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Home My WebLink AboutCERTIFICATE OF LIABILITYClient' 18579 1, 131ATLANTOW '-ACORM CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 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 holder in lieu of such endorsement(s). PRODUCER BBBT Insurance Services, Inc. PD Box 4927 Orlando, FL 32802-4927 SCANNED CONTACT NAME: PHONE FA ac Na E.1:407691-9600 ac Na: 888-635-4183 E-MAIL ADDRESS: INSURER ISIAFFORDINGCOVERAGE NAICM 407691-9600 BY I INSURER A:Ha,uo.uUnden ft.,alnsurncecompany 30104 n INSURED OUny Atlantic Tower Services Inc dba ATS INSURER B:National Fire aMannelnsummCompan 20079 INSURER C: Hamm Insurance Company Msautxeazt 3$2$1 450 S Ronald Reagan Blvd Longwood, FL 32750 INSURER D; Hanford Ins co arge MiHwezt 3]4]$ INSURERS: INSURER F: v esanveo GCKIIYIGA I E NUMBER' oesnc. 1ai.111-- 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 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 ADDLSUB INSR MD POLICY NUMBER POLICYEFF (MWOp POLICYEXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR BI/PDDed:5,000 X X 21UEAQ10623 121141201712/1412011 EEEACH $1000000 �OECTCURRENCE PREMISES Ea occu ance $300000 X MED EXP (Any one person) $10000 X XCU Incl PERSONAL a ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _ POLICY a J COT LOC GENERAL AGGREGATE $2,000,000 Contract Lla Inc PRODUCTS - COMP/OP AGG $2 000,000 OTHER: D AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUr05 AUTOS ONLY X AIOJTNOS ONLY X X 21 UEAQT6798 1211412017 INED SINGLE LIMIT 'ant $1,000,000 X X INJU_RY(Per person) $ INJURY (Per accident) $ RTY DAMAGE itlent W $ S B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X 43UM01003990 2/14/2017 CCURRENCE $7 00O000 GATE S7 OOO OOO DED X RETENTION$10 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y IN OFFICERIMEMBER EXCLUDED? � X PER $ C NIA 21WBAAT3536 2/19/2018 02/19/201 EL EACH ACCIDENT $1 000000 Ifyes decZbeund If yes, describe antler DESCRIPTION OF OPERATIONS below E.LDISEASE- EAEMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Additional Insured status is granted with respect General Liability if required by written contract per endorsement: Additional Insured _Form #HS2480 07 13. General Liability includes a.Blanket Waiver of— _ -Subrogation-per HG-00-01-06-05 and -Primary & Non Contributory per form HG00 01 O6 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) 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/M19544896 W 1 %P05-ZU10 ADUKD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MOCO ued from Page-1) Non -Pay per Contractors Broad Form Endorsement HS 30 04 1214 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 Subrogation per form WC000313. 30 Day Notice of Cancellation on policy, 10 Days for non -pay SAGITTA 25.3 (2016103) 2 Of 2 #S19546759/M19544896 _ Ut IAG RICK SCOTT. GOVERNOR STATE OF DEPARTMENT OF BUSINESS AN SCC131150970 The TOWER SPECIALTY CONTRACTOR w Named below IS CERTIFIED Under the provisions of Chapter 489-FS. _ Expiration date: AUG 31, 2018 k tl FItKt KEN LAWSON, SECRETARY RIDA tOFESSIONAL REGULATION LICENSING BOARDw -Q EKEY, BENJAMIN R ATS -2544 E LANDSTREET RD SUITE-600`='-�;14— ORLANDO- `FL82624 51 ISSUED: 0710612015 DISPLAY AS REQUIRED BY LAW SEQ# L1607060001273 . '