABILITY INSURANCE This certificate does not amend, extend or alter the coverage afforded by

HUNTING LAND LIABILITY INSURANCE 2020-2021...and affordable liability insurance coverage available. HUNTING LAND LIABILITY INSURANCE 2020-2021 Liability Protection for your Hunting

STATE OF MINNESOTA Board of Private Detective and ...Credit from a Bank, General Liability Insurance Certificate - Accord 25 Form)? If you chose a general liability insurance policy,

CERTIFICATE OF LIABILITY INSURANCE DATE …...ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC PRO-POLICY GEN'L

PUBLIC LIABILITY INSURANCE EVERYTHING EXPLAINED · PUBLIC LIABILITY INSURANCE POLICY SUMMARY µ BUSINESS Public Liability Insurance is underwritten by Royal & Sun Alliance Insurance

AC~® CERTIFICATE OF LIABILITY INSURANCEsfasu.edu/purchasing/documents/insurance-certificates/... · 2019. 1. 9. · ac~® certificate of liability insurance date(mm/ddiyyyy) ~ 09/06/2018

FINANCIAL SERVICES PROFESSIONAL LIABILITY ......2019/03/01 · FINANCIAL SERVICES PROFESSIONAL LIABILITY INSURANCE POLICY (Claims Made and Reported) CERTIFICATE POLICY Administered

Marine and Energy Liability insurance - MS Amlin plc the world. • Energy insurance • Cargo insurance ... 6 Marine and Energy Liability insurance Marine and Energy Liability

4. Liability Insurance - protrain.hs.llnwd.net Basics of Liability...4. Liability Insurance Purpose of Liability Insurance Liability is the legal responsibility for damage to another

CERTIFICATE HOLDER A CERTIFICATE HAS ... - West Shore Home · type of insurance addl subr insr policy number policy eff mm/ddiyyyy acord@ certificate of liability insurance date (mwddnyyy)

DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE x/xx/xxxx

CERTIFICATE OF EMPLOYERS' LIABILITY INSURANCE · CERTIFICATE OF EMPLOYERS' LIABILITY INSURANCE Where required by regulation 5 of the Employers' Liability (Compulsory Insurance) Regulations

Client#: 19697 AMERIHUN CERTIFICATE OF LIABILITY INSURANCE DATE

How to Read a Certificate of Insurance Appendix...How to Read a Certificate of Insurance ... general liability insurance coverage to the insured 5. Boxes marked indicate the type of

TO WHOM IT MAY CONCERN CERTIFICATE OF … · TO WHOM IT MAY CONCERN CERTIFICATE OF INSURANCE Class of Insurance: Management Liability Insured: The Duke of Edinburgh’s International

CERTIFICATE OF LIABILITY INSURANCE - Mover's … · cancellation certificate of liability insurance date (mm/dd/yyyy) ject loc pro-policy ... this additional remarks form is a schedule

Chapter 6 Liability Insurance. What is Liability Insurance? There are many different types of insurance policies available, but liability insurance is