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HomeMy WebLinkAboutCertificate of Liability Insurance/ DATE (MWDD/YYYY) ,�,coRo CERTIFICATE OF LIABILITY INSURANCE 03/22/2021 TIAIS 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 Stephanie Kramer NAME: Brown & Brown of Florida, Inc. H NN Ext : (561) 688-5094 FAX,No): (561) 686-2313 IAI1661 Worthington Rd Ste 175 E-MAIL s: skramer@bb-wpb.com ADDRE INSURER(S) AFFORDING COVERAGE NAIC # West Palm Beach FL 33409 INSURERA: Valley Forge Insurance Company 20508 INSURED INSURER B : The Continental Insurance Company 35289 Universal Engineering Sciences, LLC INSURER C : Continental Casualty Company 20443 Universal Engineering Inspections, LLC INSURER D : StarStone Specialty Insurance Company 44776 3532 Maggie Blvd INSURER E; Landmark American Ins. Company 33138 Orlando FL 32811 INSURERF: f•nvooer_ec d-=o-nru-ATF mimaGR• 2021-2022 Master RFVISInN NIIMRFR- 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. TR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE Fx_] OCCUR DA PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 • PERSONAL&ADVINJURY $ 1,000,000 A Y Y 7011856226 01/01/2021 01/01/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER: 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 AUTOS ONLY AUTOS ONLY Y Y 7011857165 01/01/2021 01/01/2022 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Underinsured motorist $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE - $ 1,000,000 B EXCESS LIAB CLAIMS -MADE Y Y 7012083093 01/01/2021 01/01/2022 AGGREGATE $ 1,000,000 DIED X RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBEREXCLUDED? (Mandatory In NH) N/A Y 7011858185 01/01/2021 01/01/2022 X PER 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 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) For Private Provider plan review and inspection services for lots 33, 34, 35, 47, 107, 108, 109, 110, 111, 112, 113, 114, 1151 116, 118, 122 wed M-ATC U^1 nr•n I f•AAVPGI 1 ATI^kl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN St. Lucie County ACCORDANCE WITH THE POLICY PROVISIONS. 2300 Virginia Avenue AUTHORIZED'REPRESENTATIVE Fort Pierce FL 34982 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD i ADDITIONAL COVERAGES Ref # I Description Cyber Liability Coverage Code Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Uninsured motorist combined single limit Coverage Code UMCSL Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description PIP -Basic Coverage Code PIP Form No. Edition Date Limit 1 10,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description WC & Employer's liability Coverage Code WCEL Form No. Edition Date Limit 1 Limit 2 Limit 3 j Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description j Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description j Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium. Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001, AMS Services, Inc. AC V AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Brown & Brown of Florida, Inc. NAMED INSURED Universal Engineering Sciences, LLC POLICY NUMBER I CARRIER li NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes D) Type of Insurance: Excess Liability; Carrier: Starstone Specialty Ins; Policy number: 77102C200ALI; Limit: $4,000,000 - Excess over lead umbrella (7012083093) for General Laibility Only E)Type of Insurance: Excess Liability; Carrier: Landmark American Insurance Co.; Policy number: LHA092746; Limit: $2,000,000- Excess over lead umbrella (7012083093)forAuto Only ACORD 101 (2008101) 1 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD