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HomeMy WebLinkAboutCertificate Of Liability InsuranceIIJIVFIJ[:�11 KCON[`NF7 A` OI2Op CERTIFICATE: OF: LIABILITY. INSURANCE DATE (MM/DDIYYYY) THIS CERTIFICATE .IS ISSUED. .AS A . MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS. CERTIFICATE .DOES NOT- AFFIRMATIVELY ORNEGATIVELY 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 HOL'DER.' ' .' _ IMPORTANT:.' If' the. certificate ITIONAL:INSURED, the olicy( ies).must. have ADDITIONAL INSURED provislo0s or. be. endorsed: P -holderfp(MI If SUBROGATION IS WAIVEb, subjectto the ..terms and'conditions of.fhe policy; certain policies may require "an endorsement. A statement_on this certificate does hot confer rights to the certificate holder -In lieu of such endorsement(§):' ... PRODUCER. "' JCr ZO2�. Ames& Gouggh .. 8300 Greensboro.Dnve: St'. Lucie.County Suite 9811 . McLean; VA'22102 .. - " :.: Permitting' CONTACT. .. M DON► o ; (703)827-2277, :" ac,No :(703) 827.2279 . E Aa E : admin@amesgough.com INSURERS AFFORDING COVERAGE -' NAIC N INSURERA:EvanSton InSUrance COm an . 35378 . INSURED'INSURERBi `. .. ,. .. - . INSUREfC:. ... .. '.GFA-IntemationaI Inc:dbeUnive'rsal.Engineeriing,Sclences _ INSURER D : Boulevard3532 Maggie :Orlando;FL 32811+6697 ' INSURER E :: INSURERF:.. " :. COVERAGES " CERTIFICATE NUMBER: ' . . " " REVISION. NUMBER:: "THIS' IS' .TO :CERTIFY. THAT .THE' POLICIES • OF -INSURANCE LISTED .BELOW. HAVE BEENJSSUED TO THE INSURED NAMED'ABOVE FOR THE POLICY PERIOD. INDICATED., . NOTWITHSTANDING'ANY REQUIREMENT, TERM OW 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 SUBJECTTO ALL THE TERMS; EXCLUSIONS -AND CONDITIONS OPSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIQ CLAIMS. INSR TYPE OF INSURANCE ' : ' , ADDL SUBR POLICY NUMBER. , POLICYEFF - POLICY EXP ' LIMITS ' COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F ..00CUR. ;. • ' 'EACH OCCURRENCE - $ ' GE TO RENTED DAMPAFAIS 'MEDFJ(P (Any one" rson ' 'PERSONAL 8, ADV INJURY $ ' GEN'LAGGREGAT..E LIMIT APPLIES PER: ' PO- OLICY PRRT' LOC JECD. OTHER: ... . GENERAL AGGREGATE ' $ ' PRODUCTS- comp/bp Ad. .. - .AUTOMOBILELV181LTIY. ANY AUTO OWNED'- SCHEDULED AUTOS ONLY AUTOS H RED . NON-0WNEO A�TOS ONLY AUTOS ONLY .. .. ' MCOBI cc dED SANGLE LIMIT BODILY INJURY Per rson $' BODILY INJURY ( Per accident $ ' PROPE�R�Yt AMAGE er ac en - $ ' UMBRELLA LUAB'A"CLAIMS.,MADE, EXCESS LIAR :. OCCUR EACH OCCURRENCE , $ AGGREGATE DE b RETENTION $. WORKERS COMPENSATION AND LITY N ONFICEO BRIM O RB uEDRE/DE ECUTIVE YIN F R/ E gE (Mandatory In NH) : If 'es, desbribe'under y DESCRIPTION OF OPERATIONS below . NIA , J.STEARTUj� I I OTFI- rR E.L. EACH ACCIDENT E.L. DISEASE = EA EMPLOYE $' E.L. DISEASE, -POLICY LIMIT A Professional Llab.'' .. • - " MKLV7PL0004492 .. 1/112021, 111I2022 . Per Claim/Aggregate 510.001000 'DESCRIPTION OF OPERATIONS f LOCATIONS 1. VEHICLES .(ACORD 101,.Additional Remarks Schedute; may baattached If more space Is required)' RE: Ocean Glass Townhomes. -CERTIFICATE 'CANCELLATION " .SHOULD'ANY.OF THE ABOVE' DESCRIBED POLICIES. BE CANCELLED BEFORE - St. Lucie County..':. .. E _THE EXPIRATION DATE THEREOF, NOTICE' BE DELIVERED: IN THE ' 2300 Virginia Avenue .. ACCORDANCE WITH POLICY PROVISIONS: Fort.Plerce, FL.34982' 'AUTHORIZED REPRESENTATIVE' ' ACORD 25 (201.6/63) ' : 01988.2015 ACORD CORPORATION. Ali rights reserved. The ACORD.name and logo are registered marKS of FACOKD AC40M ' CERTIFICATE OF LIABILITY INSURANCE DATE (14M)O9 M10 815f2021 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 15 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 endorsements . PRODucER Beecher Carlson Insurance Servicp��'EIVE� Tit 6 Concourse Parkway, Suite 2300 -COACT Judith Botch PHONE I FAXNall 770-870.3431 Atlanta, GA 30328 S E P 0 2 20 21 E•4AiUL D Ess• botch beecheroarlson.com LINISUREM AFFORDING COVERAGE NAICIr INSURERA: Charter Oak Fire Insurance Comparry INswtrRs: 'Ravelers Indemnity Co Of America 25615 25666 I,11ww.beochorcarlson.com t—L-ucie-County---- INSURED Permitting GFA International, Inc., DBA Universal Engineering Sciences 4205 Vineland Rd., Suite L1 Orlando FL 32811 INSURERC: Travelers Property Casual Co of Amer 25674 INSURERD: Travelers Casualty and Surety Company 19038 INSURERE: INSURER F : l`f1vR0A*r-4R [-ERTIFICATF NUMBER* 63258723 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 TYPE OF INSURANCE ADo1 SUS POLIC:YNUMBER M�INLDDrDf E� MPI POLICY LIMITS A U COMMERCIALOENERAI.LIABILITY ( LAIM"ADE � OCGUR Deductible SO Ll U P-630-5R0fi0261-COF-21 11/12021 1/112022 EAGHOCCURRENCE $1000000 PRt -MM (E ClxlirgpSB $ 300,000 ❑ WED EXP An one ersan) $ 5 000 PERSONAL. & ADV INJURY $1 000 000 GEWL AGGREGATE LIMIT APPLIES PER: POLICY F11 JE T 1-1 LOG OTHER: GENT RALAC-GREGATE $2,000,000 PRODuoTS-COMPIOPAGG s2000000 I ErnploWe Benefits $11000 000 B AUTO►rrORILELIABILITY D ANYAUTO MINED SCHEDULED AUTOS ONLY AUTOS N1RED NONE -OWNED AUTOS ONLY AUTOS ONLY ❑ Ded,$100D ❑ ❑ 810-7R587773-21-43•G 111t2021 11111'.022 2I•ffi IINGLE LIMIT 81000000 BODILY INJURY (Per person) $ BODILY INJURY (Par ecddenq $ PROPERTYDAMAGE $ Uninsured Motorist $1000000 C 7 UMBRELIALIAB EXCESS LIAR OOCUR CLAIMS -MADE Gt p CUP-51118640A-2143 11112021 11112022 EACHOCCURRENCE $5,000000 H AGGREGATE $ 5 000 000 DED 01 MTENTION 9 10,000 s D WORKE'PSCOMPENSATION AND EMPLOYERS' LIAABILnY N ANYPROPRIETORlPA4tiNEPJEXECU`rIVE YIN OFFICERWEMBEREXCLUfYED7 ® (Mandatary In NH) It �ya+e. aasIndbe undo DESCRIPTION OF OPERATIONS helm:, NIA ❑ UB-5RO59305.21-43-G 11112021 1/112022 gTR UTE OT3H- E.L. EACH ACCIDENT $1,000,000 E.L.]SEASE-EAEAIPLOY $ _11.000 00 E,L, DISEASE- POLICY UMITJ $1.000 000 DESCRIPTION OP OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 10i, Addlelonal Remarks Schcdula, mayhe attached It more space Is ragulrci' Re; Ocean Glass Tawnhomes St. Lucie County 2300 Virlgina Ave 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. AUTHOIiUBEDREPREst:NTATLVE ;3C (ariaarc «I olu SCYvirr�t, Beecher Carlson Insurance Services, LLC 01933.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 6325E723 1 21 22 QSsidian mates Call entitesl 1 dudith 2aich 1 V512021 6315ra2 Pre (ID" I page 1 o2 2 'j AGENCY CUSTOMER ID: LOC #: ACORO ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Beecher Carlson Insurance Services GFA International, Inc., DBA Universal Engineering Sciences POLICY NUMBER 4205 Vineland Rd., Suite L1 Orlando FL 32811 CARRIER NAIC CODE I , EFFECTIVE DATE; ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) 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 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 63258723 1 21 22 Obsidian Master (all entites) I Judith Boich 1 8/5/2021 6:15:02 PM (EDT) I Page 2 of 2