HomeMy WebLinkAboutCertificate of Liability InsuranceA� V CERTIFICATE OF LIABILITY INSURANCE
10/27/2020 Y)
DATE(MM2020
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(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 MolinaAAI
NAME:
A/CNN Ext : (561) 686-2266 nlc NII: (561) 686-2313
E-MAIL s: mmolina@bb-wpb.com
ADDRE
INSURER(S) AFFORDING COVERAGE
NAIC 0
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
r`nVCRAr:FC f_FRTIFIr_ATF NIIMRFR- 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.
I�TE
TYPEOFINSURANCE
INSD
WVD
POLICYNUMBER
MMILDIU EFF
POLICYMM/DD EXP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
D D
1,000,000
CLAIMS -MADE � OCCUR
PREMISES Ea occurrence
$
X
MED EXP (Any oneperson)
$ 10,000
Contractual Liability
A
Y
6080697842
04/01/2020
04/01/2021
X
Cross Liability/Separation of Ins.
PERSONAL&ADV INJURY
$ 1,000,000
GEN'LAGGREGATE UMITAPPLIES PER:
GENERALAGGREGATE
$ 2,000,000
PRODUCTS -COMP/OPAGG
$ 2,000,000
POLICY ❑X JECT 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 X NON -OWNED
P OPC TY DAMAGE
$
X AUTOS ONLY AUTOS ONLY
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
C
EXCESS LIAB
CLAIMS -MADE
EBU049326298
04/01/2020
04/01/2021
X
AGGREGATE
$ 5,000,000
DIED I X1 RETENTION $ 0
$
WORKERS COMPENSATION
%� STATUTE ER
AND EMPLOYERS' LIABILITY Y / N
EL. EACH ACCIDENT
$ 1,000,000
D
ANY PROPRIETOR/PARTNER/EXECUTIVE F—N
-
NIA
680697839
04/01/2020
04/01/2021
E.L. DISEASE -EA EMPLOYEE
$ 1,000,000
OFFICER/MEMBER EXCUJC
(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
ProfessionallPollution Liability
Claims Made Policy
MCH691908633
04/01/2020
04/01/2021
Aggregate
4,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
(Lot 75) — 3317 Trinity Circle, Ft. Pierce FL 34945
For Private Provider Plan Review and Inspections
DR Horton Inc
1430 Culver Drive
Palm Bay
FL 32907
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
U 1903-ZU15 AGLIKU GUKPUKAI IUN. All rlgnis reservea.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD