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Agenda Item 4H
AGENDA ITEM # 4H SEPTEMBER 9, 2013 CITY OF ATLANTIC BEACH CITY COMMISSION MEETING STAFF REPORT AGENDA ITEM: Contracts with Organizations Providing Recreation Programs at City Facilities DATE: August 19, 2013 SUBMITTED BY: Timmy Johnson, Recreation Director BACKGROUND: Several organizations have been offering recreational programs at City facilities for many years. The Atlantic Beach Athletic Association (ABAA) provides two seasons of T -ball, softball, and baseball each year. Tennis professional Brecht Catalan provides tennis lessons on Atlantic Beach courts. Yoga instructor Linda provides yoga classes at Adele Grage Cultural Center. In the past, each of these organizations entered into a contract with the City of Atlantic Beach which included the payment of a fee for the use of the facilities. These contracts have been updated for City Commission approval. The organization /person under contract provides opportunities for inclusion and participation for low income residents who may not otherwise be able to afford to participate. We are revising ABET's contract and it will be placed on the next City Commission Agenda. BUDGET: The fee in the contracts is $200 for the year, which is consistent with similar contracts in previous years. RECOMMENDATIONS: Authorize the City Manager to sign the attached contracts with ABAA, yoga instructor Linda White and tennis professional Brecht Catalan ATTACHMENTS: ABAA Proposed Contract Yoga Instructor Linda White Proposed Contract Tennis Professio al Brecht Catalan Proposed Contract REVIEWED BY CITY MANAGER: AGENDA ITEM # 4H SEPTEMBER 9, 2013 CITY {IMF ATLANTIC (BEACH RENTAL CONTRACT FOR P F It LIC FACILITIES LONG TERM AG I't EMENT made and entered into this day of at Atlantic Beach, Duval County, Florida, by and between CITY OF ATLANTIC BEACH, a Florida municipal corporation, 800 Seminole Road, Atlantic Beach, Florida 32233 (hereinafter "City "), and Atlantic Beach Athletic Association of Atlantic Beach, Florida (904) 249 -2985 (hereinafter "Renter "). WHEREAS, Renter desires to use the following public facility: Jack Russell Park Baseball Facilities and Concession Building and Donner Park Baseball Facility on Monday, Friday and Sunday and, WHEREAS, Renter desires to use said public facility on a recurring basis such as daily, weeldy, monthly, during a particular season, or the like, which is more than a one -time use, and therefore a long term use, and WHEREAS, the parties are in complete agreement regarding the terms set forth herein. NOW THEREFORE, in consideration of the covenants and promises as set forth herein, and any rental payment made hereunder, and other valuable consideration, the receipt and sufficiency of which is acknowledged by both parties, it is AGREED AS FOLLOWS: 1. Length of Rental Term: This agreement shall run from October 1, 2013 through September 30, 2014. 2. Amount and Time of Payment: Renter, in exchange for use of the facility, shall pay to the City the annual fee of $200.00 at the time of signing this agreement. Such fee may be waived at the discretion of the City Manager if Renter is a governmental agency or an organization that provides a public service available to all, is non - profit in nature, and charges no user or admission fees. Renter shall provide the City with a copy of its tax - exempt form or other proof or evidence satisfactory to the City Manager of Renter's non - profit status. 3. Conditions: This agreement is made and entered into upon the following express covenants and conditions, all and everyone of which Renter hereby covenants and agrees, with the City, to deep and perform: a. No fees or admission costs shall be charged to the public unless approved in writing by the City Manager. 1 AGENDA ITEM # 4H SEPTEMBER 9, 2013 b. No use of alcoholic beverages shall be permitted without the written permission of the City Manager c. Renter shall provide to the City a copy of audited financial statements if requested. In the event audited financial statements are not available, renter shall provide all supporting documents and financial statements. d. Renter shall insure compliance with all city, state and federal laws, as well as any rules and regulations of the City for the government and management of the public facility, together with all rules and requirements of the police and fire departments of the City. e. Renter shall allow no discrimination based on race, sex, age, religion, national origin, disability or otherwise. f. Renter shall make no alterations to the facility of a permanent nature without the express written consent of the City Manager. g. Renter's use of the facility is not exclusive outside of the dates and time as set forth below. h. Renter shall leave the facility available for use by other parties if other activities are scheduled or upon the request of City staff. This may include removal and storage of Renter's property. i. Renter shall correct any discrepancies noted by the City. Should the City require corrective action, such action shall be the financial responsibility of the Renter. • Renter shall provide a written account of all keys to the facility in possession of Renter at the end of the contract. If renter cannot account for all keys, Renter will incur the cost of re- keying or changing of the applicable locks. One key will be provided at no cost to Renter and any additional keys will require a $10 per key fee at Renter's expense. k. Any exclusive use shall be as set forth below. The use of the facility in addition to the exclusive use periods shall be requested through the Recreation Director under the general rules, i.e., a facility may be requested for short term use by applying for such use after the 15th day of each month for a day or time period within the next month. For example, any organization requesting the short-term use of a City facility in the month of February could apply for such use after the 15th day of January. AGENDA ITEM # 4H SEPTEMBER 9, 2013 1. Renter shall maintain at all times during the lease term at Renter's cost, a comprehensive public liability insurance policy protecting the City against all claims or demands that may arise or be claimed on account of Renter's use of the premises, in an amount of at least $1,000,000 for injuries to persons in one accident, $1,000,000 for injuries to any one person, and $1,000,000 for damages to property, the insurance shall be written by a company or companies acceptable to the City and authorized to engage in the business of general liability insurance in the State of Florida. Renter shall deliver to the City satisfactory proof or evidence of such insurance, and shall name the City as an additional insured under said policy. m. Renter may apply to the City Commission of Atlantic Beach for a waiver of this insurance requirement. The City Commission shall consider such application for waiver on a case by case basis, taking into account the length of the lease term, use of the public facility, number of persons involved in said use, cost of the insurance, and any other factors submitted by Renter which unique and particular to the Renter. n. Renter agrees to indemnify and hold harmless the City from any and all liability, defense costs, including other fees, loss or damage which the City may suffer as a result of claims, demands, costs or judgment against it, arising from all activities engaged in by Renter in its use of the following public facility: Jack Russell Baseball Facilities and Concession Building o. Additional provisions agreed upon by the City and Renter: Renter will actively recruit in low income areas, and provide scholarships, "work for play" or other mechanisms to assure that children are not denied the opportunity to participate due to their inability to pay the registration or other related fees. Number of scholarships will not exceed 7.5% of total registered players for that season. 4. Exclusive Use Dates and Times: August 1st through December 15th and January 1st through July 31. The City retains the right to rent and use the facility at other times not specified for use by the Renter. 5. Delivery of Facility: The City shall deliver the facility to Renter in good working condition, with any necessary facilities and utilities, and in clean condition. 6. Control of Facility: In renting said facility to Renter, the City does not relinquish the right to control the management and operation of the facility, and the City Manager or his designee may enter the facility and all of the demised premises at any time and on any occasion. 3 AGENDA ITEM # 4H SEPTEMBER 9, 20I3 7. Assignment: Renter shall not assign this agreement nor suffer any use of the facility other than herein specified, nor sublet the facility or any part thereof, without the written consent of the City. 8. DEFAULT: In case the Renter shall default in the performance of any covenant or agreement contained herein, and such default shall continue for ten (10) days after receipt by the Renter of written notice thereof given by the City, then the City, at its option, may declare this agreement ended. In that event, Renter shall immediately remove all persons and its property from the facility, and failing to do so, the City may cause such removal either with or without process of law, at Renter's expense. These expenses shall include, but not be limited to, reasonable attorney's fees incurred by the City, whether suit is filed or not." IN WITNESS WHEREOF, we have hereunto set our hands and official seals this day of CITY IF ATLANTIC BEACH By: Its: "CITY" 4 ABAA Income Statement 2012 Revenue - Registration $70,902.00 - Concessions 30,600.00 - Sponsorships and Donations 7,105.00 - Fundraisers 17,300.00 - Tournaments 2,451.85 - Refunds and Rebates 728.43 - Extra Uniform Fees 3,041.00 - Advanced Play 8,399.00 - All Stars* 38,245.18 Gross Revenue $178,772.46 Cost of Goods Sold - Uniforms $23,809.33 - Concessions Food 26,880.88 Bank 1,644.50 Supplies 193.72 -All Stars 50,859.46 - Advanced Play 5,434.20 - Trophies 3,876.86 - Fundraiser Start Up Fees 10,520.00 - Registration Refunds & Returns 1,568.00 - Fall Farewell 4,801.94 - Umpires 20,205.00 Cost of Goods Sold X933-.8 Gross Margin $ 28,978.57 Expenses - General & Administrative $12,71 L73 - Maintenance 7,502.98 - Equipment 4,902.35 - Personnel Expense Concessions Manager 8,500.00 Total Expenses $33,617.06 Net surplus / (.$0r1-05e) *All Stars are restricted fluids and will be used far specific expenses. '10 (037 ) AG1 NDA LTEM it 41 -1 SEPTEMBER 9, 2013 ACORD, CERTIFICATE OF LIAB U8 NCE AGENDA ITEM # 4H SEPTEMBER 9, 2013 UHI C tIVIlYVUU/T T T T) 3/7/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the 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 K &K Insurance Group, Inc 1712 Magnavox Way P.O. Box 2338 Fort Wayne CONTACT NAME: PHONE (A/C, No. Ext): E -MAIL ADDRESS: PRODUCER CUSTOMER ID #: Cheryl Pettibone 800 - 441 -3994 FAX (A/C, No): Cheryl .Pettibone @ka nd kinsu ran ce.co m INSURER(S) AFFORDING COVERAGE NAIC # INSURED ATLANTIC BEACH ATHLETIC ASSOC BABE RUTH LG P.O. Box 331235 Atlantic Beach, FL, 32233 INSURER A: Nationwide Life Insurance Co. INSURER B: Nationwide Mutual Insurance Co. INSURER C: INSURER D: COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR CERTIFICATE NUMBER: REVISION NUMBER: TYPE OF INSURANCE ADDL INSR SUBR wVD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN L AGGREGATE LIMIT APPLIES PER: 7 POLICY PROJECT n LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS RPG- 257083 -00 33105/2013 12:01AM 02/01/2014 12:01 AM EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS- COMP /OP AGG PARTICIPANT LEGAL LIABILITY RPG - 257083 -00 33/05/2013 12:01AM 02/01/2014 12:01 AM COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 $ 300,000 $ 5,000 $1,000,000 $5,000,000 $1,000,000 $1,000,000 $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB DEDUCTIBLE RETENTION OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABLITY ANY PROPRIETORSHIP /PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N/A WCSTATU- OTHER TORY LIMITS E.L. EACH ACCIDENT E.L. DISEASE — EA EMPLOYEE E.L. DISEASE — POLICY LIMIT PARTICIPANT ACCIDENT AD &D PRIMARY MEDICAL DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ADDITIONAL INSURED: ANY PERSON, ORGANIZATION OR ENTITY WHO IS ENGAGED IN PROVIDING THE PREMISES, IS A SPONSOR OR CO- PROMOTER, BUT SOLELY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. SEXUAL ABUSE /MOLESTATION: $1,000,000 PER OCCURRENCE /$2,000,000 AGGREGATE CERTIFICATE HOLDER CANCELLATION EVIDENCE OF COVERAGE Evidence of Coverage 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC CEO TDHCATE IF UABLOW 1NSUi\ CE AGENDA ITEM # 4H SEPTEMBER 9, 2013 UR 10 tnh It LW! I T 3/7/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the 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 K &K Insurance Group, Inc 1712 Magnavox Way P.O. Box 2338 Fort Wayne CONTACT NAME: Cheryl Pettibone PHONE (NC, No. Ext): 800-441-3994 FAX (A/C, No): E -MAIL ADDRESS: Cheryl.Pettibone@kandkinsurance.com PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED ATLANTIC BEACH ATHLETIC ASSOC BABE RUTH LG P.O. Box 331235 Atlantic Beach, FL, 32233 INSURER A: Nationwide Life Insurance Co. INSURER B: INSURER C: INSURER D: • 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 S UCH POLICIES. LIMITS S HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP DD/YYYY IMM/) LIMITS B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) CLAIMS -MADE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN L AGGREGATE LIMIT APPLIES POLICY —1 PROJECT PER: PRODUCTS- COMP /OP AGG r- LOC PARTICIPANT LEGAL LIABILITY B AUTOMOBILE A LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LIMIT (Ea Accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB DEDUCTIBLE RETENTION OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABLITY ANY PROPRIETORSHIP /PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTHER TORY LIMITS E.L. EACH ACCIDENT below E.L. DISEASE — EA EMPLOYEE E.L. DISEASE — POLICY LIMIT SPP- 257084 -00 12:01AM 03/05/2013 12:01AM 02/01/2014 AD&D PRIMARY MEDICAL A PARTICIPANT ACCIDENT $ 10,000 $ 250,000 DESCRIPTION ADDITIONAL PROMOTER, SEXUAL OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) INSURED: ANY PERSON, ORGANIZATION OR ENTITY WHO IS ENGAGED IN PROVIDING THE PREMISES, IS A SPONSOR OR CO. BUT SOLELY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. ABUSE /MOLESTATION: $1,000,000 PER OCCURRENCE/$2,000,000 AGGREGATE CERTIFICATE HOLDER CANCELLATI Evidence of Coverage 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORDTM EVIDENCE OF P PERTY INSURANCE AGENDA ITEM It 4H SEPTEMBER 9, 2013 DATE (f1M/DD/YYYY) 3/7/2013 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY MK Insurance Group 1712 Magnavox Way P.O. Box 2338 Fort Wayne, IN 46801 -2338 PHONE (A/C, No, Ext):1- 800 - 441.3994 FAX (A/C, No):1- 260. 459-5120 E-MAIL ADDRESS: Cheryl .Pettibone @kandkinsurance.com CODE: SUB CODE: AGENCY CUSTOMER DM COMPANY National Casualty Company INSURED Babe Ruth League, Inc. ATLANTIC BEACH ATHLETIC ASSOC BABE RUTH L P.O. Box 331235 Atlantic Beach, FL, 32233 LOAN NUMBER POLICY NUMBER KKO- 31294 -00 O EFFECTIVE DATE 03/05/2013 EXPIRATION DATE 02/01/2014 CONTINUED UNTIL TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATION /DESCRIPTION Various 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 EVIDENCE OF PROPERTY INSURANCE 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. COVERAGE INFORMATION COVERAGE /PERILS /FORMS AMOUNT OF INSURANCE DEDUCTIBLE $5,600.00 Unscheduled Miscellaneous Equipment REMARKS Including S ecial Conditions) Items Valued Over 55,000: SE — 51,500.00, FME — 53,500.00, CSE — 5600.00, PSU — 5.00, Deductible: $250.00 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. ADDITIONAL INTEREST NAME AND ADDRESS Evidence of Coverage MORTGAGEE LOSS PAYEE ADDITIONAL INSURED LOAN # AUTHORIZED REPRESENTATIVE ACORD 27 (2009/12) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Eage Rca a aidea,eicee, lege. Continuation of Charter This is to Certify, that Babe Ruth League, Inc. hereby renews ATLANTIC BEACH ATHLETIC ASSOC BABE RUTH LG Cal Rpken Baseball Babe Ruth Baseball Babe Ruth Softball as registered league(s) of Babe Ruth League, Inc. IN WITNESS WHEREOF, Babe Ruth League,. Inc., has caused this Certificate to be signed by its president, arid its corporate seal to be affixed hereto, and attested by its secretary. 