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HomeMy WebLinkAboutCertificate Of Liability Insurance 6-14-21L AcoR1o" CERf"IFICATE OF LIABILITY INSURANCE DATE (14MIDDIYYYY) 6114/2021 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 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). Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 ONTPRODUCER NAEAR M Camille Pettwa PHONE FAX 404-460-1375 ADDRESS; Lcpettwayabeechercarlson.com INSURERS AFFORDING COVERAGE NAIC it ►vvAvboochorcarlson.com INSURER A! Charter Oak Fire Insurance CompanyGompany 25615 INSURED GFA International, Inc. d/b!a Universal Engineering Sciences 1215 Wallace Drive INSURER B 1 11ayelel'S_Indemnity Co of America 25666 INSURERC: Travelers Property Casualty Co of Amer 25674 INSURER D: Travelers Casualty and Surety Company 19038 Delray Beach FL 33444-4600 INSURERE: INSURER F : UUVEHA"I-N rIFRTIFII-aTF NIIMRFR- R9,zngi Q 0FafI4ZIrIN MIIrJIRCO- 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 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADD SUB POLICYNUMBER MMIDDYEFF INAMIX XP LIMITS A } I CONIMERCIALOENERALLIABILITY CLAIMIS•MADE ® OCCUR P-630-5R060261-COF21 111/2021 1/112022 EACH OCCURRENCE $1,000.000 it0Er4RT�NiEp EMI��F,a.Qcs� $ 300 000 MED EXP(An one reon) $ 5 000 D Deductible SO PERSONAL & FDV INJURY S 1,000 000 GENL AGGREGATE LIMIT APPLIES PER: 3 POLICY H JEC n LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMB-OPAUG $2,000,000__.._.___ .._ Em lD ne Benefits $1.060.000 OT14ER: B AUTOI!DBILEUABILMY ANY AUTO fI [J 810-7R587773-21-43-G i111'2021 1/1/2022 C01111IINEDSINGLELIMIT _tEs�ccldentl $ 1000000 BODILY INJURY (Per Person) $ OWNED SCHEDULED AUTOS ONLY AUTOS ' tt1RED NON-UVNED AUTOS ONLY AUTOS ONLY 1 BODILY INJURY (Per sed6ent) S PROPERTYDAMAGE Eff AKIM1d9II $ L Uninsured Motorist $1 000 000 Ded, $1 000 1 C n UMBRELLaLIAe p. OcCUR U C1 CUP-SR1864OA-21-43 1/112021 111,12022 EAOHtICCURRENCE $5,000000 AGGREGATE $ 5 000 000 REXCESS LIAR CLAIl.ISMIADE DED L RETENTIONS 10,OD0 S D WORKERS COMPENSATION AND EMIPLOYERS' IJABILITY ANYPROPRIETORIPARTNER cXECUTIVE Y t H OFFICERAtEPdBEREXCLUDED? ❑ N i A ❑ UB-5R659305-21-43-G 1/1/2021 111/2022 D PE STATUTE ERH, E.L. EACHACCIDENT $1 000,000 (Mandalary In NH) El. DISEASE- EA E1V.PLOYE $ It s, desodbe INldef DESCRIPTION OF OPEWNTIONS below E.L. DISEASE- POLICY LIMIT s 1,000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Rcmrks Schodulc, m;w he adachod It more space Is rcrluircA Re; DR Hatton Creekside. For Private Provider plan review and inspection services for lots 7119 Certificate Holder is added as Additional insured on a Primary basis, with respect to the general liability coverage and waiver of subrogation applies where required by written contract. St. Lucie County 2300 Virginia Ave Fort Pierce FL 34892 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 .�eg' (riLYt061& Jf(,' UgaftM JoWiCe�,' a(; Beecher Carlson Insurance Services, LLC 019AR-2015 ACORD CORPORATION_ All rlahts reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 62303129 1 21 22 Cosidian matec (all entiteal i Camille Fettxay 1 6/1d/2021 11:55:57 AM (bin? I Paqe 1 o.E 2 Z AGENCY CUSTOMER ID: LOC #: AGENCY Beecher Carlson Insurance Services POLICY NUMBER P-630-5R060261-COF-21 CARRIER ADDITIONAL REMARKS SCHEDULE NAIC CODE 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 Virginia Ave Fort Pierce FL 34892 ADDITIONAL NAMED INSUREDS NAMED INSURED GFA International, Inc. d/b/a Universal Engineering Sciences 1215 Wallace Drive Delray Beach FL 33444-4600 EFFECTIVE DATE: Page of Contour Engineering II, LLC (Limited Liability Company, Additional Named Insured) Contour Engineering, LLC (Limited Liability Company, Additional Named Insured) 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 62303128 1 21 22 obsidian master (all entites) I Camille Pettsay 1 6114/2021 11,55:57 AF1 (EDT) I Page 2 of 2