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Home My WebLink AboutCertificate of Liability Insurance4a, 4NG-01 KSANCHEZ ACORO� `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/28/2021 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 Ames 8r Gough 8300 Greensboro Drive Suite 980 CONTACT NAME: PHONE 703 827-2277 FAX 703 827-2279 (A/c, No, Ext): ( ) (ac, No):( ) Eo RIEss: admin@amesgough.com INSURERS AFFORDING COVERAGE NAIC # McLean, VA 22102 INSURERA:Evanston Insurance Company 35378 INSURED INSURER B : INSURER C : Universal Engineering Sciences, LLC INSURER D : 3532 Maggie Boulevard Orlando, FL 32811-6697 INSURER E INSURER F : CA\/PRAGFC CERTIFICATE NUMBER' 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 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 ADDL NSD SUBR POLICY NUMBER POLICY EFF MM D POLICY EXP MM DD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREM SEE E c urrence $ MED EXP (Anyone erson $ PERSONAL & ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: POLICY JECTPRO-- LOC OTHER: GENERAL AGGREGATE PRODUCTS -COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANYAUTO OWNED F SCHEDULED AUTOS ONLY AUTOS HIRED E NON -OWNED AUTOS ONLY AUTOS ONLY Ea.cccid.n SINGLE LIMIT $ BODILY INJURY Perperson) $ BODILY INJURY(Per accident $ PROPERTY AMAGE Per accident $ UMBRELLA LIAB LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ EEXCESS DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- U TE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ A Professional Liab. MKLV7PL0004492 1/1/2021 1/1/2022 Per Claim/Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) RE: For Private Provider plan review and inspection services for lots: 1, 3, 4,11, 16, 17, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 83, 85, 87, 97, 106, 117,120, 121, 123,127 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE St. Lucie County THE EXPIRATION DATE THEREOF, 'NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2300 Virginia Avenue Fort Pierce, FL 34982 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �A� V CERTIFICATE OF LIABILITY INSURANCE.' DATE(MM/DDIYYYI) 04/28/2021 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 Brown &Brown of Florida, Inc. 1661 Worthington Rd Ste 175 West Palm Beach FL 33409 CONTACT Stephanie Kramer NAME: PHONE (561) 6885094 FVC No : (561) 686-2313 AIC No Ext n-MAIL skramer@bb-wpb.com 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 INSURERF: rnvooer_ec rFQTICl6ATF MnlilllaPR• 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 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 INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMBS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE �. OCCUR DAMAGE RENTED PREMISES Ea occurrence $ 100,000 MED FRCP (Any one person) $ 10,000 A Y Y 7011856226 01/01/2021 01/01/2022 PERSONALaADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY [g jECT F1 LOC OTHER: Employee Benefits $ 11000,000 AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea accdent $ 11000,000 BODILY INJURY (Per person) $ X ANYAUTO BODILYINJURY (Per accident) $ B OWNED F7 SCHEDULED AUTOS ONLY AUTOS HIRED H NON -OWNED AUTOS AUTOS ONLY AUTOS ONLY Y Y 7011857165 01/01/2021 01/01/2022 PR DAMAGE Per accident $ Underinsured motorist $ 1,000,000 X UMBRELLALIAB 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 x RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDEo? EN (Mandatory In NH) NIA Y 7011858185 01/01/2021 01/01/2022 /� STER ATUTE ER 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 I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) For Private Provider plan review and inspection services for lots: 1,3,4,11,16,17,19,20,21,22,23,24,25,26,27,28,29,30,31,32,83,85,87,97,106,117,120,121,123,127 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 UT9tfS=1UT5AGUKU L:UKI-UKAIIUN. Au ngnis reservea. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES U 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 # 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 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 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 Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001, AMS Services, Inc. ACQ AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Brown & Brown of Florida, Inc. NAMED INSURED Universal Engineering Sciences, LLC POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes of Insurance: Excess Liability; Carrier: Starstone Specialty Ins; Policy number. 77102C200ALI; Limit: $4,000,000 - Excess over lead umbrella 13093) for General Laibility Only; Policy Period: 01/01/2021 - 01101/2022. of Insurance: Excess Liability; Carrier: Landmark American Insurance Co.; Policy number: LHA092746; Limit: $2,000,000- Excess over lead umbrella 13093)forAuto Only; Policy Period: 01/01/2021 - 01/01/2022. ACORD 101 The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. All