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HomeMy WebLinkAboutCertificate of Liability InsuranceI INIVFNn.n1 KSANCHF7 7 144C400RO- `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 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 & Gough 8300 Greensboro Drive Suite 980 CONTACT AME: acNN , Exs : (703) 827-2277 FAX Ne):(703) 827-2279 E-MAIL DD ESs: admin@amesgough.com INSURERS AFFORDING COVERAGE NAIC # McLean, VA 22102 INSURERA:Evanston Insurance Company 35378 INSURED INSURER B : INSURER C : Universal Engineering Sciences, LLC INSURERD: 3532 Maggie Boulevard Orlando, FL 32811-6697 INSURER E INSURER F : frnvoDAcoe L`PDTIPIr%ATP NIIMRPR- RFVISIAN NIIMRFR- 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM D/YYYYJ POLICY EXP IMMIDDIYYYYI LIMITS MERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED RE SES Ea occurrence) $ HCOM MED EXP An one person) PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JET LOC OTHER: AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG Ea accc tlen SINGLE LIMIT $ $ BODILY INJURY Perperson) $ BODILYINJURY Per accident $ �OPERTY AMAGE Per accident $ $ UMBRELLA LIAB LIAB CLAIMS -MADE EACH OCCURRENCE HOCCUR AGGREGATE $ EEXCESS DED I I RETENTION$ I $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory m NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER;OTH- STA U E 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 moresp ace is required) RE: For Private Provider plan review and inspection services for lots: 1, 3, 4,11,16,17,19, 20, 21, 22, Z3, 24, 25, 26, 27, 28, 29, 30, 31, 32, 83, 85, 87, 97, 106, 117,120,121,123,127 f•cDTlcll`ATc Ylli r%=D CANCFI 1 ATIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE St. Lucie County tY 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) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,a►`o�20® CERTIFICATE OF LIABILITY INSURANCE F°A�`I""°°°""'"' 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 8 Brown of Florida, Inc. 1661 Worthington Rd Ste 175 CONTACT Stephanie Kramer NAME: aC N Ext : (561) 688 5094 FAX No : (561) 686-2313 n oREss: skramer@bb-wpb.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: 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 INSURERD: StarStone Specialty Insurance Company 44776 3532 Maggie Blvd INSURER E: Landmark American Ins. Company 33138 INSURERF: Orlando FL 32811 H/1\/C0APCC PCQTICIr`ATC 1d11MRC0. 2U21-2UY"L Master - RFVISInFJ NIIMRFR- THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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 INSURANCEAJJUL INSD WVD POUCYNUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 A Y Y 7011856226 01/01/2021 01/01/2022 PERSONAL &ADV INJURY $ 1,000,000 LAGGREGATE LIMTTAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑X ECT LOC O'OTHER: PRODUCTS-COMPIOPAGG $2,000,000 Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY MBINEDSINGLE LIMIT (CEO, accident $ 1,600,000 BODILY INJURY (Per person) $ X ANYAUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY(Per. Y Y 7011857165 01/01/2021 01/01/2022 PROPERTY DAMAGE Per accident $ Underinsured motorist $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS -MADE Y Y 7012083093 01/01/2021 01/01/2022 AGGREGATE $ 1,000,000 DED I X RETENTION $ 101000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE YIN OFFICERIMEMBEREXCLUDED? (Mandatory In NH) NIA Y 7011858185 01/01/2021 01/01/2022 �/ /� STATUTE 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES 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 [OFADTLCV Copyright 2001, AMS Services, Inc. AC O `J AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY NAMEDINSURED Brown R Brown of Florida, Inc. Universal Engineering Sciences, LLC POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: IDITIONAL REMARKS Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I 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; Policy Period: 01/01/2021 - 01/01/2022. 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; Policy Period: 01/01/2021 - 01101/2022. AP/lOr% 4A4 l9nnotn4\ The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. All riahts reserved.