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HomeMy WebLinkAboutCertificate of Liability InsuranceA� " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDnYrY) 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(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 HONE Ext : (561) 686-2266 Fn/c No : (561) 686-2313 E-MAIL mmolina@bb-wpb.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N West Palm Beach FL 33409 INSURER A : American Casualty Company of Reading, Pennsylvania 20427 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 1215 Wallace Drive INSURER E : Continental Casualty Company 20443 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. IPOLICY LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMMILDIU EFF EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR 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 LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY ❑X JECT LOC M'OTHER: PRODUCTS-COMP/OPAGG $2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY 6080697887 04/01/2020 04/01/2021 BODILYINJURY (Per acddent) $ PROPERTYDAMAGE Per accident $ $ UMBRELLALIAB 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 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) - N /A 6 80697839 04/01/2020 04/01/2021 X1 STATUTE I I ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below Each Claim 2,000,000 E ProfessionaYPollution Liability Claims Made Policy MCH591908633 04/01l2020 04/01/2021 Aggregate 4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS r VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) (Lot 73) — 3235 Trinity Circle, Ft. Pierce FL 34945 For Private Provider Plan Review and Inspections. CERTIFICATE 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 9 ` O //�j,1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD