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HomeMy WebLinkAboutCertificate of Liability InsuranceNIVENG.01 KSANCHE7 ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE (MMrDDIYY1f1f) 4/20/2021 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 pollcy()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 endomement(s). PRODUCER' NO�TCT Ames & Gough 8300 Greensboro Drive Suite 980 McLean, VA 22102 PHONE FAX Arc, No, Etd : (703) 827 2277 Arc, No):(703) 827 2279 EpeaL . admin@amesgough.com INSURERS AFFORDING COVERAGE NAIL 8 INSURERA:Evanston Insurance Company 35378 INSURED INSURER B INSURERC: Universal Engineering Sciences, LLC INsuIiERD: 3532 Maggie Boulevard Orlando, FL 32811-6697 INSURER E INSURER F : COVERAGES CERTIFICATE Nt1MRFR- REVISION NLIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCELISTED 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 BYRAID CLAIMS: . INSR TYPE OF INSURANCE ADS L SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ PRA MGEToRENTED nce $ MED EXP (Any and -person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POUCY jECT LOC OTHER GENERAL AGGREGATE $ PRODUCTS,- COMPIOP AGG $ AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY MBINdIeD SINGLE OMIT $ BODILY INJURY Per erson $ BODILY INJURY Per accident $ Per a� dent AMAGE $ S UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS' LIABILITY YIN OFFlPCEWMEMBER D(AC UDED7 ECUTIVE ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA T SEA ER E.L. EACH ACCIDENT $ E.L. DISEASE - FA EMPLOYE $ E.L. DISEASE - POLICY LIMIT A Professional Liab. MKLV7PL0004492 1/1/2021 1/1/2022 Per Clairn/Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached.U.mare space Is required) RE: For Private Provider plan review and inspection services for lots: 2, 5, 6, 7, 8, 9,10,13,14,15 9, 47, 76, 89, 90, 91, 92,.93, 94, 119, 124, 125, 126, 128 St. Lucie County 2300 Virginia Avenue Fort Pierce, FL 34982 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE -THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE . _//*ize . ACORD 25 (2016103) ©1988 2015 ACORD CORPORATION. All rights reserved: The ACORD name and logo are registered marks of ACORD Ai C) ) ® C CERTIFICATE OF LIABILITY INSURANCE DATE (/Y) oa/2/zo/20212D21 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 NAME: CONTACT Stephanie Kramer ; (561) 686-2313 PHONE (561) 688-5094 FAX No): A/C No Ext A REST. skramer@bb-wpb.com INSURERS AFFORDING COVERAGE NAIC If INSURERA: Valley Forge Insurance Company 20508 West Palm Beach FL 33409 INSURED INSURER B : The Continental Insurance Company 35289 INSURERC: Continental Casualty Company 20443- Universal Engineering Sciences, LLC INSURER D : StarStone Specialty Insurance Company 44776 Universal Engineering Inspections, LLC INSURERE: Landmark American Ins. Company 1 33138 3532 Maggie Blvd INSURER F : Orlando FL 32811 2n-2i_in99 rotor omflainm FillI IFIND. V THIS IS TO CERTIFY THATTHE 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. ILT R LTR TYPE OF INSURANCE ADDLISUISH INSD WVD POLICY NUMBER MMIDDY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR RENTED PREMISES Ea occurrence . $ 100,000 MED EXP (Any one person) $ 10,000 A Y Y 7611856226 01/01/2021 01/01/2022 PERSONAL aADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG' $ 2,000,000 PRO- JECT LOC Employee Benefits $ 1,000,000 RPOLICY OTHER - Ea a8 den SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ X ANYAUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED Y Y 7011857165 01/01/2021 01/0112022 AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE Per accident $ AUTOS ONLY AUTOS ONLY HUnderinsured motorist $ 1.000,000 X UMBRELLA LIAB X OCCUR ....O.........21N" ,,..,.. EACH CCURRENCE $ 1,000,000 EXCESSLIAB CLAIMS -MADE Y Y 7012083093 01/01/2021 01/01/2022 AGGREGATE $ 1,000,000 DED I X1 RETENTION $ 10,000 $ r13 WORKERS COMPENSATION /� STATUTE ERH " AND EMPLOYERS' LIABILITY YIN E.LEACHACCIDENT 1,000,000 $ C ANY PROPRIETORIPARTNERIEXECUTIVE M OFFICERIMEMBER EXCLUDED? NIA Y 7011858185 01/01/2021 01/01/2022 E.L. DISEASE -EA EMPLOYEE 1,000,000 $ (Mandatory in NH) 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: 2, 5, B. 7, 8, 9, 10, 13,'14, Q19, 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 (2016103) The ACORD name and logo are registered marks of ACORD i V ADDITIONAL COVERAGES _J 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 Forth 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. 7Edition 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 I Limit 2 • I 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. V AGENCY CUSTOMER ID: ACiORD ADDITIONAL REMARKS SCHEDULE Page of AGENCY Brown & Brown of Florida, Inc. NAMED INSURED Universal Engineering Sciences, LLC POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: NUUI I IVIYl%L RGIt1#Ar%r%0 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 Lalbility Only E)Type of Insurance: Excess Liability; Cartier. Landmark American Insurance Co.; Policy number. LHA092746; Limit: $2,000,000- Excess over lead umbrella (7012083093)forAuto Only I ACORD CORPORATION. All riahts reserved. I OCr1Rn 1111 r2558rnll The ACORD name and logo are registered marks of ACORD