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HomeMy WebLinkAboutCertificates of Insurance Page 1 of 2 ' CERTIFICATE OF LIABILITY INSURANCE DATE 12/30/2024 /2024 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 WTW Certificate Center NAME: Willis Towers Watson Insurance Services West, Inc. c/o 26 Century Blvd PHONE 1-877-945-7378 FAX 1-888-467-2378 AIC No Ext: (A/C,No): E-MAIL certificates@wtwco.corn P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual Fire Insurance Company 23035 INSURED INSURERB: Liberty Insurance Corporation 42404 CPH Consulting, LLC 500 West Fulton Street INSURERC: American Guarantee and Liability Insurance 26247 Sanford, FL 32771 INSURERD: Allied World Surplus Lines Insurance Compa 24319 INSURERE: Indemnity National Insurance Company 18468 INSURERF: RSUI Indemnity Company 22314 COVERAGES CERTIFICATE NUMBER:W37157617 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LTR MM/DDIYYYYJ fMM1DDIYYYYJ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE � OCCUR DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ A MED EXP(Any one person) $ 25,000 Y TB2-641-446161-054 12/31/2024 12/31/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 4,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y AS7-641-446161-044 12/31/2024 12/31/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident C X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE Y AUC 8344746-01 12/31/2024 12/31/2025 AGGREGATE $ 10,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER PER EMPLOYERS'LIABILITY YIN STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? No NIA WC7-641-446161-064 12/31/2024 12/31/2025 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Professional Liab incl Pollution 0313-8987 12/31/2024 12/31/2025 Each Claim Limit $5,000,000 Policy Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I .. SEE ATTACHED y 4.7.25 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 AUTHORIZED REPRESENTATIVE PO BOX 1026 4, KEY WEST, FL 33041 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 26998488 BATCH: 3756610 AGENCY CUSTOMER ID: LOC#: ACCOR 0 ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Insurance Services West, Inc. CPH Consulting, LLC 500 West Fulton Street POLICY NUMBER Sanford, FL 32771 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance CERTIFICATE HOLDER IS AN ADDITIONAL INSURED WITH REGARDS TO GENERAL LIABILITY, AUTO LIABILITY AND UMBRELLA LIABILITY WHEN REQUIRED BY WRITTEN CONTRACT. INSURER AFFORDING COVERAGE: Indemnity National Insurance Company NAIC#: 18468 POLICY NUMBER: XS001814 24 EFF DATE: 12/31/2024 EXP DATE: 12/31/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Automobile Liability Each Occurrence $1,500,000 excess $2,000,000 INSURER AFFORDING COVERAGE: RSUI Indemnity Company NAIC#: 22314 POLICY NUMBER: NRA604323 EFF DATE: 12/31/2024 EXP DATE: 12/31/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Automobile Liability Each Occurrence $1,500,000 excess $2,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 26998488 13ATCH: 3756610 CERT: W37157617 CPHINCO-01 KMCINTOSH ACORO"° CERTIFICATE OF LIABILITY INSURANCE DAT2/2/2D/YYYY) 022 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: JCJ Insurance Agency, LLC PHONE 2208 Hillcrest Street (A/C,No,Ext): (321)445-1117 (A/c,No):(321)445-1076 Orlando,FL 32803 ADDRESS:certs@jcj-insurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Contractors Bondin &Insurance Co. RLI 37206 INSURED INSURER B:RLI Insurance Company 13056 CPH Consulting, LLC DBA CPH,LLC INSURER 7 500 West Fulton Street INSURER D: Sanford,FL 32771 INSURER E INSURER F: COVERAGES CERTIFICATE 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CKB0200150 4/1/2022 4/1/2023 DAMAGE TO RENTED 300,000 X PREMISES Ea occurrence $ X Contractual Liab MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT1:1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO X PSA0003057 4/1/2022 4/1/2023 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE X CKB0200157 4/1/2022 4/1/2023 AGGREGATE $ 5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N PSW0002907 1/1/2023 1/1/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000'OOO If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Professional Liab RDP0046508 4/1/2022 4/1/2023 Per Claim 5,000,000 B RDP0046508 4/1/2022 4/1/2023 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insureds with regards to General,Auto and Umbrella Liability when required by written contract. A:A7 y ° By 2 . 14 2 3 DAB CERTIFICATE HOLDER CANCELLATION WAMM K?A-X yft-`- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ty ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1026 Key West,FL 33041 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) / ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD