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Home My WebLink AboutSandy Beach Credentials 2014-15u" i PAC I M4S "Wh NAME F -p_ REQUIPEDVVI'M`%� 4c jj, Fl�� Id. rl "A" 2,64 a, A"W", u" i PAC I M4S "Wh NAME F -p_ REQUIPEDVVI'M`%� 4c jj, Fl�� Id. rl DA; (;;;)T.Vyyyy) CERTIFICATE" OF LIABILITY INSURANCE 5/28J2014 __T1;F4T1__S_FC1'E__ -ATE 1.1, ISSUEE) AS A WATWEIR OF INFORMATM3N ONLY AND CONFER, UPON THE CERMFICATE HOLDER. THIS S HT CERMFICAT'E DOES NOT AFFIRMATIVELY OR NEGAIWELY AMEND, EXTEND OR ALTER 'n4E COVE -RAGE AFFORDED BY THE POLICIES, BIELOW. THIS CERT�FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BrETWE.EN THE iSSWAIG WSURER(S), AUI�HORIZED RFPRESENTATIVEOR PRODUCER, AND THE CERRFICATE HOLDER, IMPORTANT: If the certificate holder is an AE01710NAL INSURED, the poficy(ies) must be endorsed If SUBROGAMON IS WAIVED, subject to the terms and conditions of the palicy, certain policier may requife an endorsenwent A statement an this cerrtificate does, not confer OqWs to the oertfficate hoider in Neks of such endorsiement(s), CONTACT SUNSHINE STATE INSURANCE --- 0i . . . . .... ................. — (352) 371-9f, Ru_ 1111 NW23RDAVE - 3 - 5 - 2) - 3 - 7 - 3-7 , 48 - 9 GAINESVILLE, FL. 32609-5420 E -W& ADDR . .. . .................. . .. - ----- (352) 371 -9696 iMSUR I-- R(S) AFFORDiNG C OVER AQE NAC 0 . ... . ........ . ... ..... ...... ........ . -- ---------- - ------- ---------- IMSURER A United States Fire Insurance., 21113 .. ....... . _.__,___.__.____.._. . ...... . ..... . ... - --------- . . . . ........ . . . . . ........... —.11, - ------ ....... ... iNSJRED SPORTSAND RECREATiON PROVIDERS AS�P(:IATION (PLYRCHA,,.,[NG GRCIJP� AND INSWRER 8 iTS FART, rd,3PAThNC,, VJENIBERS - -_-_ -_ - ------ ... ..... . ......... . . .. . ....... . ..... INSURER C � . . .. . ................... .. . ... . ........ Sandy Beach Surfing, LLC INSURER D, 7920 Ridgewood Ave. _._____..____. . . .. ......... - . ... . ............ ... .. IftrAWERE: Cape Canaveral, FL, 32920 _._ - -------- ------ -------- -- - __ - --- ------------- - INIURER F COVERAGES CERMFICATE NUMBEW, LiSF1152800 REVISION NUMBER: TFbS iS TO CIERTFY THAT THE POLIC�ES OF 04SURANGE. USTED BEL(Ni HAVE y4EEN IRSUED �'(), THE R4,IR.JRE.D NAMED APXYJE FOR �HE P(DUCY PERJOD fyiMCATIED tqOTWTHS�`ANIANG A14Y REGUIREMENT, TERM, OR GONENFK,"Al Cf- ANY CONTRACF T�R OTHER D(YCUMENT WWH RESPEC� TO%�N44iCIH rwsCERT�RCAJE MAY BE iSSUED OR MAY PERTAiN, THE R4SLJFVkNCE AFFORUED BY THL DEFYCR2ED, HEREIN IS SUBJECr TO ALL �HE TERMS, EXO USiCNS AND fXXIDHIONS U"E'MUCH POLICES �,WffS SHOWN MAY HAVE BEEN REDUCED BY PAO CLAWS . ...... . ...... . ........ .. . .......... -- - -- ------------- POLOCY EFF POLICY EXP TYPE OF iNSURANC E PO . UCY NUMBER -202an -Y-yj- __ UWTS GENERALLIARAST"y GENERA�. AX3GREGATE $2,000,000.00 X $2,000,000,00 ... ....... ------ __..____. CLMMS -1rIR PERSIVOLAk ADV iNJURY $1,000,000m 050 ,Sf2015 0512812014 EACH CCCURREW E $1,000,000.00 - ------ ---- --------------- ------ SRPGP-101 -0414 11171 AM 12-01 AM . ............ . . . . . ... ......... . ... . ........ .... .... .. .... F I RE DAMAGE (Any one fire) $300,=, DO GEM, Aa3RE13Aff.'[iJ,9R APPLI�rS PER MED EXP (Any one rxrsui) $5,000.00 --------- . ...... Or. -an ....... LLLL� 2-1— r/0UMNED S[WIIS LURT AArTiDAK5MLE UAB1JTY BCCU� Y WJUR Y (Per wirsdfv� M L CMED SLHEM.ED 800�LY rMAJRY �Pef =Aenp,.� AUTOS WON �0&1 E 0 WFEDNRO PUTOS s� . .......... UNIMMELLA U ;y. $ CVCURRFrK..,E 'GRE EXCESS LL48 aAAM-MAIX AG --CWE $ �ACH (=,URFP1".P4r_E $ GENERAL ACXRECATE $ $ ...... . ... .... . . ........ GENERAL AGGWErATE $ GL Premium $37800 DCW_R�PTXW OF OMRA 7 IOUSf LOCATIONS I V90CLSS �Alkwh ACORD 101, Addikswral Rwiiwks Sc.Pwd�de, ff wore aprx�* is required) SUrfing Camp GERITFICATE HOLDER CANCELLATION Sandy Beach SUrfing, LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N 792D Ridgewood Ave. ACCORDANCE WffH THE POUCY PROVIMONS. Cape Canaveral, FL 32920 AUTHORIZED REPRESENTATWE T`rancis.L, (Dean ACORD 25 (2010f06) @ 1988-2010 ACORD CORPORATKMI, Ai� rights reservotil. The ACORD name and logo are registered marks of ACORD To be considered for a Contract for this RFP, each Proposer must have a Drug -Free Workplace Program in-place. In order to have a drug-free workplace program, a Proposer shall: I . Publish a statement notifying employees that the unlawful manufactiire, distribution, dispensing or possession of a controlled substance is prohibited in the workplace and spccifyin, the actions that shall. be taken. against ernplovees for violations of such .91 prohibitiow 2. Inform employees about the dangers of drug abuse in the workplace, the Proposer's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations - 3. Give each employee engaged in providing the commodities or contractual services a copy of the statement specified in subsection �I) above. 4, In the statement specified in subsection (1) above, notify the employees that, as a condition of working on the commodities or contract" services, the employee shall abide by the terms of the statement and shall notify the employer of an), conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the work -place no later than five (5) days after such convictiom 5� Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's coinn-tunity, by ar�y employeemho is so convicted. 6� Make a good faith effort to continue to maintain a drug-firee workplace through implementation of this section. As the person authorized to sign the statement, I cer* that this Proposer complies fully with the above requirements. A e Propo r Signatur Name oftlompany Proposepl3rinted Name 40MIZI-IfiNNA BLS CPR (Adult/Childlinfant) Greg Silvers TWs Individual has successfully completed the above mentioned course, and has demonstrated Academy of CPR & First Aid, Inc. ABM&347-6" 09MI2013 0910812015 Certificate Number Issue Date Renewal Date 4 American Academy of CPR & First Aid, Inc. Issued by American Academy of CPR & First Aid Director of Training Training Site Online Training Holders Signature Aid, Inc. Basic First Aid Course re Silvers Th s in ivi ual has succes — sfullY completed the above mentioned course, and has demonstrated Proficiency in the subject by asj' "'X E IM I - .6aw- - —1111S Ono conditions of American Academy of CPR & First Aid, Inc. AB328347-FA 09/30/2013 09/3012015 No Events No Name History Fsandy bea,_ 11111 1 1111111111 1 1111-71111 111 ITS 0�� I t, I , Florida Limited Liability Company SANDY BEACH SURFING, LLC Filing Information Document NumberL10000090731 FEI/EIN NumberN/A Date Filed08/30/2010 StatcFL StatusACTIVE Principal Address 7916 AURORA CT CAPE CANAVERAL, FL 32920 Changed: 04/15/2013 Mailing Address 7916 AURORA CT CAPE CANAVERAL, FL 32920 Changed: 04�15/2013 Registered Agent Name & Address SILVERS, GREGORY A 7920 RIDGEWOOD AVE CAPE CANAVERAL, FL 32920 Address Changed-- 12/12/2011 Authorized Personts) Detail Name & Addres-v Im I AN 0 11 w i a I IN -my womejA -.1 M'Xo.- amok" Annual Reports Report Year Filed Date 2012 � 01/04/2012 2013 01/17/2013 2014 03/19/2014