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Home My WebLink AboutCertificate of Liability InsuranceAC oO O CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 04/20l2021 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 terns 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) 6885094 Nc, No : (561) 686 2313 AIC No Ext IL skramer@bb-wpb.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Valley Forge Insurance Company 20508 INSURED Universal Engineering Sciences, LLC Universal Engineering Inspections, LLC 3532 Maggie Blvd Orlando FL 32811 INSURERS: The Continental Insurance Company 35289 INSURER C : Continental Casualty Company 20443 INSURER D : StarStone Specialty Insurance Company 44776 INSURERS: Landmark American Ins. Company 33138 INSURER F : rrlvGoer_�c CERTIFICATE NUMBER: 2021-2022 Master REVISION NUMBER: v 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. INSR LTR TYPE OF INSURANCE ADDLISUBK 1NSD WVD POLICY NUMBER MM/�DY EFF MMIDDIY Y LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 $ 100,000 CLAIMS -MADE F OCCUR PREMISES Eaoccurrence - MED EXP (Any one person) $ 10,000 A Y Y 7011856226. 01/01/2021 01/01/2022 PERSONAL SADVINJURY $ 1,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2/0001000 POLICY ❑X PRI LOC JECTEmployee Benefits $ 1.000,000 OTHER: CO BANEen D SINGLE LIMIT (Ea acciX $ 1,000,000 AUTOMOBILE LIA ILITY BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Par accident) $ B OWNED SCHEDULED Y Y 7011857165 01/01/2021 01/01/2022 AUTOS ONLY AUTOS HIRED NON -OWNED _ - PROPERTYDAMAGE - Per accident $ AUTOS ONLY AUTOS ONLY Underinsured motorist • $ 1,000.000 X UMBRELLA W1B X OCCUR .EACH OCCURRENCE $ 1,000,000 B EXCESS.LUIB CLAIMS -MADE Y Y 7012083093 0.1101/2021 01/01/2022 AGGREGATE $ 1,000.000 DED I X RETENTION $ 101000 $ WORKERS COMPENSATION X PER ER E.LEACH ACCIDENT - 1,000,000 $ AND EMPLOYERS' LIABILITY YIN C ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? NIA Y 7011658185 0001/2021 01/01/2022, E.L. DISEASE -EA EMPLOYEE 1,000,000 $ (Mandatory in NH) E.L, DISEASE- POLICY LIMIT 1,000,000 $ it yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) For Private Provider plan review and ins ection services for lots: 2, 5, 6, 7, 8, 9, 10, 13,14,15, 19, 47, 0, 91, 92, 93, 94, 124,125, 126, 128 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 ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD r ADDITIONAL COVERAGES Ref # Description Cyber Liability Coverage Code . Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # I 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 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 _T 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 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Form No. Edition Date Premium Ref # I 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 Coverage Code Form No. 7Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001, AMS Services, Inc. AC40REO AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Brown & Brown of Florida, Inc. NAMED INSURED Universal Engineering Sciences, LLC POLICY NUMBER CARRIER TAIC CODE 71 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 , Arnnn 4n4 vinnarn4i The ACORD name and logo are registered marks of ACORD All rights reserved: