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HomeMy WebLinkAboutCertificate of Liability InsuranceAC40R0® CERTIFICATE OF LIABILITY INSURANCE DATE4/20/2DIYoz1 o/2ol 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((es) 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 Stephanie Kramer NAME: AHI o Et ; (561) 688-5094 aC, No): (561) 686-2313 E-MAIL s. skramer@bb-wpb.com ADDRE INSURER(S) 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 INSURER B : The Continental Insurance Company .35289 INSURER C : Continental Casualty Company 20443 INSURER D : StarStone Specialty Insurance Company 44776 INSURERE: Landmark American Ins. Company 33138 INSURER F : nr.v�e wnr� rroD'rerr eTe unReDCD. 2021-2022 Master I RPVISInN NIIMRER- THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY EFF POLICY EXP MMIDUnYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 7 OCCUR A PREMISES Ea occurrence 100,000 $ MED EXP:(Any one person) $ 10,000 A Y Y 70.11856226 01/01/2021 01/01/2022 PERSONAL BADVINJURY $ 1,000,000 'LAGGREGATELIMITAPPLIESPER: POLICY ❑X JECT ❑ LOC ROTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY - Ea BIKED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ X ANYAUTO 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 UMBRELLA LIAB X OCCUR EACHOCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS -MADE Y Y 7012083093 01/01/2021 01/01/2022 AGGREGATE $ 1,000,000 DED I X1 RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIMBER ARTNER/EXECUTNE �. In NER EXCLUDED? (Mandatory in NH) (Mandatory If yes, describe under DESCRIPTION OF OPERATIONS below NIA Y 7011858185 01/01/2021 01/01/2022 X STA UTE ERH E.LEACH ACCIDENT 1,000,000 $ E.L. DISEASE- EA EMPLOYEE 1,000,000 $ E.L. DISEASE- POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) fF& Private Provider plan. review and inspection services for lots: [2,15. 6, 7; 8, 9, 10,13,14, 15, 19, 47. 89, 90, 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 (2016/03) The ACORD name and logo are registered marks of ACORD 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 # Description Uninsured motorist combined single limit' Coverage Code UMCSL Form No. Edition Date Limit 1 1,000,0001 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 TDeductible 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 9 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 # 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 OFADTLCV Copyright 2001, AMS Services, Inc. ACC 16.� AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Brown 8. Brown of Florida, Inc. NAMED INSURED ' Universal Engineering Sciences, LLC POLICY NUMBER CARRIER 7�'�i EFFECTM 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 (20081011 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD