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HomeMy WebLinkAboutCERTIFICATE OF LIABILITY INSURANCESCANNED Client#: 14(- JI RY TLANTOW ACORDTM CERTIFICATE OP W*15IIILLMY INSURANCE DATE(MM/DD/YYYY) 2/19/2018 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 any rights to the certificate,h older in lieu of such endorsement(s). PRODUCER BB&T Insurance Services, Inc. CONTACT NAME: a/c°Nr o Ext ; 407 691-9600 AAIC No): 888-635-4183 PO Box 4927 IOrlando, FL 32802-4927 407 691-9600 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Hartford Underwriters Insurance Company 30104 INSURED Atlantic Tower Services Inc dba ATS 450 S Ronald Reagan Blvd j Longwood, FL 32750 !I/ j INSURER B • National Fire & Marine Insurance Compan 20079 INSURER C HaMardinsurance company olSoutheast : 38261 INSURER D ; Hartford Ins Co of the Midwest 37478 INSURER E : INSURER F : 1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSU}2ANCE 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 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. LTR TYPE OF INSURANCE NSRADDLSUBR WVD POLICY NUMBER MMIDD�F MM/DDYYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR BI/PD Ded:5,000 X X I 21 UEAQ10623 Contract LiaInc 12/14/2017 12/14/2018 EACH OCCURRENCE $1 OOO OOO PREa.N.T rnce EMISES $300 000 X MED EXP (Any one person) $1 O 000 X XCU Incl PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F_X1 ECT LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ D AUTOMOBILE LIABILITY ANY AUTO SCHED AUTOS ONLY AUTOSULED AUTOS ONLY X NON -OWNED AUTOS ONLY X X 21 UEAQT6798 12/14/2017 12/14/201 8 COMBINED SINGLE LIMIT Ea accident 1 OOO OOO $ , , X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X 1 X 43UM01003990 12/14/2017 12/14/2018 EACH OCCURRENCE $] OOO OOO AGGREGATE s7,000,000 DED I X RETENTION $1 O 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/ N OFFICER/MEMBEREXCLUDED? F`N1 (Mandatory In NH) yes, describe under DESCRIPTION OF OPERATIONS below NIA 21 WBAAT3538 2/19/2018 02/19/201 X PER OTH- E.L. EACH ACCIDENT $1 00O 000 E.L. DISEASE - EA EMPLOYEE $1 000 000 ' E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Additional Insured status is granted with respect General Liability if required by written contract per endorsement: Additional Insured Form #HS2480 0713. General Liability includes a Blanket Waiver of Subrogation per HG 00 01 06 05 and Primary & Non Contributory per form HGOO 01 06 05. The General Liability policy contains a severability of interest provision per endorsement and Contractual Liability -Railroads, per Form #HGO01 03 14. General Liability policy includes 30 day Notice of Cancellation, 10 day notice for (See Attached Descriptions) VCK I Ii-11-A I C MULUIZ1: GANULLLA I IUN St. Lucie County Building Department 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) 1 of 2 #S19546759/Ml9544896 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MOCO i DESCRIPTIONS (Continued from Page.1) Non -Pay per Contractors Broad Form Endorsement HS 30:04 12 14 page 6 of 6. Additional Insured status is granted with respect to Auto Liability if required by written contract per form: Commercial Automobile Broad Form Endorsement HA 9916 03 12. Auto Liability includes a Blanket Waiver of Subrogation per form HA 99 16 0312. Automobile policy includes a 60 day Notice of Cancellation with 10 days for Non -Payment per Commercial Automobile Broad Form Endt. HA 9916 03 12, page 5 of 5. Umbrella is follow form. Workers Compensation includes a Blanket Waiver of Sub logation per form WC000313. 30 Day Notice of Cancellation on policy, 10 Days for non -pay r I k SAGITTA 26.3 (2016/03) 2 of 2 #S19546759/M19544896