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HomeMy WebLinkAboutFiling of State Certified Contractors PLANNING & DEVELOPMENT ' BOARD OF SERVICES DEPARTMENT COUNTY s p COMMISSIONERS p I O R 0 0 Building & Code Re ulation Division_ RECEIVED FILING OF STATE CERTIFIED CONTRACTORS FEB 10 ";'0 Please complete the following form and return the ORIGINAL signed and n5tarlaesldeuSty, Permitting Lucie County Contractor Licensing.Department, along with the chec aist beiNi: LICENSED QUALIFIER NAME JOHN T.STEGE COMPLETE HOME ADDRESS HOME PHONE E-MAIL ADDRESS JSTEGE@STANSELLCONSTR.COM BUSINESS NAME STANSELL PROPERTIES&DEVELOPMENT, LLC COMPLETE 11607 PROSPECT RD. BUSINESS ADDRESS ODESSA, FL 33556 BUSINESS PHONE AND FAX Office:727-372-0781 Fax:727-372-0366 E-MAIL ADDRESS Jstege@stanseliconstr.com Please make sure that the Business Entity Name,Workers'Compensation and Liability insurance, all match the State Certified License. 1. Provide a Certificate of Insurance for Workers'Compensation and General Liability directly from the Insurance Company with the certificate holder's address reflecting as follows: St. Lucie County Contractor Licensing, 2300 Virginia Avenue,Fort Pierce, FL 34982 2. Provide a copy of the License provided by the Florida Department of Business and Professional Regulation. 3. A clear copy of the qualifier driver's license. STATE OF FLORIDA COUNTY OF PASCO suso °a The foregoing instrument was acknowledged befo me this Nolsry pabG0"an1Flan 31ST JANUARY �� Lee Mn HotM1no�31e167 a of 20 by � aS MYranmts�one23 N T. STEG who is C- Expres 07n0R personally known 10 In or has produced Licefsed Contractor Signature ig ature of Notary CHRIS DZADOVSKY,District No.1• LINDA DARTZ,District No.3•FRANNIE HUTCHINSON,District No.4•CATHY TOWNSEND,District No.5 2300 Virginia Avenue•Fort Pierce,FL. 34982-5652'Website:smsr.slluclece.ora CONTRACTOR LICENSING(772)462-1672•FAX:(772)462-1148 Ennad:contractor licensinarasliucieco.ora •CODE ENFORCEMENT:(772)462-1571'INSPECTIONS:(772).462-2165 PERMITTING AND ZONING:Phone(772)462-1553 FAX(772)462-1578 AC V CERTIFICATE OF LIABILITY INSURANCE i�3iF/o2D o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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(les)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 endomement(s). PRODUCER BBB. Amanda Yoder-Carr CGB Insurance, LLC PHONE E t (g13)749-7948 ac Na, Ie131:0o-23:4 2531 Green Forest Lane aoDREss:Amandallcgloinsurance.com #101 INSURER AFFORDING COVERAGE NAIC0 Lutz FL 33558 WSURERA:FCCI. Insurance Co 33472 INSURED WSURER a:National Trust Ins Co 20141 Stansell Properties 6 Development, LLC WSURERC:St Paul Fire S Marine Ins Cc 24767 MSURERo:Liberty Mutual 24082 11607 Prospect Rd INSURERS: Odessa FL 33556 1 SURER I. COVERAGES CERTIFICATE NUMBER:2019-2020 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR ADDL SUER PODCY UP PoLgYE1fP LTR TYPE OF INSURANCE POLICYNUMBER MMIO MRIO LLVUS GENERALLWBILnY EACH OCCURRENCE s 1,000,000 X COMAfERCb1L OENERALllAB41TY PED OR WSES Ea NTaca . $ 100,000 B CWL MADE �X OCCUR L100043105-01 /31/2019 /31/2020 MED EJ (AM me person) $ Excluded PERSONAL SADVPuURY 5 1,000,000 GENERALAGGREGATE $ 2,000,000 GENL AGGREGATE UMT APPLIES PER PRODUCTS-COMPMPAGG 5 2,000,000 POLICY X PRP LOC $ AUTOMOILELWBRrTY C8INNN.EO SINGLE WIIT 1,000,000 A X ANYAUTO Seely 94JURr(Per person) 5 ALL GINNED 5CHEOUIED AIOOO43116-00 /31/2019 /31/2020 BOOMY INJURY(P,reo w) $ AUTO$ AUTOS NON-0 NEO PROPERTYDMIAGE $ IUREDAUTOS AUTOS aaoJJdenl $ X UA19ROAALIM - X OCCUR EACH OCCURRENCE $ 6,000,000 `. ErCESS L103 CIN6ISAIADE UF-91M71234-19-NP /32/2019 /31/2020 AGGREGATE $ 6,0000000 DED I X I RETENNON 5 10,00 $ WORHERSCOYPENSATION X I M5TATU- OTM- Me EMPLOYERS'LVU1R.RY IWY PROPRRiTOWPARINERIEXECUBVE YIN 01-HC19A-76003 /31/2039 /31/2e20 EL.EACH ACCIDENT '3 _ _ 1,000,000 CERI OFR WER URLLUDEM NIA A .(Mandnmy m"I EL.DISEASE-EAEMPLOYEE $ 1 000 000 IIyaa,de4tllb0 under OESCRIPDON OF OPERATWNS beb.] EL DISEASE-POLICYLUAT $ 1 '000 000 DESCWMON OFOPERATIONSI LOCATIONSIWRIOLES(Attach ACORD IDI,AddiUonal Romadu Sehudule,U mnm.P c.h mWhd) John T. Stage CBC1260211 CERTIFICATE HOLDER CANCELLATION (772)462-1148 contractor licensing@stluciec SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN St Lucie County Contractor Licensing ACCORDANCE WITH THE POLICY PROVISIONS. 2300 Virginia Ave AUTHORIZED REPRESENTATIVE Ft Pierce, FL 34982 'T Rogers/AMANDA I ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026'(znw5)of The ACORD name and logo are registered marks of ACORD pdb RICK SCOTT,GOVERNOR JONATHAN ZACHEM;SECRETARY -- r� d � Florida Floridr STATE OF•FLORIDA DEPARTMENT-OF'BUSINE§$J .D-z FESSIONALREGULATION CONSTRUC E, NG BOARD THE BUILDING Cq IT UNDER THE PROVI I °C�I�-F��aT;ERf 48 UTES • _ SP . ,- 5 POP 7 F y VE4Uv �f le 1 EXPIRAT -N29 ST 31, 2020 Always verity'licenses online it MyFloridaLicense.com Do not alter this-document in any form. Sr This is your license: ItIs unlawful for anyone other than the licensee to use this document. Dlitr+ u