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HomeMy WebLinkAboutCertificate of Insurance DATE(MM/DD/YYYY) ACoR" CERTIFICATE OF LIABILITY INSURANCE o2/oa/2o22 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Erinn E Collinsworth Collinsworth Ins & Risk Mgmt Services In PHONE FAX P.O. Box 661628 A/C No Ext: (786) 930-4795 A/C No: (786) 930-4794 E-MAIL Miami Springs FL 33266 ADDRESS: erinn@collinsworthinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Phoenix Insurance Company 25623 INSURED (305) 296-1347 INSURER B:Travelers Cas & Surety Co 19038 Bender & Associates Architects, P.A. INSURER C:Travelers Property Casualty of 25674 410 Angela Street INSURER D:Liberty Insurance Underwriters 19917 Key West FL 33040 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 12112 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR Y 660-8178X318 02/10/2022 02/10/2023 PREMISES Ea occurrence $ 1,000,000 APPROVED BY RIS4G. MED EXP(Any one person) $ 5,000 MANAGEMENT.... PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: DATE__ 2.... POLICY PE LOC WAVER NIA YES PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 A ANY AUTO Y 660-8178X318 02/10/2022 02/10/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Par.", Per accident C X UMBRELLA LIAB X OCCUR CUP-4K489840 02/10/2022 02/10/2023 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED J X J RETENTION$ 10,000 1 $ WORKERB AND EMPLOYERTIONS' Y/N UB-OK197735 02/10/2022 02/10/2023 X STATUTE EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR(PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I NJ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Professional Liability AEXNYAB62TB002 02/10/2022 02/10/2023 Each Claim $ 2,000,000 Claims Made Basis Policy Aggregate $ 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) When required by written contract, Monroe County Board of County Commissioners is an additional insured, excluding professional services, on the General & Auto Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissioners Insurance Compliance PO Box 100085 - FX AUTHORIZED REPRESENTATIVE Duluth GA 30096U ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1302303136 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 rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER Fsjoo!F!Dpmmjotxpsui NAME: Dpmmjotxpsui!Jot!'!Sjtl!Nhnu!Tfswjdft!Jo FAX PHONE )897*:41.58:6)897*:41.58:5 (A/C, No): (A/C, No, Ext): Q/P/!Cpy!772739 E-MAIL dbjumzoAdpmmjotxpsuijotvsbodf/dpn ADDRESS: Njbnj!Tqsjoht!GM!44377 INSURER(S) AFFORDING COVERAGENAIC # Uif!Qipfojy!Jotvsbodf!Dpnqboz!36734 INSURER A : INSURED Usbwfmfst!Dbt!'!Tvsfuz!Dp2:149 INSURER B : Cfoefs!'!Bttpdjbuft!Bsdijufdut-!Q/B/ Usbwfmfst!Qspqfsuz!Dbtvbmuz!pg36785 INSURER C : 521!Bohfmb!Tusffu SMJ!Jotvsbodf!Dp/24167 INSURER D : INSURER E : Lfz!Xftu!GM!44151 )416*3:7.2458 INSURER F : DEDfsu!JE!29867)47* COVERAGESCERTIFICATE NUMBER: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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY BY!!!2-111-111 EACH OCCURRENCE$ DAMAGE TO RENTED Y CLAIMS-MADEOCCUR$ Z 771.9289Y42913021031361302103137!!!2-111-111 PREMISES (Ea occurrence) MED EXP (Any one person)$ 6-111 PERSONAL & ADV INJURY$ !!!2-111-111 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ !!!3-111-111 PRO- Y POLICYLOCPRODUCTS - COMP/OP AGG$ !!!3-111-111 JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ !!!2-111-111 (Ea accident) ANY AUTO BODILY INJURY (Per person)$ BZ 771.9289Y42913021031361302103137 OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS NON-OWNED HIREDPROPERTY DAMAGE $ YY (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB DYY DVQ.5L59:95113021031361302103137 EACH OCCURRENCE$ !!!3-111-111 OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ !!!3-111-111 $ Y!!!!21-111 DEDRETENTION$ PEROTH- WORKERS COMPENSATION Y STATUTEER C VC.1L2:884613021031361302103137 AND EMPLOYERS' LIABILITY Y / N ANYP ROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ !!!2-111-111 N / A O OFFICER/MEMBER EXCLUDED? !!!2-111-111 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under !!!2-111-111 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below EQspgfttjpobm!Mjbcjmjuz SEQ116848413021031361302103137 Fbdi!Dmbjn $ !!!3-111-111 Dmbjnt!Nbef!Cbtjt Qpmjdz!Bhhsfhbuf $!!!4-111-111 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Jg!sfrvjsfe!cz!xsjuufo!dpousbdu-!Npospf!Dpvouz!Cpbse!pg!Dpvouz!Dpnnjttjpofst!jt!bo!beejujpobm jotvsfe-!fydmvejoh!qspgfttjpobm!tfswjdft-!po!uif!Hfofsbm!'!Bvup!Mjbcjmjuz/ CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Npospf!Dpvouz!Cpbse!pg!Dpvouz!Dpnnjttjpofst Buuo;!Qspkfdu!Nbobhfs AUTHORIZED REPRESENTATIVE 2211!Tjnpoupo!Tu/-! Sppn!3327 Lfz!Xftu!GM!44151 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD Qbhf!2!pg!2