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OCA Certificates of Insurance 2019ACOROW CERTIFICATE OF LIABILITY INSURANCE ‘......---- DATE(MMIDD/YYYY) 08/19/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER JDA Insurance Group 120 N Federal Hwy #301 Lake Worth , FL 33460 CONTACT NAME: Christine Dewey ACPHONE. Ext): (561) 296-0373 FAX No): 5612960392 E-MAIL christine thecom ADDRESS: � 1jda rou 9 p• INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Philadelphia Indemnity Insurance Company 18058 INSURED Okeechobee Christian Academy 701 South Parrott Ave Okeechobee, FL 34974 INSURER.B: Philadelphia Indemnity Insurance Company 18058 INSURER c : Philadelphia Indemnity Insurance Company 18058 INSURER D : Insurance Co Of The West 27847 INSURERE: Philadelphia Indemnity Insurance Company 18058 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL TYPE OF INSURANCE ADDL NSR SUBR WVD POLICY NUMBER EFF (MMIDD/YYYY) POLICY EXP /YPOLICY (MM/DDYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY _...'..: Viz,'.-', ti ...---} PHPK2000717 07/01/2019 07/01/2020 EACH OCCURRENCE $ 1000000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ 3000000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS PHPK2000717 07/01/2019 07/01/2020 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE PHUB681884 07/01/2019 07/01/2020 EACH OCCURRENCE $ 1,000,000.00 AGGREGATE $ 1,000,000.00 DED X RETENTION $ 10,000.00 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVEANY (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YN N N / A WFL 5042021 01 07/02/2019 07/02/2020 WC STATU-NeOTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE -POLICY LIMIT $ 1,000,000.00 E Professional Liability PHPK2000724 07/01/2019 07/01/2020 Directors & Officers $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) RE: School Resource Officer THE CITY OF OKEECHOBEE IS ADDED AS AN ADDITIONAL INSURED FOR GENERAL LIABILITY ONLY WITH CONTRACT AND WITH RESPECTS TO THE OPERATIONS PERFORMED BY THE INSURED AS THEIR INTEREST MAY APPEAR. CERTIFICATE HOLDER CANCELLATION CITY OF OKEECHOBEE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 50 SE 2ND AVENUEt _...'..: Viz,'.-', ti ...---} OKEECHOBEE FL 349974 <' ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK2000717 Additional Insured Grace Brethern Church 701 S Parrott Ave Okeechobee, FL 34974-5137 CG2011 - FL - Loc #1 Additional Insured The Christ Fellowship Church 5343 Northlake Blvd Palm Beach Gardens, FL 33418-4554 CG2011 - FL - Loc #1 CG2026 - General Liability Additional Insured Orange County BCC 201 S Rosalind Ave Orlando, FL 32801-3527 CG2026 - General Liability Re: Educational field trip Additional Insured The City of Okeechobee R.E. Hamrick Testamentary Trust 55 SE 3rd Ave Okeechobee, FL 34974-2903 CG2026 - General Liability Re: With respect to a field day event for the school Additional Insured The City of Okeechobee, Florida and Police Department 55 SE 3rd Ave Okeechobee, FL 34974-2903 CG2026 - General Liability Page 1 of 1 Philadelphia Indemnity Insurance Company Locations Schedule Policy Number: PHPK2000717 Prems. Bldg. No. No. Address 0001 0001 701 S Parrott Ave Private School Okeechobee, FL 34974-5137 Page 1 of 1 POLICY CHANGES ENDORSEMENT DESCRIPTION In consideration of the premium reflected, the policy is amended as indicated below: Added: Additional Insured: The City of Okeechobee, Florida and Police Department Coverage for Employed Security Guard Per attached PATH ID: 13050336 REMOVAL PERMIT If this policy includes the Capital Assets Program (Output Policy) Coverage Part with all property scheduled on the Sche- duled Location Endorsement OP 14 01, or the Commercial Property Coverage Part, the following applies with respect to such Coverage Part(s): If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the previous location. IL 12 07 07 02 © ISO Properties, Inc., 2002 Page 2 ❑ POLICY NUMBER: PHPK2000717 IL 12 07 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA POLICY CHANGES Effective Date of Change: 08/16/2019 Change Endorsement No.: 1 Revision No.: 1 Named Insured: Okeechobee Christian Academy The following item(s): ❑ Insured's Name 0 Insured's Mailing Address ❑ Policy Number 0 Company 0 Effective/Expiration Date 0 Insured's Legal Status/Business of Insured ❑ Payment Plan 0 Premium Determination 14 Additional Interested Parties 14 Coverage Forms and Endorsements IR] Limits/Exposures 0 Deductibles ❑ Covered Property/Location Description ❑ Classification/Class Codes ❑ Rates 0 Underlying Insurance is (are) changed to read {See Additional Page(s)}: Path ID 13050336 The above amendments result in a change in the premium as follows: NO CHANGES TO BE ADJUSTED AT AUDIT ADDITIONAL PREMIUM $ 1,357.00 RETURN PREMIUM Countersigned By: Issue Date: 09/24/2019 IL 12 07 07 02 (Authorized Agent) © ISO Properties, Inc., 2002 Page 1 0