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Home My WebLink AboutCertificate of Liability InsuranceA� Q® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/2020 Y) 10/27/2ozo 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 IN 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 Brown & Brown of Florida, Inc. 1661 Worthington Rd Ste 175 West Palm Beach FL 33409 CONTACT Maria MolinaAAI NAME: PAH1 No Ext : (561) 686-2266 A C.No): (561) 686-2313 E-MAILDmmolina@bb-wpb.com INSURER(S) AFFORDING COVERAGE NAIC # 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 : rnveow'rec CFRTIFIL'ATF MI IMRFR• 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. 1�TR TYPE OF INSURANCE ADDLISUDR INSD WVD POLICYNUMBER MM/DDYEFF POLICYEXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ;c/ CLAIMS -MADE I -%I OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 X Contractual Liability MED EXP Any oneperson) $ 10,000 X Cross Liability/Separation of Ins. PERSONAL&ADV INJURY $ 1,000,000 A Y 6080697842 04/01/2020 04/01/2021 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY [g PRO- LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY (CEOaccident SINGLE LIMIT $ 1,000,000 BODILYINJURY(Perperson) $ ANYAUTO BODILYINJURY(Peraccident) $ BOWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Ix 6080697887 04/01/2020 04/01/2021 PROPERTYDAMAGE Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE - $ 5,000,000 C X EXCESSUAB CLAIMS -MADE EBU049326298 04/01/2020 04/01/2021 AGGREGATE $ 5,000,000 DIED I X1 RETENTION $ 0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBEREXCLUDED? LNJ (Mandatory in NH) NIA 680697839 04/01/2020 04/01/2021 X1 STA UTE I I ERH E.L.EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 EL 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, may be attached if more space Is required) (Lot 81) - 3341 Trinity Circle, Ft. Pierce FL 34945 For Private Provider Plan Review and Inspections. r_FRnFIrATF Ho i nFR 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 44.11 4 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD