HomeMy WebLinkAboutCertificate of Liability Insurance® �� a
A� o CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
04/20/2021
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 8 Brown of Florida, Inc.
1661 Worthington Rd Ste 175
West Palm Beach FL 33409
CONTACT Stephanie Kramer.
NAME:
PHONE (561) 688-5094 FAX (561) 686-2313
AIC No Ext : A/C No):
E-MAIL s: skramer@bb-wpb.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Valley Forge Insurance Company
20508
INSURED
Universal Engineering Sciences, LLC
Universal Engineering Inspections, LLC
3532 Maggie Blvd
Orlando FL 32811
INSURER B: The Continental Insurance Company
35289
INSURER c : Continental Casualty Company
20443
INSURER D: StarStone Specialty Insurance Company
44776
INSURER E : Landmark American Ins. Company
33138
INSURER F :
CnvFRAr%FC CFRTIFICATF NUMRFR- 2021-2022 Master 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 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
MOL DY EFF
POLICY EXP
MMIDD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000.000
PREMISES Ea occurrence
$ 100,000
CLAIMS -MADE 7 OCCUR
MED EXP (Any one person)
$ 10.000
A
Y
Y
7011856226
01/01/2021
01/01/2022
PERSONAL BADVINJURY
$ 1,000.000
GEN'L AGGREGATE LIMITAPPLIES PER:
HPOLICY ❑X PR LOC
OTHER:
GENERAL AGGREGATE
$ 2.000,000
PRODUCTS - COMP/OP AGG
$ 2.000,000
Employee Benefits
$ 1,000,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
$
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Y
Y
7011857165
01/01/2021
01/01/2022
PROPERTY DAMAGE
Per. accident
$
Underinsured motorist
$ 1,000.000
X
UMBRELLALUIB
X
OCCUR
EACHOCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
B
EXCESS LIAB
CLAIMS -MADE
Y
Y
7012083093
01/01/2021
01/01/2022
DED I X RETENTION $ 10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUE
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
Y
7011858185
01/01/2021
01/01/2022
X S ATUTE ERH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
1,000,000
$
E.L. DISEASE -POLICY LIMIT
1,000.000
$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES. (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
For Private Provider plan review and inspection services for lots:
2, 5, 6, 7, 8, 9, 10. 13, 14, 15. 19, 47, 89. 90, 91, 92, 93, 94. 124, 125, 126, 128
St. Lucie County
2300 Virginia Avenue
Fort Pierce
FL 34982
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
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD