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Home My WebLink AboutCertificate of Liability Insurance/.RV® _ _t ° - A Cll...••• CERTIFICATE OF LIABILITY INSURANCE DATE (MM/D/Y 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: A NN Ext : (561) 688-5094 ac No : (561) 686-2313 ADDRESS: skramer@bb-wpb.com INSURER(S) AFFORDING COVERAGE NAIC t/ 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 : StarStone Specialty Insurance Company 44776 INSURERE: Landmark American Ins. Company 33138 INSURER F : rnVFRACFS rFRTIFIrATF NIIMRFR. 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 INSURANCEADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD/YYYY LIMBS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE %� OCCUR DAMAGE D PREMISES Ea occurrence 100,000 $ MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 A Y Y 7011856226 01/01/2021 01/01/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2.000,000 POLICY 19 PEC LOC Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO BOWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY I Y Y 7011857165 01/01/2021 01/01/2022 BODILY INJURY (Per accident) $ PROPERTY 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 I X RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUE � (Mandatory in NH) N/A Y 7011858185 01/01/2021 01/01/2022 %C STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E,L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 (`CDTICI!`ATC Wn1 rICR rANrFI I OTInN 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 # 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 rOFADTLCV Copyright 2001, AMS Services, Inc. ,+ ACORV `� 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 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 - 01/01/2022. I ACORn 1n1 t2nnwn11 0 F n 2nnR ACORn CORPORATION_ All riahts The ACORD name and logo are registered marks of ACORD INIVENG-01 KSANCHEZ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD0 9rn 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 NAME: PHONE 703 827-2277 FAX (A/C, No, Ell): ( ) (ac, No):(703) 827-2279 AI DR1Ess: admin@amesgough.com McLean, VA 22102 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Evanston Insurance Company 35378 INSURED INSURER B : INSURERC: Universal Engineering Sciences, LLC I INSURERD: 3532 Maggie Boulevard Orlando, FL 32811-6697 INSURER E INSURER F : COVERAGES 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY M ICY EFF DMOM POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED P EM SES a occurrence) MED EXP An one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: POLICY D %Cof LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accide t $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ Parr. nt AMAGE $ UMBRELLALUIB EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER EXCLUDED? ECUTIVE ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- S TA UTE 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, may be attached If more sppace Is re aired) RE: For Private Provider plan review and inspection services for lots: 1, 3, 4,11, 16,17, 19, 20, 21, 22, 23, 24, 2S, 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 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