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HomeMy WebLinkAboutCERTIFICATE OF LIABLILTY INSURANCEA`c)kb® CERTfriCATE OF LIABILITY INSURANCE DA TE 3/7/2018 "' 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(les) must 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 endomement(s). PRODUCER Bateman Gordon and Sands 3050 North Federal Hwy SCANNED Lighthouse Point FL 33064 BY CONTACT PHONE 9ry�941-0900 FUA°c Na:954 941-2006 E-MAIL AooREss: kdunn BGSA en .com INSURER(S)AFFORDING COVERAGE NAIC9 �T LUCIE COUNTY INSURER A: Amedsure Mutual Insurance Co. 23396 INSURED PREWA Precast Wall Systems, Inc. Solar Manufacturing Inc. 1888 NW 22nd Ct Pompano Beach FL 33069 INSURER B: Amedsure Insurance Co. 19488 INSURER C: INSURER D: INSURER E: INSURERF- COVERAGES CERTIFICATE NUMBER: 1264131997 RFVISInhl NIIMRFR- 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. ILIR TYPE OF INSURANCE ADD SUB pOLICYNUMBER PMp EFF MMILIr1CU EJrP YYVI LIMITS A GENERALLWBILITY Y Y G1.20109811502 6=017 6122018 EACH OCCURRENCE $I'WD000 X COMMERCIAL GENERAL LIABILITY DAMAGE1O E P EMI E Ee oc =nce $100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE r-XI OCCUR X XCU/Contractual PERSONAL&ADV INJURY It1,000,00D X Broad Form PD GENERALAGGREGATE $2,00G00D GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $2000,D00 POLICY X PRO-JPCT LOC E B AUTOMOBILELUIBILITY Y Y CA20499121001 1122017 11=018 COMBINEDSIN LIMB Ea acadent X BODILY INJURY (Per person) $ALLA ANYAUTO GOWNED A EDULED AUTOS I BODILY INJURY(PeraeadeN) $ X HIRED AUTOS X AUTOS PROP DAMAGE $ A X UMBRELLA LIAB X OCCUR Y CU13810911602 a22017 Br12D1B EACH OCCURRENCE It100worto AGGREGATE $10,000,000 EXCESS LIAB CLAIMS -MADE DELI I X I RETENTION SO $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINLIM ANY PROPRIETOWARTNERJEXECUTNE OFFICER/MEMBER EXCLUDED? NIA Y WC20163351402 11112018 1112019 X I WCSTATU- DTH- EL EACH ACCIDENT $500,000 EL DISEASE -EA EMPLOYE It500,0DO (Mandatory In NH) 11 ye9, tleefflbB Mtler DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMB I E500,000 A Rented & Leased Equipment IM20462881002 622017 622018 limit $1,000,000 Dedudble: $2,S00 DESCW PTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Runn tda Schedule, K mare space Is required) DOCUMENT IS NOT COMPLETE UNLESS ACCOMPANIED BY THE ACORD 101. General Liability: Primary & Non -Contributory, Additional Insured, On -Going and Completed Operations, as required by written contract, per CG7048 1015. Waiver of Subrogation as required by written contract, per CG7049 1109. �g0 Days Notice of Cancellation other than non-payment of premium per Notice per Form IL7074 0116 Auto Liability: Additional Insured, Waiver of Subrogation as required by Wditan contract, per CA7171-0508. -Primary-Non Contributory as required by written contract, Per CA7165 0911- - c - -- - ------ __ - See Attached... - CERTIFICATE HOLDER CANCELLATION - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Port St. Lucie County Building and Code Regulation Department ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE wo - R . 2300 Virginia Avenue Fort Pierce FL 34982 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD r- - AGENCY CUSTOMER ID: P.!_.<i LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Bateman Gordon and Sands Precast Wall Systems, Ina POLICY NUMBER Solar Manufacturing Ina 1888 NW 22nd Ct Pompano Beach FL 33069 CARRIER NAIC CODE EFFECTIVE DATE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Workers' Compensation: Waiver of Subrogation as required by written contract, per WC000313 0484 Umbrella Liability: Extends coverage to underlying General Liability (excludes the general liability per project aggregate), Auto Liability and Workers' era] Information:The General Liability policy contains no specific residential exclusions. pendent Contractors Liability is included in the General Liability per forth CG0001 0413. COVERAGE IS SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS D 101 (2008101) © 2008 ACORD COI The ACORD name and logo are registered marks of ACORD reserved.