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HomeMy WebLinkAboutCertificates of Insurance MCFAJOH-01 KLISH 1441_1X> EV CERTIFICATE OF LIABILITY INSURANCE DA 1i212026 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 PRODUCER irtlficate does not con hts,ferri6 to the certificate holder in lieu of such endorsements. C,%TACT Michael Burns NwwweneE: Insurance Office of America E tf�. Edl;(607)754-0329 INC.No):(607)754-9797 31 Lewis Street Suite 201 Jiss:Michael.Burns@ioausa.com Binghamton,NY 13901 INSURER(S)AFFORDING COVERAGE NAIC k INSURERA:Valley Forge Insurance Company 20508 INSURED INSURER B;Amerlcan Casualty Company of Reading,Pennsylvania �20427 McFarland Johnson,Inc.49 Court Street INSURER c:The Continental Insurance Company '36289 Suite 240 INSURER tNational Fire Insurance Company of Hartfordi20478 Binghamton,NY 13901 INSURER E IN F COVERAGES CERTIFICATE N MBE : 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 ASR INCE ��SUER Y NUMBER I POLICY EFF POLICY EXP LIMITS _ IN COMMERCIAL GENERAL IA aNVD POLIC,,,,,,, 1.000 000 X TYPEOFINSURA,LWBILITY E,FsCFI OCCURfrCt�kCE; CLAIMS-MADE ' X OCCUR 6056803227 1/1/2025 111/2026 PREW ET'C1REccurrI 100,0••00 X X I��EM sEs iEa and $ ME EXP(awry rlr*porsen, S 15,000 T PERSONAL 1 1,000,000 _W a s .. .m GENERAL AGGREGATE _._... $ S 2,000,000 JCT X LOC 2,000,000GEN"LGGREGATELIMITAPPLIESPER BYA LA, Wm LOMPrO __ acht OTHER' .......................... ................. .."".."'"".".. COMBINED SINGLE LIMIT 1,660,000''.. B AUTOMOBILE LIABILITY (Ea accident) �. X ANY AUTO X X 6066803213 11112025 1H12026 BODILY INJURY(Per person) T OWNED SCHEDULED AUTOS ONLY !AUTOS BODILY INJURY(Per accident)''f AUTOS ONLY A.L9T0' ,..WP (Per aWd nt)AMAGE S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAR CLAIMS-MADE X X 60568032" 11112025 111/2026 AGGREGATE s. 10,000,000 DED X RETENTIONS 10,000 _ S WC656803230 11112025 111/2026 WORKERS C MPENS�ATI? . STATUTE'. RIB ANDEMPL ERS'LIAeNLI ANY PROPREIIETggO��RRqIPARTNER/EXECUTIVE YIN X E L EACH ACCIDENT S 1,fj00,000 rrlppraCletoryln EXCLUDED? N NIA 1,000,000'. E L DISEASE-EA EMPLOYEE S II as,describe under 1,000 000' RI PTnOPI OF OPERAT NS below PISM2 POINCY"q.IMVT A Vat Pprs&Records �6151103227 11112/21 11112021 ,Blanket Limit 1,000,000 ........... _- .................. _ DESCRIPTION Or OPERATIONSI LOCATIONS 1 VEHICLES(ACORD 101.Addllional Remarks Sche:dulo,may ba Attached If more space Is requlred) Project Key West International Airport Concourse A and Terminal Improvements Program. Monroe County BOCC and all other parties as required by written contract are additional insured on a primary and noncontributory basis including completed operations in regard to general liability per endorsement numbers CNA74858NY,CNA76079XX,CNA74987XX,in regard to auto per endorsement number CNA71627,A Waiver of Subrogation applies In favor of the certificate holden,owner and all other parties as required by written contract in regard to general liability per endorsement number CNA'74858NY,in regard to auto per andorserrierlt„number CA 04 4410 13,In regard to Workers compensation per endorsement WC 00 0313.The umbrella policy is following form of the underlying policies per endorsement#CNA76604XX. CERTIFICATE H'OLDmER�..._,. 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. AUTHORIZED REPRESENTATIVE Monroe County BOCC 1100 Simonton Street -Key-WAsUL1 040.. ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD _ci NEW Workers' ers Compensation CERTIFICATE OF INSURANCE COVERAGE �Tt Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured MCFARLAND-JOHNSON,INC. (607)-723-9421 49 Court Street Suite 240 (Binghamton,NY 13901 Work Location of Insured(Onlyrequiredif coverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 16 0770183 _W 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) :3b_he Guardian Life Insurance Company of America Monroe County Department of Aviation Greater Rochester International Airport Plicy Number of Entity Listed in Box 1 a 1200 Brooks Avenue 018268 0003 Rochester,NY 14624 3c.Policy Effective Period 01/01/2025 to 12/31/2025 4. Policy provides the following benefits: [Z] A.Both disability and Paid Family Leave benefits. B.Disability benefits only. C.Paid Family Leave benefits only. 5. Policy covers: A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B Only the following class or classes of employer's employees: Under penally of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured g disability y � g s described above Dale Signed 12I09/20YS 24 and/or Paid Family Leave benefits stfra coverage a (Signature of insurance carrier's authorized representative or NYS licensed insurance agent of that insurance carrier) Telephone Number 1-888-276-454 Name and Title Michael Prestileo,Head of Group Benefits Slrate .Product&Underwriting 2 _...... ........ IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carriers authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 58 is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton, NY 1390 2-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if sox 4B,4C or 5B have been checked) _.� .. .. State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By .... ....�....,.,_.�,.,........�,... _. ........ --- �......... ......... ......,,,,,,.,, . ........(Signature of Authorized NYS Workers'CanpensaLiontion Board Employee) Telephone Number y Name and Tille ........ Please Note:Only insurance carriers licensed to write NYS disability and Paid Family Leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form 08-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 1111111,111111111NIINII1IIIIII1IIIIIIIIIgII, I�I Additional Instructions for Form 1313-120.1 By signing this form,the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail,)Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier. This Certificate is issued as a matter of information only and confers no rights upon the certificate holder.This Certificate does not amend,extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board,commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (12-21)Reverse AC . CERTIFICATE OF LIABILITY INSURANCE 06/03/20224YY) Il 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 1-201-262-1200 CONTNAMEACT Timothy P. Esler, CPCU Fenner & Esler Agency, Inc. PHONE FAX A/C No Ext: 201-262-1200 (A/C,No): 201-262-7810 E-MAIL PO Box 60 ADDRESS: certs@fenner-esler.com INSURER(S)AFFORDING COVERAGE NAIC# Oradell, NJ 07649 USA INSURERA: HARTFORD FIRE IN CO 19682 INSURED INSURER B: McFarland-Johnson, Inc. INSURER C 49 Court Street INSURERD: Suite 240 INSURERE: Binghamton, NY 13901 USA INSURERF: COVERAGES CERTIFICATE NUMBER: 535497509 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 POLICY NUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ OCCUR DAMAGE S( RENTED CLAIMS-MADE PREMISES Ea occurrence) ccurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident I' $ UMBRELLALIAB OCCUR i m'' EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE .... w.,(r ^'^' "'""""" AGGREGATE $ DED RETENTION$ 6.6.24 $ WORKERS COMPENSATION ,®o,�„� �� � ^^�^^^^�^-*�^ """" PER OTH- AND EMPLOYERS'LIABILITY �p�g� STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N � N'r'`_„' X �''- E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Prof Poll Liability 39 OH 0546136-24 06/15/24 06/15/25 Per Claim 5,000,000 FULL PRIOR ACTS Annual Aggregate 5,000,000 Deductible per clm 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Monroe County Airports Term Agreement CERTIFICATE HOLDER CANCELLATION 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 ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street, Room 2-216 AUTHORIZED REPRESENTATIVE Key West, FL 33040 USA , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD jvalentino 535497509