2013 Season President Secretary AGENDA ITEM # 41-1 SEPTEMBER 9, 2013 NON - PROFIT RGANIZATION DIRECTORS AND OFFICERS INCLUDING EMPLOYMENT PRACTICES LIA IL ITY CERTIFICATE OF INSURANCE e r tca e Number: 16171 Company Affording Coverage: NATIONWIDE MUTUAL INSURANCE COMPANY ISSUED: 03/05/2013 AUTHORIZED AGENT: K&K INSURANCE GROUP, INC. THE COVERAGE SHOWN ON THIS CERTIFICATE IS CLAIMS MADE COVERAGE WHICH APPLIES ONLY TO CLAIMS FIRST MADE DURING THE COVERAGE PERIOD. This Certificate of Insurance provides you (the Insured Member) with the insurance indicated below as part of Master Policy #RPG- 257055 -00 issued to the Sports, Leisure and Entertainment RPG. This Certificate of Insurance together with the Master Policy Declarations, Coverage Form, Endorsements and Enrollment Form constitute the contract between the Insurer, the Organization and the Individual Insureds. Item A. INSURED MEMBER/PARENT ORGANIZATION ATLANTIC BEACH ATHLETIC ASSOC BABE RUTH LG P.O. Box 331235 Atlantic Beach, FL, 32233 ITEM B. COVERAGE PERIOD Effective: 03/05/2013 Expiration: 02 / 01 /14 (at 12:01 a.m. Standard Time at the address of the Parent Organization) ITEM C. LIMITS OF INSURANCE $1,000,000 EXCLUDED $ 500 EXCLUDED EXCLUDED Limit of Liability Maximum Aggregate Limit of Liability for each Policy Year: Outside Service Coverage: Retention (Each Claim): Medical Payments for Participants Directors and Officers: Volunteers: Total Premium Fully Earned at Inception: NOTICES: ALL NOTICES REQUIRED TO BE GIVEN TO THE INSURER UNDER THIS COVERAGE SHALL BE ADDRESSED TO: K &K Insurance Group, Inc. PO Box 2338, 1712 Magnavox Way Fort Wayne, IN 46801 PREMIUM $500.00 EXCLUDED INCLUDED EXCLUDED EXCLUDED $500.00 By: 4rAtV AUTHORIZED REPRESENTATIVE SIGNATURE SRPG3500 CERT (02/05) Nation Me AGENDA ITEM # 411 SEPTEMBER 9. 2013 NATIONWIDE LIFE INSURANCE COMPANY (Herein called the Company) Home Office: P.Q. Box 2399, Columbus, Ohio 43216 CERTIFICATE OF INSURANCE MEMBER: ATLANTIC BEACH ATHLETIC ASSOC BABE RUTH LG ADDRESS. P.0. Box 331235 Atlenlic Beach, FL, 32233 The Company hereby certifies that the Member shown above Is insured under Policy Number 6A SPP- 257084 -00 which It has issued to: BABE RUTH LEAGUE, INC. 1770 BRUNSWICK PIKE TRENTON, NJ 08638 The Company will provide the insurance described herein. All of the benefits and provisions of this program of insurance will be determined in accordance with all of the terms of the Policy. COVERAGE PERIOD: From 12 :01 AM on 0105/2013 to Midnight an 1131/14 All insurance under this Certificate will terminate on the earlier of the date of termination of the Policy, or at midnight on the last day of the Coverage Period shown above, without prejudice to any claim incurred while this Certificate is in force. Insured Person means rostered players, managing personnel (bat and ball boys /girls, score keepers, umpires and league officials), volunteers, persons trying out for team positions or persons acting in the capacity of managing personnel during preseason tryout sessions and Ladies Auxillary/Booster Club members; includes these persons and registered campers at the Babe Ruth League, Inc. sponsored baseball camp and World Series participants. Covered Event means a Babe Ruth League, Inc. approved baseball/ softball activity, practice sessions and baseball /softball games scheduled and supervised by Babe Ruth League, Inc. or one of its member leagues. Covered Event Includes any period when the Insured Person is participating under the direct supervision of the proper authorities of the league In approved tournament games as a member of the tournament team and while staying at the place of the tournament game. Covered Event includes Covered Travel as defined below. Covered Travel means team or group travel to or from the site of a Covered Event under the supervision of a coach or designated representative of Babe Ruth League, Inc. or one of lts member leagues. This certificate is subject to the laws of the state of New Jersey. BLANKET ACCIDENT BENEFITS CERTIFICATE SRBR -100 -1 C AGENDA ITEM # 4H SEPTEMBER 9, 2013 6A SPP- 257084 -00 TABLE OF CONTENTS HEADING SECTION General Definitions 1 Schedule of Insurance 2 Certificateholder Provisions 3 Benefits Provisions 4 General Exclusions and Limitations 5 Uniform Provisions 6 Special Provisions and Conditions 7 SRBR- 101 -1C 6A SPP- 257084 -00 SECTION 1 GENERAL DEFINITIONS AGENDA ITEM II 4H SEPTEMBER 9, 2013 1. "Accident" or "Accidental" means an unforeseen, unexpected and unintended occurrence. 2. "Injury" or "Bodily Injury" means bodily injury which results directly from an Accident and which is independent from disease, sickness or other bodily infirmity. 3. "Covered Accident" means an Accident which occurs while the Policy is in force at a Covered Event. 4. "Covered Event" means those events and activities specified on the face page. 5. "Doctor' means a licensed physician, chiropractor, physical therapist, or other practitioner of the healing arts acting within the scope of his or her license. 6. "Insured Person" means those persons specified on the face page. 7. "Intoxication" or "Intoxicated" means that the level of alcohol in the Insured Person's blood is found to be at the time of injury at or above the level a person is presumed to be intoxicated in the jurisdiction where the Covered Accident occurred. SRBR -102 -1 C 6A SPP- 257084 -00 Initial Premium SCHEDULE CE INSURANCE (hereinafter referred to as Schedule) SUBSEQUENT PREMIUMS PREMIUM DUE DATE PER INVOICE ACCIDENTAL DEATH AND DISMEMBERMENT ENEFIT Principal Sum ACCIDENT MEDICAL EXPENSE BENEFITS Covered Accident Deductible Amount Coinsurance Percentage Deductible Establishment Period Benefit Period Qualifying Period Maximum Benefit Limit for other than Covered Travel Maximum Benefit Limit for Covered Travel Daily Room and Board Limit For Private or Semi - Private Room For Intensive or Special Care LIMIT OF AGGREGATE LIABILITY BR -103 -2 (11 -02) AGENDA ITEM # 4H SEPTEMBER 9, 2013 PER INVOICE AMOUNT DUE PER INVOICE $10,000.00 $100.00 or, if greater, the amount of benefits applied for on behalf of the Insured Person; Covered Expenses from all Disablements will be combined for the purpose of satisfying the Deductible Amount. 100 6 Months 12 Months 365 $250,000.00 $100,000.00 Days The Average Semi - Private Rate of the Hospital in Which Confined Reasonable and Customary Charge NONE AGENDA ITEM # 4H SEPTEMBER 9, 2013 6A SPP- 257084 -00 SECTION 3 CERTIHICATEHOLDER PROVISIONS PREMIUM The initial premium must be paid on or before the effective date unless otherwise agreed to in writing by the Company. Subsequent premiums, if any, must be paid on or before the due dates or insurance will cease in accordance with the Grace Period provision described below. TERM OF POLICY AND CERTIFICATES The Policy is issued for the term specified in its face page. The Policyholder may terminate the Policy at any time by giving written notice to the Company. Such termination will be effective on the latter of a. the date the notice is received by the Company, and b. the day specified in the notice. The Company will make a refund of any premium paid for periods after the termination date. This Certificate is issued for the Coverage Period shown on its face page. The Certificateholder may terminate it at any time by giving written notice to the Company. Such termination will be effective on the latter of a. the date the notice is received by the Company, and b. the day specified in the notice. The Company will make a refund of any premium paid for periods after the termination date. GRACE PERIOD If the Policyholder has not previously given written notice to the Company that the Policy is to be terminated, a grace period of thirty -one (31) days, without interest charge, will be granted to the Policyholder for payment of every premium except the initial premium. During the grace period, the Policy will continue in force. REINSTATEMENT The Policy may be reinstated with the written consent of the Company. Application for reinstatement must be made by the Policyholder on forms provided by the Company. The Company will act promptly on an application for reinstatement. Failure of the Company to respond to any application for reinstatement within thirty (30) days of its receipt will automatically reinstate the Policy. All correspondence between the Company and the Policyholder concerning reinstatement must be conducted in writing. RENEWAL The Policy may be renewed with the mutual consent of the Policyholder and the Company. At least thirty (30) days before the Policy's ending date shown on the face page, the Company will advise the Policyholder in writing of the cost of continuing the Policy for another term unless it has advised the Policyholder of its intention to discontinue the policy. BR -103 -2 (11 -02) 6A SPP- 257084 -00 SECTION 4 ENEFIT PRSV SGSNS ACCIDENTAL EATH AND ISMEM EMI ENT AGENDA ITEM # 4H SEPTEMBER 9, 2013 The Company will pay the amount shown in the Table of Losses for a listed loss which: a. results solely from an Injury to the Insured Person which occurs during a Covered Event, and from no other contributory cause; and b. is sustained within one year after the date of the Injury. FOR LOSS OF: Life Both Hands Both Feet Sight of Both Eyes One Hand and One Foot One Hand and Sight of One Eye One Foot and Sight of One Eye Speech or Hearing (both ears) One Hand One Foot Sight of One Eye Hearing of One Ear Finger or toe, each Permanent, natural and sound teeth TABLE OF LOSSES AMOUNT PAYABLE: The Principal Sum The Principal Sum The Principal Sum The Principal Sum The Principal Sum The Principal Sum The Principal Sum One -Half the Principal Sum One -Half the Principal Sum One -Half the Principal Sum One -Half the Principal Sum One -Half the Principal Sum $500 or 2% of the Principal Sum, whichever is Tess Single: $25; Each additional: $10 Loss of hands and feet means Toss by severance at or above the wrist or ankle joint or total and irrecoverable loss of use of these members as a result of damage to tissue of that member. Loss of finger or toe means total and irrecoverable loss of entire phalanges. Loss of sight, speech or hearing means their total and irrecoverable loss. In the event of multiple losses resulting from a single covered accident, only the largest amount payable will be paid. SRBR - 105 -3C 6A SPP- 257084 -00 SECTOIN 4 BENEFIT REVISIONS CCIDENTAL DEATH AND ISMEMCBER ENT (continued) AGENDA ITEM # 4H SEPTEMBER 9, 2013 EXCLUSIONS AND LINIITATI ®INS No benefits are payable under this benefit provision for any loss caused or contributed to by: a. illness, or medical or surgical treatment thereof, including diagnosis; b. bacterial infection, except septic infection of and through a wound accidentally sustained; c. intentionally self- inflicted injury; d. a state of war or any act of war whether or not the Insured Person is in the armed services; e. participation in a riot or insurrection or as the result of the commission of a felony by the Insured Person; f. travel or flight in or descent from any aircraft, unless the Insured Person is a fare - paying passenger on a regularly scheduled flight on a commercial airline; or is a passenger on an aircraft chartered solely for the purpose of travel which has a valid airworthiness certificate from the jurisdiction in which operated and which is being operated by a duly licensed pilot; nuclear risk or incident. g. BENEFICIARY The beneficiary of the Insured Person is the person designated by him or her, on a form satisfactory to the Company, to receive any amount of insurance becoming payable under the terms of the Policy on account of his or her death. An Insured Person may change the beneficiary without the consent of any designated beneficiary, prior to designation of an irrevocable beneficiary, by filing written notice of the change on a form satisfactory to the Company. The new designation will be effective when the notice is received by the Company. The Company will not be liable for any payments it makes before receiving the notice. A new designation of beneficiary terminates the interest of any previous beneficiary. If more than one beneficiary is designated, but their respective interests are not specified, they will share equally. The interest of a beneficiary predeceasing the Insured Person will terminate and be shared equally by beneficiaries surviving the Insured Person, unless otherwise provided in the beneficiary designation. SRBR- 106 -2C 6A SPP- 257084 -00 SECTION 4 BENEFIT PROVISIONS ACCIDENT MEDICAL BENEFITS AGENDA ITEM # 46 SEPTEMBER 9, 2013 The Company will pay the coinsurance percentage of "Covered Expenses" in excess of the Covered Accident Deductible Amount incurred by an Insured Person: a. in each Benefit Period: b. as a result of a Disablement. The amount payable will not exceed the Maximum Benefit Limit shown on the Schedule (Section 2). "Disablement" means an Injury sustained in a Covered Accident. All Injuries sustained in any one accident are considered one Disablement. COVERED EXPENSES For the purpose of these benefits, the term "Covered Expenses" means the reasonable and customary expenses incurred by or on behalf of an Insured Person for those services and supplies listed below which are: administered or ordered by a Doctor; medically necessary to the diagnosis and treatment of any injury; and not excluded by any provision of the Policy. Covered Expenses are limited to charges: 1. made by a Hospital for: i. daily room and board and general nursing services, or confinement in an intensive care unit, not to exceed the applicable maximum limits shown in the Schedule; ii. use of an operating, treatment or recovery room; and emergency treatment even if confinement is not required. 2. made by a Doctor for professional services; 3. made by a licensed nurse, occupational therapist or physical therapist (who is not a member of the Insured Person's immediate family); 4. for professional ambulance service to and from a Hospital for necessary emergency care; 5. for drugs requiring the written prescription of a Doctor; 6. for diagnostic tests; 7. for the processing and administration of blood and blood components; 8. for oxygen and other gases and their administration; 9. for the cost and administration of an anesthetic; 10. for dressings, sutures, casts, splints, trusses, crutches, braces (except dental braces or corrective shoes), or other necessary medical supplies; 11. for the rental of a wheelchair, hospital bed or other durable medical equipment required for temporary therapeutic use, or the purchase of this equipment if economically justified, whichever is less; 12. for confinement in an Extended Care Facility which commences within five (5) days of a Hospital confinement of five (5) days or more; 13. for Home Health Care which is a. b. established and approved in writing by a Doctor and commences within seven (7) days of a Hospital confinement of five (5) days or more; 14. for artificial limbs, eyes or larynx (but not their replacement). SRBR -107 -1 C 6A SPP- 257084 -00 SEMI S hi 4 BENEFIT PROVISI ACCIDENTAL MEDICAL (continued) NS ENEFITS AGENDA ITEM # 4H SEPTEMBER 9, 2013 DEFINITIONS 1. "Extended Care Facility" means an institution operating pursuant to the law or regulations where it is located a. which has facilities for ten (10) or more inpatients; b. which is engaged in providing skilled nursing care and related services under the supervision of a Doctor and Registered Nurses to persons recovering from illness or injury; and c. which maintains written records of the medical treatment of each of its patients. 2. "Home Health Care" means nursing care and treatment in a person's home by a Hospital certified to provide Home Health Care Services or by a certified Home Health Care agency. It includes daily living care services, such as, cooking, feeding, bathing, dressing, and personal hygiene, which the Insured Person is unable to perform for himself or herself. 3. "Hospital" means an institution which meets all of the following requirements; a. it is licensed (if required) as a Hospital; b. it is open at all times; c. it is operated mainly to diagnose and treat illnesses and injuries on an inpatient basis; d. it has a staff of one (1) or more Doctors on call at all times; e. it provides nursing services by Registered Nurses twenty -four (24) hours a day; f. it is not, other than incidentally, a skilled nursing facility, clinic, nursing home, rest home, convalescence home or similar institution; and it has organized facilities for major surgery or provides for such facilities for its patients through formal written agreement with other Hospitals. 4. As to professional fees, the term "reasonable and customary" means that the charge is not in excess of the most common charge for similar professional services in the locality where the services are received. If the charge is in excess of the most common charge, no payment will be made with respect to the excess, and the excess will not qualify as a Covered Expense under the Policy. The "most common charge" for any given service and locality will be determined in good faith by the Company. As to other services or supplies, "reasonable and customary" charges will be determined in good faith by the Company, using a comparison of charges made by other providers of similar services or supplies in the locality where the services or supplies are received. No payment will be made with respect to any amount in excess of the "reasonable and customary" charge. g. 5. "Pre- Existing Condition" means a condition for which the Insured Person received medical advice or treatment by a Doctor within twenty -four (24) months prior to his or her becoming insured under the Policy. SRBR -108 -1 C 6A SPP- 257084 -00 SEMI N 4 ENEFIT PROVISIONS ACCIDENTAL MEDICAL BENEFITS (continued) AGENDA ITEM # 4H SEPTEMBER 9, 20I3 EXCLUSIONS AND LIMITATIONS Covered Expenses will never include, and no benefits will ever be payable for any charges which: a. exceed the reasonable and customary charges; b. are incurred for dental work unless the Insured Person sustains a Disablement which results in damage to his or her natural teeth; c. are incurred for television, telephone, water pitcher, and other personal convenience items, or expenses for other persons, except as may be specifically provided for elsewhere; d. are incurred for services or supplies not specifically provided for in the Policy; e. which would not have been made in the absence of insurance or which the Insured Person is not legally obligated to pay; f. result from an intentionally self - inflicted injury; g. arise out of the Insured Person's participation in a riot or his or her commission of a felony; h. are incurred for cosmetic procedures, unless made necessary by a Disablement; 1 are incurred for eyeglasses, contact lenses or hearing aids or for any examination or fitting related to these devices unless made necessary by a Disablement; J. are incurred for care or treatment which is not medically necessary to the diagnosis or treatment of a Disablement; k. are incurred for the professional services of a person who is a member of the Insured Person's immediate family; I. are incurred for care which is custodial in nature; m. are incurred for experimental treatment or procedures; n. are incurred for articles of clothing which are intended for use more than once; o. are incurred for treatment of a Pre - Existing Condition, unless 1. During the period immediately preceding coverage under the Policy, the Insured Person was covered under another blanket accident benefits Policy issued by the Company, and 2. The Company paid benefits for the condition under the blanket accident policy under which the Insured Person was previously insured; arise out or war, invasion, acts of foreign enemies, civil war, rebellion, insurrection or insurgencies; and arise out of nuclear risk or incident. p. q• SRBR -109 -1 C 6A SPP- 257084 -00 SECTION 4 BENEFIT PROVISIONS ACCIC• ENTAL ME ICAL BENEFITS AGENDA ITEM # 4H SEPTEMBER 9, 2013 COVERED ACCIDENT DEDUCTIBLE AMOUNT The "Covered Accident Deductible Amount" to be deducted from the total Covered Expenses incurred by each Insured Person for each Benefit Period, will be the Deductible Amount shown in the application of the Policyholder. Only those Covered Expenses incurred during the Qualifying Period shown in the Schedule will be used to satisfy the Covered Accident Deductible Amount. The Covered Accident Deductible Amount will not apply to Covered Expenses specifically identified in the Schedule as not being subject to it. If no Covered Expenses are incurred within the Deductible Establishment Period following the Covered Accident, no Benefit Period will begin and no benefits will be payable for that Disablement. QUALIFYING PERIOD The "Qualifying Period" shown in the Schedule is the period of time within which the Covered Accident Deductible Amount must be satisfied. It begins on the date of the Covered Accident. MAXIMUM BENEFIT LIMIT The "Maximum Benefit Limit" shown in the Schedule, is the total benefit payable for eligible Covered Expenses incurred during a Benefit Period. EXTENDED COVERAGE Termination of an Insured Person's insurance under the Policy shall not affect benefits payable for any Disablement originating prior thereto. BENEFIT PERIODS "Benefit Period" means that period which: a. begins on the date of the Covered Accident; and b. ends i. on the expiration of the Benefit Period shown in the Schedule, or ii. if earlier, at the end of any period of twelve (12) months during which less than $500 of Covered Expenses are incurred by the Insured Person. "Benefit Period" will be not less than 36 months with respect to the removal of internal fixation devices installed in an Insured Person as the result of a Covered Accident. SRBR- 111 -2C 6A SPP- 257084 -00 SECT IN 5 GENE L EXCLUS • NS AND LIMIT AT INS AGENDA ITEM # 4H SEPTEMBER 9, 2013 This Policy does not cover, and no payment will be made for any loss or expense arising out of Injury caused by or resulting from: a. self - destruction or attempts of self - destruction while sane, or intentionally self - inflicted injury; b. the attempt by the Insured Person to commit a felony; c. the Insured Person's being intoxicated; d. the use by the Insured Person of narcotics unless administered on the advice of a Doctor; e. illness or disease, except: 1. as may result from an Injury sustained in a Covered Accident; 2. a cardiovascular accident, stroke or other similar traumatic event caused by exertion while participating in a Covered Event; 3. the aggravation of a condition such as tendonitis, strains, sprains and other similar conditions caused by exertion while participating in a Covered Event; f. war, invasion, acts of foreign enemies, civil war, rebellion, insurrection or insurgencies; g. nuclear risk or incident. The liability of the Company will not exceed the Limit of Aggregate Liability shown on the Schedule for all losses or expense resulting from a single Covered Accident or a single conveyance. If this amount is insufficient to pay all claims, each claim or Toss will be paid at the ratio of the Limit of Aggregate Liability to the actual total liability resulting from the Covered Accident. SRBR - 116 -2C 6A SPP- 257084 -00 SECTION 6 UNIFORM PROVISIONS AGENDA ITEM # 41-I SEPTEMBER 9, 2013 NOTICE OF C_ M Written notice of any Injury which may lead to a claim under the policy must be given to the Company within 30 days after the Injury, or as soon thereafter as is reasonably possible. Failure to give notice within such time shall not invalidate nor reduce any claim if it is shown that notice was given as soon as was reasonably possible. CLAIM FORMS The Company, upon receipt of a written notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If these forms are not furnished within 15 days after the notice is sent, the claimant may comply with the proof of loss requirements of the policy by submitting within the time fixed in the Policy for filing proofs of loss, written proof showing the occurrence, nature and extent of the loss for which claim is made. PROOFS OF LOSS Written proof of Toss must be furnished to the Company within ninety (90) days after the date of loss. However, in case of claim for loss for which the Policy provides any periodic payment contingent upon continuing loss, this proof must be furnished within ninety (90) days after termination of each period for which the Company is liable. Failure to furnish proof within the time required will not invalidate nor reduce any claim if it is not reasonably possible. TIME FOR PAYMENT OF CLAIM Benefits payable under the Policy will be made immediately upon receipt of satisfactory written proof of loss, unless the Policy provides for periodic payments. Where the Policy provides for periodic payments, the benefits will accrue and be paid monthly, subject to satisfactory written proof of loss. PAYMENT OF CLAIM Benefits payable on account of the Insured Person's death will be made to the beneficiary. If no valid beneficiary has been designated, the Company will pay the Insured Person's estate, or at the option of the Company, to the following: a. the Insured Person's spouse, if living; otherwise b. the Insured Person's then living children, if any, equally; otherwise c. the Insured Person's surviving parent(s), equally; otherwise d. the Insured Person's surviving brothers and /or sisters, equally. If any indemnity of this Policy shall be payable to an estate of the Insured Person, or to the Insured Person or beneficiary who is a minor or otherwise unable to give a valid release, the Company may pay such indemnity, up to an amount not exceeding $1,000, to any relative by blood or by marriage of the Insured Person or beneficiary who is deemed by the Company to be equitably entitled thereto. Payment in accordance with this paragraph will release the Company from all liability hereunder for any amount so paid. The death benefits provided hereunder shall not be assigned, transferred, or encumbered, and to the extent permitted by law will be exempt from attachment and otherwise free from the claims of creditors of the Insured Person or beneficiary. All other indemnities of the Policy are payable to the Insured Person. All or any portion of any indemnities provided by the policy on account of hospital, nursing, medical or surgical services may, at the Company's option be paid directly to the Hospital or other person rendering such services; but it is not required that the service be rendered by a particular Hospital or person. Any payment made by the Company in good faith pursuant to this provision will fully discharge the Company's obligation to the extent of the payment. REIMBURSEMENT OF CLAIMS The Company shall reimburse all claims or any portion of any claim from an insured or an insured's assignee, for payment under the policy, within 60 days after receipt of the claim by the Company. If a claim or a portion of a SRBR-117-1C 1 AGENDA ITEM # 411 SEPTEMBER 9, 2013 SECS! N UNIFORM PROVISIINS REIMBURSEMENT OF CLAMS (continued) claim is contested by the Company, the insured or the insured's assignee shall be notified in writing within 45 days after receipt of the claim by the Company, that the claims is contested or denied; except that, the uncontested portion of the claim shall be paid within 60 days after receipt of the claim by the Company. The notice that a claim is contested will identify the contested portion of the claim and the reasons for contesting the claim. The Company, upon receipt of the additional information requested from the insured or the insured's assignee, will pay or deny the contested claim or portion of the contested claim, within 90 days. Payment will be treated as being made on the date a check is placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery. CONTRACT The entire contract between the Company and the Policyholder consists of the Policy, the application of the Policyholder, and the applications, if any, of the Insured Persons all of which shall be attached to the Policy when issued. All statements contained in the applications will be deemed representations and not warranties. No statement made by an applicant for insurance will be used to void the insurance or reduce the benefits, unless contained in a written application signed by the applicant. No agent has the authority to make or modify the policy, or to extend the time for payment of premiums, or to waive any of the Company's rights or requirements. No changes to the Policy will be valid unless approved by an officer of the Company and evidenced an endorsement on the Policy or amendment of the Policy, signed by the Policyholder and the Company. TITLES OR HEADINGS The titles or headings used in the Policy are intended for reference only. They are not intended and will not be construed to be a substantive part of the Policy. They will not affect the validity, construction or effect of the Policy provisions. PHYSICAL EXAMINATION AND AUTOPSY The Company, at its own expense, will have the right and opportunity to examine an Insured Person, when and as often as may be reasonably required during the pendency of a claim under the Policy and to make an autopsy in the case of death, where it is not forbidden by law. LEGAL ACTION No action at law or in equity may be brought to recover on the policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of the Policy. No such action may be brought after the expiration of three (3) years after the time of written proof of loss is required to be furnished. CONFORMITY WITH STATE STATUTES Any provision of the Policy which, on its effective date, is in conflict with the statutes of the state in which it is delivered is hereby amended to conform to the minimum requirements of those statutes. ASSIGNMENT No assignment of the Policy, or any part of it, will be binding on the Company unless approved in writing by the President or Vice President, and Secretary of the Company. The Company does not assume any responsibility for the validity of any assignment. OTHER INSURANCE WITH THIS INSURER If an Insured Person is covered by other insurance issued by the Company which: a. duplicates any coverage of the Policy; and b. is not subject to the Coordination of Benefits or Excess provisions of this Policy, then the Insured Person (or his or her beneficiary) will elect the coverage of one policy. The Company will then return all premiums paid for the Insured Person's coverage under all other policies not paying benefits because of this paragraph. SRBR -117 -1 C 2 AGENDA ITEM # 411 SEPTEMBER 9, 2013 ABAA 2013 -2014 Fee Schedule Softball $75 Baseball $110 (Tball, Rookies, Minors, Majors) Seniors $120 AGENDA ITEM # 41-I SEPTEMBER 9, 2013 CITY OF ATLANTIC BEACH RENTAL CONTRACT FOR PUBLIC FACILITIES LONG TERM AGREEMENT made and entered into this day of at Atlantic Beach, Duval County, Florida, by and between CITY OF ATLANTIC BEACH, a Florida municipal corporation, 800 Seminole Road, Atlantic Beach, Florida 32233 (hereinafter "City "), and Brecht Catalan, Tennis Instructor of 12855 Greenmeadow Place Jacksonville, FL 32246 (904) 241 -4625 (hereinafter "Renter "). WHEREAS, Renter desires to use the following public facility: Jack Russell Park Tennis Courts 4, 5, & 6 and, WHEREAS, Renter desires to use said public facility on a recurring basis such as daily, weekly, monthly, during a particular season, or the like, which is more than a one -time use, and therefore a long term use, and WHEREAS, the parties are in complete agreement regarding the terms set forth herein. NOW THEREFORE, in consideration of the covenants and promises as set forth herein, and any rental payment made hereunder, and other valuable consideration, the receipt and sufficiency of which is acknowledged by both parties, it is AGREED AS FOLLOWS: 1. Length of Rental Term: This agreement shall run from October 1, 2013 through September 30, 2014. 2. Amount and Time of Payment: Renter, in exchange for use of the facility, shall pay to the City the annual fee of $214.00 at the time of signing this agreement. Such fee may be waived at the discretion of the City Manager if Renter is a governmental agency or an organization that provides a public service available to all, is non - profit in nature, and charges no user or admission fees. Renter shall provide the City with a copy of its tax- exempt form or other proof or evidence satisfactory to the City Manager of Renter's non -profit status. 3. Conditions: This agreement is made and entered into upon the following express covenants and conditions, all and everyone of which Renter hereby covenants and agrees, with the City, to deep and perform: a. No fees or admission costs shall be charged to the public unless approved in writing by the City Manager. b. No use of alcoholic beverages shall be permitted without the written permission of the City Manager 1 AGENDA ITEM # 4H SEPTEMBER 9, 2013 c. Renter shall provide to the City a copy of audited financial statements if requested. In the event audited financial statements are not available, renter shall provide all supporting documents and financial statements. d. Renter shall insure compliance with all city, state and federal laws, as well as any rules and regulations of the City for the government and management of the public facility, together with all rules and requirements of the police and fire departments of the City. e. Renter shall allow no discrimination based on race, sex, age, religion, national origin, disability or otherwise. f. Renter shall make no alterations to the facility of a permanent nature without the express written consent of the City Manager. g. Renter's use of the facility is not exclusive outside of the dates and time as set forth below. h. Renter shall leave the facility available for use by other parties if other activities are scheduled or upon the request of City staff. This may include removal and storage of Renter's property. i. Renter shall correct any discrepancies noted by the City. Should the City require corrective action, such action shall be the financial responsibility of the Renter. J• Renter shall provide a written account of all keys to the facility in possession of Renter at the end of the contract. If renter cannot account for all keys, Renter will incur the cost of re- keying or changing of the applicable locks. One key will be provided at no cost to Renter and any additional keys will require a $10 per key fee at Renter's expense. k. Any exclusive use shall be as set forth below. The use of the facility in addition to the exclusive use periods shall be requested through the Recreation Director under the general rules, i.e., a facility may be requested for short term use by applying for such use after the 15th day of each month for a day or time period within the next month. For example, any organization requesting the short-term use of a City facility in the month of February could apply for such use after the 15th day of January. 2 AGENDA ITEM # 4I-1 SEPTEMBER 9, 2013 1. Renter shall maintain at all times during the lease term at Renter's cost, a comprehensive public liability insurance policy protecting the City against all claims or demands that may arise or be claimed on account of Renter's use of the premises, in an amount of at least $1,000,000 for injuries to persons in one accident, $1,000,000 for injuries to any one person, and $1,000,000 for damages to property, the insurance shall be written by a company or companies acceptable to the City and authorized to engage in the business of general liability insurance in the State of Florida. Renter shall deliver to the City satisfactory proof or evidence of such insurance, and shall name the City as an additional insured under said policy. m. Renter may apply to the City Commission of Atlantic Beach for a waiver of this insurance requirement. The City Commission shall consider such application for waiver on a case by case basis, taking into account the length of the lease term, use of the public facility, number of persons involved in said use, cost of the insurance, and any other factors submitted by Renter which unique and particular to the Renter. n. Renter agrees to indemnify and hold harmless the City from any and all liability, defense costs, including other fees, loss or damage which the City may suffer as a result of claims, demands, costs or judgment against it, arising from all activities engaged in by Renter in its use of the following public facility: Jack Russell Park Tennis Courts 4, 5 & 6 o. Additional provisions agreed upon by the City and Renter: None 4. Exclusive Use Dates and Times: See attached for schedule. The City retains the right to rent and use the facility at other times not specified for use by the Renter. 5. Delivery of Facility: The City shall deliver the facility to Renter in good working condition, with any necessary facilities and utilities, and in clean condition. 6. Control of Building: In renting said facility to Renter, the City does not relinquish the right to control the management and operation of the facility, and the City Manager or his designee may enter the facility and all of the demised premises at any time and on any occasion. 7. Assignment: Renter shall not assign this agreement nor suffer any use of the facility other than herein specified, nor sublet the facility or any part thereof, without the written consent of the City. 3 AGENDA ITEM # 4H SEPTEMBER 9, 2013 8. DEFAULT: In case the Renter shall default in the performance of any covenant or agreement contained herein, and such default shall continue for ten (10) days after receipt by the Renter of written notice thereof given by the City, then the City, at its option, may declare this agreement ended. In that event, Renter shall immediately remove all persons and its property from the facility, and failing to do so, the City may cause such removal either with or without process of law, at Renter's expense. These expenses shall include, but not be limited to, reasonable attorney's fees incurred by the City, whether suit is filed or not." INTNESS WHEREOF, we have hereunto set our hands and official seals this 3 day of CITY OF ATLANTIC BEACH By: Its: "CITY" 4 AGENDA ITEM # 4H SEPTEMBER 9, 2013 ACGR ® CERTIFICATE LIABILITY I Page 1 of 1 DATE (MMIDDIYYYY) 06/21/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the 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 Willis Insurance Services of Georgia, Inc. c/o 26 Century Blvd. P.O. Box 305191 Nashville, TN 37230 -5191 CONTACT NAMF• PHONE 877 -945 -7378 (Arc,No)• 888- 467 -2378 (AIn,NOIFXT)• E-MAIL nRSS: certificates®wiliiE.com INSURER(S)AFFORDINGCOVERAGE NAIC# INSURERA: Philadelphia Insurance Companies 18058 -900 INSURED United States Professional Tennis Association, Inc. 3535 Briarpark Drive Suite One Houston, TX 77042 INSURER B:ACE American Insurance Company 22667 -008 INSURER C: $ INSURER D: INSURERE: X OCCUR INSURER F: -- -.._._- ........_....._ $ 1,000,000 GOVERALibb t,CRI IrILAI c tVUmocrc. J.77ao4, o -- --- 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 ITR A TYPE OF INSURANCE INSRr ADD'L SUBR win POLICY NUMBER PHPK948137 POLICYEFF (MMInnTVVYV) 12/31 /2012 POLICYEXP LIMITS (MMmnrYYVY) 12/33./2011 EACHOCCURRENCE $ 1, 000, 000 $ 500,000 GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY PREMISES(Eaoccurence) MED EXP (Any one person) $ CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 X Athletic Participant GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP /OPAGG $ 1,000,000 GEN'L AGGREGATE POLICY LIMIT APPUESPER: pFCDr 100 $ X AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT C aaccident) $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED AUTOS NONAWNEO gUTOS BODILY INJURY(Peraccident) $ pROPERTYDAMAGE (Peracddent) $ $ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE PmUB403104 12/31/2012 12/31/2012 EACH OCCURRENCE $ 3,000,000 $ 3,000,000 $ AGGREGATE DED I X (RETENTIONS 10,000 NIA WCSTATU• TORY IIMITS OTH- FR WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE I / I OFFICERIMEMBEREXCLUDED7 Ifyes,d oryinNH) lSCRI Bonder DESCRIPTION OF OPERATIONS below E.L EAGHACCIDENT $ E.L. DISEASE EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Excess Liability _ XCQ G25833442 12/31/201212/31 /2012 $5,000,000 Limit DESCRIPTION Brecht USPTA operating OF OPERATIONS/LOCATIONS/VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space is required) Catalan #29482 Members are Insureds for General Liability for playing, teaching or officiating in tennis or a tennis ball machine for practicing or teaching. CERTIFICATE HOLDER CANCELLATION City of Atlantic Beach B00 Seminole Rd Atlantic Beach, FL 32233 ACORD 25 (2010105) 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 .-$2/1/14r f /-LL.CA {rACl1 C011:4135281 Tp1:1659177 Cert:19988279 © 1988- 2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENDA ITEM # 4H SEPTEMBER 9, 2013 2012 Atlantic Beach Financial Report for Tennis lessons at Jack Russell Park ATT: Timmy Johnson FR: Brecht Catalan Winter /Spring Programs 14 Ladies 12 weeks $225.00 $1200.00 lO Men 12 weeks $150.00 $ 850.00 10 Juniors 12 weeks $150.00 $1200.00 Private Lessons 5 Students 12 weeks $ 200.00 $2000.00 Summer Programs 5 Ladies 6 weeks $ 75.00 $ 300.00 10 Men 6 weeks $150.00 $ 450.00 Juniors Camp (10) 2 weeks $175.00 $ 350.00 Private Lessons 6 students 6 weeks $240.00 $1800.00 Fall Programs Juniors Clinic(20) 12 weeks $120.00 $1500.00 Private Lessons 12 students 12 weeks $200.00 $1640.00 Adult Clinics 10 Ladies 12 weeks $ 75.00 $ 920.00 15 Men 12 weeks $225.00 $1115.00 Sunday Monday Tuesday Wednesday Thursday Friday Saturday AGENDA ITEM # 4H SEPTEMBER 9, 2013 Jack Russell Park Tennis Schedule Courts 4, 5, 6 Reserved for Lessons 2013 3 pm — 4 pm Private 4 pm — 5 pm Developmental Clinic 5 pm — 6 pm Cardio Tennis 6 pm — 7 pm Private 9 am —1 pm Junior Clinics — Private (seasonal) 11 am — 2 pm Juniors — Advanced 4 pm — 5 pm Private 5 pm — 6 pm Junior Group Clinic 6 pm — 9 pm Men's Advanced Clinic 10 am —11 am Private 11 am —1 pm Junior Group 5 pm — 6 pm Private 6 pm — 8 pm Ladies 11 am —1 pm Private 4:30 pm — 5:30 pm Private 5:30 pm — 6:30 pm Ladies League 6:30 pm — 7:30 pm Developmental 11 am —1 pm Juniors 1 pm — 2 pm Private 5:30 pm — 6:30 pm Juniors 5 pm — 7 pm 6 pm — 9 pm Private League Match Play (seasonal) 12 pm — 4 pm Women's Doubles League (seasonal) For tennis Lessons or program information at Jack Russell Park, please contact Breck Catalan at (904) 803 -7213. Miscellaneous (less than 5 lessons each) Pro bono work Tennis Carnivals, Volunteer hours (45 hours) $1840.00 $ 00.00 Total earned $13,325.00 Fee Schedule Private Lessons Cardio Group Lessons $40 per person $10 per person $15 person person AGENDA ITEM # 4H SEPTEMBER 9, 2013 AGENDA ITEM # 4H SEPTEMBER 9, 2013 CITY OF ATLANTIC BEACH RENTAL CONTRACT FOR PUBLIC FACILITIES LONG TERM AGREEMENT made and entered into this day of at Atlantic Beach, Duval County, Florida, by and between CITY OF ATLANTIC BEACH, a Florida municipal corporation, 800 Seminole Road, Atlantic Beach, Florida 32233 (hereinafter "City "), and Linda White of 422 17th Avenue North, Jacksonville Beach, Florida 32250 (hereinafter "Renter "). WHEREAS, Renter desires to use the following public facility: The Adele Grage Cultural Center Community Room and, WHEREAS, Renter desires to use said public facility on a recurring basis such as daily, weeldy, monthly, during a particular season, or the like, which is more than a one -time use, and therefore a long term use, and WHEREAS, the parties are in complete agreement regarding the terms set forth herein. NOW THEREFORE, in consideration of the covenants and promises as set forth herein, and any rental payment made hereunder, and other valuable consideration, the receipt and sufficiency of which is acknowledged by both parties, it is AGREED AS FOLLOWS: 1. Length of Rental Term: This agreement shall run from October 1, 2013 through September 30, 2014. 2. Amount and Time of Payment: Renter, in exchange for use of the facility, shall pay to the City the annual fee of $214.00 at the time of signing this agreement. Such fee may be waived at the discretion of the City Manager if Renter is a governmental agency or an organization that provides a public service available to all, is non -profit in nature, and charges no user or admission fees. Renter shall provide the City with a copy of its tax- exempt form or other proof or evidence satisfactory to the City Manager of Renter's non -profit status. 3. Conditions: This agreement is made and entered into upon the following express covenants and conditions, all and everyone of which Renter hereby covenants and agrees, with the City, to deep and perform: a. No fees or admission costs shall be charged to the public unless approved in writing by the City Manager. b. No use of alcoholic beverages shall be permitted without the written permission of the City Manager 1 AGENDA ITEM # 4H SEPTEMBER 9, 2013 c. Renter shall provide to the City a copy of audited financial statements if requested. In the event audited financial statements are not available, renter shall provide all supporting documents and financial statements. d. Renter shall insure compliance with all city, state and federal laws, as well as any rules and regulations of the City for the government and management of the public facility, together with all rules and requirements of the police and fire departments of the City. e. Renter shall allow no discrimination based on race, sex, age, religion, national origin, disability or otherwise. f. Renter shall make no alterations to the facility of a permanent nature without the express written consent of the City Manager. g. Renter's use of the facility is not exclusive outside of the dates and time as set forth below. h. Renter shall leave the facility available for use by other parties if other activities are scheduled or upon the request of City staff. This may include removal and storage of Renter's property. i. Renter shall correct any discrepancies noted by the City. Should the City require corrective action, such action shall be the financial responsibility of the Renter. J. Renter shall provide a written account of all security key cards to the facility in possession of Renter at the end of the contract. If renter cannot account for all keys, Renter will incur the cost of canceling the lost card and issuing a new one. One key will be provided at no cost to Renter and any additional keys will require a $20 per key fee at Renter's expense. k. Any exclusive use shall be as set forth below. The use of the facility in addition to the exclusive use periods shall be requested through the Recreation Director under the general rules, i.e., a facility may be requested for short term use by applying for such use after the 15th day of each month for a day or time period within the next month. For example, any organization requesting the short-term use of a City facility in the month of February could apply for such use after the 15th day of January. 2 AGENDA ITEM # 4H SEPTEMBER 9, 2013 1. Renter shall maintain at all times during the lease term at Renter's cost, a comprehensive public liability insurance policy protecting the City against all claims or demands that may arise or be claimed on account of Renter's use of the premises, in an amount of at least $1,000,000 for injuries to persons in one accident, $1,000,000 for injuries to any one person, and $1,000,000 for damages to property, the insurance shall be written by a company or companies acceptable to the City and authorized to engage in the business of general liability insurance in the State of Florida. Renter shall deliver to the City satisfactory proof or evidence of such insurance, and shall name the City as an additional insured under said policy. m. Renter may apply to the City Commission of Atlantic Beach for a waiver of this insurance requirement. The City Commission shall consider such application for waiver on a case by case basis, taking into account the length of the lease term, use of the public facility, number of persons involved in said use, cost of the insurance, and any other factors submitted by Renter which unique and particular to the Renter. n. Renter agrees to indemnify and hold harmless the City from any and all liability, defense costs, including other fees, loss or damage which the City may suffer as a result of claims, demands, costs or judgment against it, arising from all activities engaged in by Renter in its use of the following public facility: Adele Grage Cultural Center Community Room o. Additional provisions agreed upon by the City and Renter: None 4. Exclusive Use Dates and Times: Yoga classes will take place on Sundays from 4 to 5 pm. The City retains the right to rent and use the facility at other times not specified for use by the Renter. 5. Delivery of Facility: The City shall deliver the facility to Renter in good working condition, with any necessary facilities and utilities, and in clean condition. 6. Control of Building: In renting said facility to Renter, the City does not relinquish the right to control the management and operation of the facility, and the City Manager or his designee may enter the facility and all of the demised premises at any time and on any occasion. 7. Assignment: Renter shall not assign this agreement nor suffer any use of the facility other than herein specified, nor sublet the facility or any part thereof, without the written consent of the City. 3 AGENDA ITEM # 41-I SEPTEMBER 9, 2013 8. DEFAULT: In case the Renter shall default in the performance of any covenant or agreement contained herein, and such default shall continue for ten (10) days after receipt by the Renter of written notice thereof given by the City, then the City, at its option, may declare this agreement ended. In that event, Renter shall immediately remove all persons and its property from the facility, and failing to do so, the City may cause such removal either with or without process of law, at Renter's expense. These expenses shall include, but not be limited to, reasonable attorney's fees incurred by the City, whether suit is filed or not." IN WITNESS WHEREOF, we have hereunto set our hands and official seals this !v day of tTUO L 2-0 (3 . CITY OF ATLANTIC BEACH By: Its: "CITY" co--(4e,e2_ "RENTER" 4 AGENDA ITEM # 4H SEPTEMBER 9, 20I3 Yoga Financials 2013 January (20 participants) /4 $200 February (17 participants) /4 $170 March (15 participants) /4 $150 April (21 participants) /4 $210 May (15 participants) /4 $150 2013 TOTAL $880 Serving 88 participants in 20 classes Fee for participants is $10 /per class ACORD,„ CERTIFICATE OF LIABILITY INSURANCE PRODUCER Sports & Fitness Insurance Comp P.O. Box 1967 Madison, MS 39130 DATE (MM/DD/YYYY) 9/5/2013 THIS CERTIFICATE IS ISSUED AS AGENDA ITEM # 4H ONLY AND CONFERS NO RIGH' HOLDER. THIS CERTIFICATE DOI SEPTEMBER 9, 2013 ALTER THE COVERAGE AFFORDL— INSURERS AFFORDING COVERAGE NAIC# INSURED Linda White, Linda White 422 17th Avenue North Jacksonville Beach, FL 32250 INSURER A: General Insurance Company of America INSURER B: INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L ;, l',_. k_Uii,C,. POLICY POLICY EFFECTIVE uul ..Ali POLICY EXPIRATION r ❑I AA LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY LPF-9634381A 3/31/2013 3/31/2014 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENED PREMISES (aoccureence) $ 1,000,000 CLAIMS MADE X OCCUR MEDEXP(Anyoneperson) $ 10,000 X Professional PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? 0 yes, describe under SPECIAL PROVISIONS below WC STATU- OTH- TORY LIMITS ER E.L EACHACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Yoga Instructors Certificate holder is named Insured. e. Linda White v 422 17th Avenue North Jacksonville Beach, FL 32250 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08)