Certificate of LiabilityDATE(MMIDD/YYYY)
A�� �� CERTIFICATE OF LIABILITY INSURANCE
08/31/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Christine Dewey
NAME:
JDA Insurance Group PHONE (561) 296-0373 F'4X (561) 828-0997
a✓c No Ext : A/C, No :
120 N. Federal Hwy., #301 e M R�F��. christine@thejdagroup.com
Lake Worth
INSURED
COVERAGES
INSURER(S) AFFORDING COVERAGE NAIC #
FL 33460 iNsuReRa: Philadelphia lndemnity Insurance Company 18058
iNsuReR e: Insurance Company of the West 27847
Okeechobee Christian Academy, IIIC. INSURER C:
701 South Parrott Ave INSURER D:
INSURER E :
Okeechobee FL 34974 INSURERF:
CERTIFICATE NUMBER: CL2183100816 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ �,OOO,OOO
CLAIMS-MADE �X OCCUR PREM SESOEa occE ence $ 500,000
MED EXP (Any one person) $ 5,000
A Y PHPK2268175 07/01/2021 07/01/2022 pERSONAL&ADVINJURY g 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 3,000,000
X POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ 3,000,000
JECT
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ �,OOO,OOO
(Ea accident)
ANYAUTO BODILY INJURY (Per person) $
A OWNED SCHEDULED PHPK2268175 07/01/2021 07/01/2022 BODILYINJURY(Peraccident) $
AUTOS ONLY AUTOS
X HIRED �/ NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY �� AUTOS ONLY Per accident
$
X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ �,OOO,OOO
/a EXCESSLIAB CLAIMS-MADE PHU6765957 07/01/2021 ��/��/2�22 qGGREGATE $ �,���,���
DED X RETENTION $ 10,000 Products-Comp/OpAgg $ 1,000,000
WORKERS COMPENSATION X STATUTE E�RH
AND EMPLOYERS' LIABILITY Y� N 'I,OOO,OOO
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
B OFFICER/MEMBER EXCLUDED? ❑ N IA WFL 5042021 03 07/02/2021 07/02/2022
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
Each Claim $1,000,000
A Professional Liability pHPK2282925 07/01/2021 07/01/2022 Aggregate $1,000,000
Retention $1,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: School Resource Officer
The City of Okeechobee is included as an Additional Insured under the General Liability policy as required by written contracUagreement, with respects to
the operations performed by the named insured, as their interests may appear.
CERTIFICATE HOLDER
City of Okeechobee
50 SE 2nd Avenue
Okeechobee
ACORD 25 (2016/03)
CANCELLATION
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
FL 34972 I ��"^�
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