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HomeMy WebLinkAboutCERTIFICATE OF LIABILITY INSURANCEUNIVENG-01 KGOD ACORO® DATE:"TDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE - s2/zoal . THIS .CERTIFICATE IS ISSUED AS A MATTER OF :INFORMATION ONLY AND CONFERS NO -RIGHTS UPONTHE CERTIFICATE BOLDER- THIS CERTIFICATE -DOES -NOT AFFIRMATIVELT OR .NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW., '.THIS: CERTIFICATE' OF INSURANCE DOES' •NOT CONST UPE A CONIRACT: BETWEEN THE ISSUIlVG INSURE R(S), AUIHORTZEED . REPRESENTATIVE OR PRODUCER, AND'THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL.INSURED the policy(ies) must have ADDIIMONAL INSURED provisions of be endorsed. If SUBROGATION:IS WAIVED; subject to the terms and conditions of the policy, certain policies may regiiiie an endorsement A statement on . thiscertificate does -not confer rights* tothe.ceitificateholderinlieu-ofsuchendorsement(s). PRODUCER' c : Ames &doug h - - .. 8300-GreensbQoio Drive- suite 980• McLean, VA 22102 PHONE :. FAX (Arc, No, Ext)i (703) 827-2277 (A/c, Noi: (703) 827-2279 b ..admire@amesgou h:com . INSURERS AFFORDING COVERAGE NAIC #' " . usuREria: Evanston Inm � surance Coan .' 35378 . .. INSURED INSURER B E " - INSURERC GFA'IDternational, Inc. dba Universal Engineering Sciences B35tlRER D 3532 Maggie Boulevard' Orlando; FL 32811-6697 IISURERE: .. MbRERFL ,.COVERAGES- - ' CERTIFICATE NUMBER . REVISION NUMBER: TM.. IS TO CERTIFY THAT THE: POLICIES .OF INSURANCE . LISTED. BELOW HAVE BEEN ISSUED TO THE INSURED. NAMED ABOVE FOR THE POLICY PERIOD wicATED:' . NoT wI THsTANDRc ANY. REQuaEMENr, , TERM OR :CONDITION OF -ANY CONTRACT -OR OTHER -DOCUMENT. WITH RESPECT TO WHICHTHIS. CERTIFICATE MAY BE 'ISSUED: OR MAY PERTAIK THE, INSURANCE AFFORDED -irk-THE POLICIES .DESCRIBED: HERE Nis sUBJECTTO ALL t:HE TERMS, EXCLUSIONS A_ ND CONDITIONS OF SUCH POLICIES. LII4M SHOWN MAY HAVE BEEN REDUCED.BY:PAID CLAM.' IP$R LTRTYPE OF II SURANCE ' ..: .. ADDL SUB . POLICY NMMER . .. POLICY EFF POLICY EXP . COMMERCIAL GENERAL iJABILIlY GIA1lyS-MADE OCCUR . :. EACHOCCURRENCE.. TO RENTED DAMAGEMUMS MED one so EXP . PERSONAL&ADVZURY '.- GENL AGGREGATE IDAIT APPLIES PER POLICY0 Fla F-1 LOC OTHER:' GENERAL AGGREGATE PRODUCTS - COMP OP AGG AU TOMB ILE LIABILITY .(Ea ANY AUTO OWN®. SCHEDULED AUTOS ONLY AAUUTOSSyy. .p A171 DS ONLY AUTOS ONLY' COMBINED SMLE LI .ff accident) BODILY iNIURY Per rso ' BODILY MURY Pera ' OPER Y GE . . era U10RE IA110 EXCESS 1.1A-B _ - .HCIAIMS-imbE OCCUR EACHOCCURRENCE. AGGREGATE- .. . DED' . MENTION$ WORKERS COMPENSATION AND EMPLOYERS' LiABIIJTY Y N ANYPPER�O/P.RI�EIO�RR/PPCLT . . CUTIME � ffyyeesstlssmbe, DESCRIPTION OF OPERATIONS below N/A PER': �' .. 'OTH• .• ' E.LEACHACCIDENT• E1 DISEASE = EA EMPLOY E.L DISEASE - POLICY IR-ff A Professional Liab: ' ' . M(Q:V7PL0004492 . ` . 1/112021 . 1/1/2022.' . Per Claim/Aggregate 5,000,000 DESCRIPMONOF OPERA71ONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remaii6 Schedule may be attached"ff more space is required) RE: Pallas Residence 30-day Notice of.Cancellation will be issued for the' Professional Liability in accordance. With policy terms and conditions. CERTIFICATE' HOLDER : CANCELLATION St Lucie County . 2300 Virigina Avenue Fort Pierre, FL 34982 SHOULD.ANY OFTHEABO $SCRIBED POLICIES CANCELLED BEFORE THE:. EXPIRATION DATE OF, ,NOTICE. WILL 'BE' DELIVERED- IN ACCORDANCE WTTHTHE-PY PROVISIONS. `'L' 'AUIHORMD REPRESENTATIVE ACORD 25'(26i6/03) ©1988-2.015 ACORD CORPORATION All rights reserved. The ACORD name and logo are registerbd marks of ACORD ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (11INDDlYYYY) 1 81212021 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(les) 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 Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 Atlanta, GA 34328 ONer NAME Lynda Volpe 11 PHONE s4s-74asz17 PAfC . DRESS• 1volpefteecheroarlson.com INSURER AFFORDING COVERAGE NMC* INSURERA: Charter Oak Fire Insurance Company 25615 ,1n1Av.beechorcarison.com INSURED INSURER B : Travelers Indemnity Co of America 25666 Gl'A International, Inc., DBA Universal Engineering Sciences 4205 Vineland Rd., Suite L1 Orlando FL 32811 INSURERc: Travelers PropertyPfoperty Casualty CD of Amer 25674 INSURERD: Travelers Casualty and Surety Company 1908 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 691790.11 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. ILTR TYPEOFWSURANCE ADD SUB POLICYEFF MWODNYYY POLICY EXP Mram LIMITS A U COMIAERCIALGENERALLIABILITY CLAIMS -MADE � OCCUR Deductible SO rJ P-630-5R060261-COF-21 11112021 11112022 EACHOCCURRENCE -LVOlAGEES 31,000,000 . T (EB pccunramW S 300 ODD ❑ ME13 EXP (Any one emn $ 5 000 PERSONAL. & ADV INJURY $1,000 000 GEHLAGGREGATE LIMITAPPLIESPER: Policy JECT LOG OTHER: GENERAL AGGREGATE S2,000.000 PROIDVCTS-0061HOPAGGw $2,000,000 I Employee Benefits $1,000 000 B AUTOIdOBILELIABUW ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED PION 04VNED AUTOS ONLY AUTOS ONLY Ded, $1 ODD ❑ U 810.7R587773-21-43-G 111/2021 11112022 COMIII11 DSINGLELIMIT 51 000000 U BODILY INJURY (Par person) $ BODILY INJURY (Per accldent) $ PRQPERTYDAMAGE $ ❑ Uninsured Motorist $1.000 000 C D uMBRELLALIAB EXCESS LIAR 0 OCCUR CLAIMS-MADC Q 0 CUP-51318640A-2143 IIIQ021 11112022 EACH OCCURRENCE S5000000 AGGREGATE $ 5 000 000 DED I ❑ I RETENTIONS10.000 $ D WORKERSCOrePENSATIox AND EMPLOYERS' LIABILITY ANYPROPRIETORIP.ARINERfE (ECO7IVE YIN OFFICER,AIEMBER EXCLUDED? (Mnndalory In NH,) It yea, describe under DESCRIPTION OF OPERATIONS bylaw N ! A p UB-5RO593D5-21.43-G 11112021 111/2022 © ST UTE ERH E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE- EA EMPLOY $ E.L. DISEASE - POLICY UNIT S 1.000 000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Addlllanal Romprks Schcdula may Im anachod It nrom sppFc Is raqulrsd) Re; Pallas Residence Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION %d St. Lucie County 2300 Vlrlgina Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 1, E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISN Fort Pierce FL 34982 AUTHORiZEDREPRES£NTATIVE +�� �s 9iE�r�acciltCe SCYIfe �.C.{;(� Beecher Carlson Insurance Services, LLC @ 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 63172031 1 21 22 Obsidian Ft9rter (a11 entitesl I Lynda Volpe 1 D1212021 C12li42 144 (=Vrl I Page I er- 2 AGENCY CUSTOMER ID: _ LOC #: A� i ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMEDINSURED GFA International, Inc., Beecher Carlson Insurance Services DBA Universal Engineering Sciences POLICY NUMBER 4205 Vineland Rd., Suite 11 Orlando FL 32811 P-630-5R060261-COF-21 CARRIER NAIC CODE Charter Oak Fire Insurance Company 25615 EFFECTIVE DATE: 1/1 /2021 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03116) HOLDER: St. Lucie County ADDRESS: 2300 Virigina Ave Fort Pierce FL 34982 ADDITIONAL NAMED INSUREDS Contour Engineering II, LLC (Limited Liability Company, Additional Named Insured) Contour Engineering, LLC (Limited Liability Company, Additional Named Insured) DBA Geotek Engineering Co., Inc. *Coverage applies as of 06/30/2021* GFA International, Inc (Corporation, Additional Named Insured) IQC Southwest LLC (Limited Liability Company, Additional Named Insured) Nova Geotechnical & Inspection Services - N Nev LLC (Limited Liability Company, Additional Named Insured) Nova Geotechnical & Inspection Services LLC (Limited Liability Company, Additional Named Insured) Nova Geotechnical & Services - So Cal LLC (Limited Liability Company, Additional Named Insured) Obsidian Group Acquisitions, Inc (Corporation, Additional Named Insured) Vaughn Road Properties, LLC (Limited Liability Company, Additional Named Insured) Geoservices, LLC (Limited Liability Company, Additional Named Insured) ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 63172031 1 21 22 Obsidian Master (all entites) I Lynda Volpe 1 8/2/2021 4:21:42 PM (EDT) I Page 2 of 2