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HomeMy WebLinkAboutCOI & CCAPPLBrAS-01 TGARRIDO ACOIeO` CERTIFICATE OF LIABILITY INSURANCE DATE3YYYY) 6/300/20120 20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Sandy Simeon Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square BNtl Suite 301 Miami Lakes, FL 33016 PHONE I'm INC. No, Exn: (AIC, No): EDo IL . ssimeon@caffllc.com INSURE 3 AFFORDING COVERAGE NAICB INSURER A: Executive Risk Indemnity Inc. 35181 EACH OCCURRENCE E INSURED INSURER B: Federal Insurance Company 20281 INSURER C:GreatAmerican Insurance 16691 Driveway Maintenance, Inc. INSURER D: Pacific Indemnity Company 20346 P O Box 530035 Miami Shores, FL 33153 INsuRERE:AGCS Marine Insurance CO 22837 INSURER F: AUTOMOBILE X X COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL RM SUBR %WD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A TCOMMERCIAL GENERAL LIABILITY1,000,000 CLAIMS -MADE ❑X OCCUR X X 54310206 711/2020 7/1/2021 EACH OCCURRENCE E DAMAGE TO RENfE T rte S 100,000 PREMISESMED EXP (Any ow n S 5'000 PERSONAL& ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYJECT [--]LOC OTHER: GENERAL AGGREGATE S 2'000'000 PRODUCTS-COMPIOPAGG S 2,000,000 $ B AUTOMOBILE X X WABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUUTOSWN� AUT03 ONLY X AUTN ONLD X 54310205 7/1/2020 711/2021 COMBINEDSINGLE LIMIT S 1,000,000 BODILY INJURY Per on S BODILY INJURY Per accidem S P �acECRitlen� SAGE S C X UMBRELLA LUAB EXCESS LIAB X OCCUR CLAIMS -MADE TUU316082101 7/1/2020 71112021 EACH OCCURRENCE $ 51000,006 AGGREGATE $ 5'000'000 DED I X I RETENTION$ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORNARTNER/EXECIfTNE YIN OFRCERIMEM�, ?IXCWOED? (Mande ,Yn••^, If esdesaibewn DESCRIPTION OF OPERATIONSbelow NIA X 54310207 7/1/2020 7/1/2021 X PER OR - E.L EACH ACCIDENT $ 1,000,000 E.L DISEASE -EA EMPLOYEd $ 1'000'000 1,000,000 EL. DISEASE -POLICY LIMIT I E E LeasedlRented MX1930798242848 7/1/2020 7/1/2021 w/$1000. Ded 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 141, Addiflonal Rema,ks Schedule, may M attached H mom apxe Is,agolnd) St Lucie County Contractor Certification 2300 Virginia Avenue Ft. Pierce, FL 34982 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORUED ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD County Certification Number.- Applebaum, umber. Applebaum, Ray Carter Driveway Maintenance Inc P O Box 530035 Miami Shores, FL 33153 Class Code: PAVING 23500 Planning 8 Development services ^ Building 8 Code Regulation Division 2300 Virginia Ave Ft Pierce, FL 34982 Phone: (772) 462-1672 Fax: (772) 462-1148 http://v .stiucleco.org/planning/contract licen.htm License Type: COUNTY CERTIFICATION This Competency Card, issued by the St. Lucie County Contractor Certification Division, authorizes work for the Class Code stated, for the unincorporated areas of St. Lucie County. It does not authorize work for the City of Ft. Pierce, St. Lucie Village or the City of Port St. Lucie. It is the Contractor's responsibility to maintain this card in a current status by providing a Certificate of Insurance, current address and telephone information, and renewing this card annually as required. Wallet Contractor ID Card Cui to fit, then fold in half ---------------- ---- /fD E.NT•j-f FIC ll/��� CouA V Co'Y2ltreatiMrt N h / This i LucieC nnty, dQlpn;,�d uniess NN^ 11 so is 16 oke. L----------------------- ON CARD t;WS M RY RTER. D'nIVEwAY ounty Cercafe in St. CDA endny un 91,'.0/2020, i /anielie witlialns Authorized Licemmny Official Expiration Date: 9/30/2020 Danialle Wiiliams Contractor Licensing: Contractor Fax Llne: Automated Inspection; Line: Inspection L;ne: (772)462-1672 (77=)462-1143 (866) 284-1280 (772)462-21?2