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Home My WebLink AboutCertificate of Liability Insurance11 ACo o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/27/2020 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 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 Brown & Brown of Florida, Inc. 1661 Worthington Rd Ste 175 West Palm Beach FL 33409 CONTACT Maria Molina AAI NAME: IPA o EM : (561) 686-2266 FAX No): (561) 686-2313 E-MAIL mmolina@bb-wpb.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N INSURERA: American Casualty Company of Reading, Pennsylvania 20427 INSURED GFA International, INC.; Obsidian Group Holdings, LLC Obsidian Group Acquisitions, Inc. 1215 Wallace Drive Delray Beach FL 33444 INSURER B : Transportation Insurance Company 20494 INSURER C : National Union Fire Insurance Company of Pittsburgh PA 19445 INSURER D : Valley Forge Insurance Company 20508 INSURER E: Continental Casualty Company 20443 INSURER F : PnVCDA(ree rCRTIFIrATF N1IMRFR• Master 2020-2021 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 SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1POLICY LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DDYEFF EXP MMIDD YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO D PREMISES Ea occurrence $ 1,000,000 X Contractual Liability MED EXP (Any oneperson) $ 10,000 A X Cross Liability/Separation of Ins. Y 6080697842 04/01/2020 04/01/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE UMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANYAUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED 6080697887 04/01/2020 04/01/2021 AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE Per accident $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAB CLAIMS MADE EBU049326298 04/01/2020 04/01/2021 AGGREGATE $ 5,000,000 DED I X1 RETENTION $ 0 $ WORKERS COMPENSATION %/ STATUTE ER AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ 1,000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE � N /A 6 80697839 04/01/2020 04/01/2021 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUE (Mandatory in NH) E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below Each Claim 2,000,000 E Professional/Pollution Liability Claims Made Policy MCH591908633 04/01/2020 04/01/2021 Aggregate 4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) (Lot 84) — 3411 Trinity Circle, Ft. Pierce FL 34945 For Private Provider Plan Review and Inspections. eeoTicrrATe unl neo CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DR Horton Inc ACCORDANCE WITH THE POLICY PROVISIONS. 1430 Culver Drive NE AUTHORIZED REPRESENTATIVE Palm Bay FL 32907 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD