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A� o CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNYYY)
10/27/2020
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 Maria Molina AAI
NAME:
Brown & Brown of Florida, Inc.
1661 Worthington Rd Ste 175
HOE NNo Ext : (561) 686-2266 FA/�C No): (561) 686-2313
E-MAIL s: mmolina@bb-wpb.com
ADDRE
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: American Casualty Company of Reading, Pennsylvania
20427
West Palm Beach FL 33409
INSURED
INSURER B : Transportation Insurance Company
20494
GFA International, INC.; Obsidian Group Holdings, LLC
INSURER C : National Union Fire Insurance Company of Pittsburgh PA
19445
Obsidian Group Acquisitions, Inc.
INSURER D : Valley Forge Insurance Company
20508
INSURER E : Continental Casualty Company
20443
1215 Wallace Drive
Delray Beach FL 33444
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MMIDD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
-DAMAGE TO RENTED
PREMISES Ea occurrence)
$ 1,000,000
X
MED EXP (Any oneperson)
$ 10,000
Contractual Liability
X
Cross Liability/Separation of Ins.
PERSONAL &ADV INJURY
$ 1,000,000
A
Y
6080697842
04/01/2020
04/01/2021
GEWLAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY [g JECT LOC
PRODUCTS -COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
6080697887
04/01/2020
04/01/2021
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY HAUTOS ONLY
•
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
X
AGGREGATE
$ 6,000,000
C
EXCESS LIAB
CLAIMS -MADE
EBU049326298
04/01/2020
04/01/2021
DED I X1 RETENTION $ 0
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNERIEXECUTIVE �
(MandatoryIn N )EXCLUDED?
(Mandatory In NH)
NIA
680697839
04/01/2020
04101/202,
X STA UTE ERH
E.L.EACHACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
1,000,000
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
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 41) — 3330 Trinity Circle, Ft. Pierce FL 34945
For Private Provider Plan Review and Inspections.
CFRTIFICATF HOLDER 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
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD