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HomeMy WebLinkAboutCertificate of Liability Insurance`P --, ® A o CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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" AIC-N Et : (561) 688�094 FAX No): (561) 686 2313 E-MAIL s: skramer@bb-wpb.com ADDRE INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: 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 • Star -Stone Specialty Insurance Company 44776 INSURERE: Landmark American Ins. Company 33138 INSURER F f.I1VCnAf-CQ PCDTICIr ATC Ia I7MDCD• 2021-2022 Master REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEADDLISUBR INSD WVD POLICYNUMBER 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 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY FX— I JPECTT El LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 Employee Benefits $ 11000,000 OTHER: AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT a accident $ 11000,000 BODILY INJURY (Per person) $ X ANY AUTO 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 $ 11000,000 x UMBRELLALIAB 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 Y I N ANY PROPRIETORIPARTNEWEXECUTNE OFFICERIMEMBEREXCLUE (Mandatory In NH) NIA Y 7011858185 01/01/2021 01/01/2022 X1 S ATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EAEMPLOYEE $ 1,000,000 E.L. DISEASE- POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / 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 I v = C U 19t3t$-ZU15 AGUKLI GUKI-UKAI IUN. All rlgnis reserve0. ACORD 25 (2016103) 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 1,000,000 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 FoFADTLCV Copyright 2001, AMS Services, Inc. AC V AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY NAMEDINSURED Brown & Brown of Florida, Inc. Universal Engineering Sciences, LLC POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: DDITIONAL 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 - 01/0112022. rights The ACORD name and logo are registered marks of ACORD UNIVENG-01 KSANCHEZ CERTIFICATE OF LIABILITY INSURANCE DATE (MM0 MDNYirn 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 ONTACT CAME: FAX PHONE (AIC No): (703) 827-2279 (A/c, No, E.: (703) 827-2277 Ao REss: admin@amesgough.com INSURERS AFFORDING COVERAGE NAIC # McLean, VA 22102 INSURER A: 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 nnv�owr_ee 0%=DTICIL-AT= M111MIRFR• RFVISIrIN NIIMFSFR- 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 N D SUBR WVD POLICY NUMBER POLICY EFF M DD POLICY EXP (MM10DrYYYY1 LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 1 EACH OCCURRENCE $ DMGORENTED EEa occurrence) SE $ MED EXP (Any oneperson) PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY El jEa LOC OTHER: AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTO ONLY H GENERAL AGGREGATE S PRODUCTS -COMP/OPAGG $ C e acciideD SINGLE LIMIT $ $ BODILY INJURY Perperson) $ INJURY Per accident $ -BODILY PPeOracc�dent AMAGE $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORlPARTNER/EXECUTIVE El OFFICER/MEMBER EXCLUDED? (Mandatory in NFHt) If yes, describe under DESCRIPTION OF OPERATIONS below / A PER OTH- S U E I 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 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 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD