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BOYSGIR47
GOON
BATE10/30/2024
Client#: 1684676
ACORD. CERTIFICATE OF LIABILITY INSURANCE
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: ff 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 any rights to the certificate holder In lieu of such endorsement(s).
PRODUCER ROMA’ Jack Taylor
USI Insurance Services, LLC PHONE, ext), 585-736-5054 TAS, No):
726 Exchange St. Ste 618 EMALjg, [email protected]
Buffalo, NY 14240 INSURER(S) AFFORDING COVERAGE Nalc#
716 314-2000 INSURER A; Philadefphia Indemnity Insurance Co. 18058
INSURED ISURER8 :
Boys & Girls Club of East Aurora, Inc. NeuneR c:
24 Paine Street INSURER b
East Aurora, NY 14052 WSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THE POLICY PERIOD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED JO THE INSURED NAMED ABOVE FOR
TO WHICH THIS
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT
TO ALL THE TERMS,
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
‘TYPE OF INSURANCE ie POLICY NUMBER (HREO eV) OBEY LimiTs
Ne
|_X| COMMERGIAL GENERAL LIABILITY X | X | PHPK2619030 14/01/2024 | 11/01/2025 EAcH OCCURRENCE $1,000,000
A
| crae-wane [_X] occur PRIUREL ENTE B ony [51,000,000
|_| MED EXP (Anyone person) | $20,000
PERSONAL & ADV INJURY _ | $1,000,000
GENERAL AGGREGATE $3,000,000
| GENT. AGGREGATE LIMIT APPLIES PER:
Lx] Loc PRODUCT S AGG | $3,000,000
- COMP/OP
|_X! powicy | iS
$
OTHER:
A | AUTOMOBILE LIABILITY PHPK2619030 11/01/2024 | 11/07/2025 GOMBINER SINGLELIMTT | .4,000,000
BODILY INJURY (Per person) | $
X| any Auto
SCHEDULED BODILY INJURY (Par accident) | $
RUS PONLY NON-OWNED. PROPERTY DAMAGE $
[|] HIRED {Per accident)
|__| AUTOS ONLY AUTOS ONLY
$
| X | occuR PHUB887415 41/01/2024 | 11/07/2025, EACH OCCURRENCE $7,000,000 |
A |X| UMBRELLALIAB
EXCESS LIAB CLAIMS-MADE AGGREGATE 37,000,000
oe |_XL retention s10000 QTH-
PER
WORKERS COMPENSATION
AND EMPLOYERS’ LIABILITY YIN [fue | ER
ANY PRO RITES ENGL BeGRECUTIVE NIA E.L, EACH ACCIDENT $
EL. DISEASE - EA EMPLOYEE] $
(Mandatory in NH)
Ifyes, describe under E.L. DISEASE - POLICY LIMIT _|$
DESCRIPTION OF OPERATIONS below
A |Professional PHPK2619030 4 1/01/2024| 11/04/2025 Each Incident $1,000,00
Liability Aggregate $3,000,000
attached if more space is required}
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be
coverage Is
Additional insured and/or waiver of subrogation coverage marked with an X apply only when such
required by a written contract signed by all parties prior to a loss, per policy forms. The umbrella
lability limits are in addition to those provided by the general liability, auto liability, and
professional liability policies, per policy forms.
CERTIFICATE HOLDER CANCELLATION
eA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEFORE
Town of Aurora THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Martha Librock ACCORDANCE WITH THE POLICY PROVISIONS.
575 Oakwood Avenue
East Aurora, NY 14052 AUTHORIZED REPRESENTATIVE
S mn Tt
pee
© 1988-2015 ACORD CORPORATION. All rights reserved.
AGORD 25 (2016/03) 14 of 1 The ACORD name and logo are registered marks of ACORD
H#EAGRRE192/MAM4G6876777 SACT