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HomeMy WebLinkAboutCertificate of Liability InsuranceC UNIVENG-01 KSANCHEZ r :�►CORO� 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 & Gough 8300 Greensboro Drive Suite 980 COMENTACT PHONEFAX (A/c, No, Ext): (703) 827-2277 (A/c, No :(703) 827-2279 ADDRIEss: admin@amesgough.com McLean, VA 22102 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Evanston Insurance Company 35378 INSURED INSURER B : INSURERC: Universal Engineering Sciences, LLC INSURER D : 3532 Maggie Boulevard Orlando, FL 32811.6697 INSURER E INSURER F : CAVFRAGFS 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 ADDINSDL SUBR WVD POLICY NUMBER fPIOLICY EFFLTR MIDQfYYYY1IPOLICY EXP LIMBS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREM MSEa occurrence $ MED EXP (Any oneperson) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: POLICY mcofE LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO OWNED L SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY CO MBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY AMAGE Peracadent $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/M'MBER EXCLUDED? ECUTIVE ❑ (Mandatory m NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- U TF ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE 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 mores ace Is required) RE: For Private Provider plan review and inspection services for lots: 1, 3, 4, 11, 16, 17,19, 20, 21, 22, �3, 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 r~��® /`1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/2DrYYYY) oa/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 CONTACT Stephanie Kramer NAME: Brown & Brown of Florida, Inc. A/CNNo Et : (561) 688-5094 ac No): (561) 686-2313 E-MAIL s: skramer@bb-wpb.com ADDRE 1661 Worthington Rd Ste 175 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 INSURER D : StarStone Specialty Insurance Company 44776 INSURERE: Landmark American Ins. Company 33138 3532 Maggie Blvd INSURERF: Orlando FL 32811 COVERAGES CERTIFICATE NUMBER: 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 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 INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR A D PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 A Y Y 7011866226 01/01/2021 01/01/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY ❑X JET LOC PRODUCTS -COMP/OPAGG $ 2,000,000 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 Y Y 7011857165 01/01/2021 01/01/2022 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Underinsured motorist $ 1,000,000 [AND UMBRELLALIAB X X OCCUR ��"����'����-R'„y,C���• EACH OCCURRENCE 1,000,000 $ BEXCESS LIAB CLAIMS -MADE Y Y 7012083093 01/01/2021 01/01/2022 AGGREGATE $ 1,000,000 DED X RETENTION $ 101000 $ C RKERS COMPENSATION EMPLOYERS'LIABILITY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBEREXCLUDED7 (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 / LOCATIONS I 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 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 rOFADTLCV Copyright 2001, AMS Services, Inc. r— 1 � 1 AC V `� 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, 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. 101 (2008/011 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD