HomeMy WebLinkAboutCertificate of Liability Insurance1 ® _
AC<?R V CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
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(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 8 Brown of Florida, Inc.
1661 Worthington Rd Ste 175
HONE Ext : (561) 688-5094 ac No): (561) 686-2313
E-MAIL skramer@bb-wpb.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Valley Forge Insurance Company
20508
West Palm Beach FL 33409
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
INSURERE: Landmark American Ins. Company
33138
Orlando FL 32811
INSURERF:
COVERAGES CERTIFICATE NUMBER: 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 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
POLICY NUMBER
MM DDY EFF
EXP
MM DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
;z/
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 10,000
PERSONALBADVINJURY
$ 1,000,000
A
Y
Y
7011856226
01/01/2021
01/01/2022
GEN'LAGGREGATE LIMITAPPLIES PER:
POLICY ECT 7 LOC
GENERAL AGGREGATE
$ 2,000.000
PRODUCTS - COMP/OP AGG
$ 2,000,000
Employee Benefits
$ 1,000,000
OTHER:
I
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
Y
Y
7011857165
01/01/2021
01/01/2022
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Underinsured motorist
$ 1,000,000
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
$ 1.000,000
AGGREGATE
$ 1,000.000
B
EXCESS LIAR
CLAIMS -MADE
Y
Y
7012083093
01/01/2021
01/01/2022
DED I X1 RETENTION $ 101000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
Y
7011858185
01/01/2021
01/01/2022
SPER TATUTE 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 / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
For Private Provider plan review and inspection services for lots:
2, 5, 6, 7, B. 9, 10, 13, 14, 15, 19, 47, 89, 90, 91, 92. 93, 94, 124, 125, 126, 128
CERTIFICATE HOLDER CANCELLATION
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
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