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HomeMy WebLinkAboutCertificates of Insurance 710/29/2025 E(MM/DD/YYYY) ACCORD® CERTIFICATE OF LIABILITY INSURANCE 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 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: Rebecca Swain Bowen, Miclette& Britt of Florida, LLC a//C"No Ext: (407)647-1616 p/c No:(407)628-1635 850 Concourse Parkway S (A AMAIL Suite#105 ADDRESS: rswain@bmbinc.com Maitland FL 32751 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:James River Insurance Co. 12604 INSURED PEDROFALCO INSURERB:Amerisure Mutual Insurance Company 23396 Pedro Falcon Electrical Contractors, Inc. dba Pedro Falcon Contractors, Inc INSURERC: 31160 Avenue C INSURER D7 Big Pine Key FL 33043-4516 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 137217948 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 MMIDD/YYY MMIDD/YYY A X COMMERCIAL GENERAL LIABILITY Y Y P0000003090 11/2/2025 11/2/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY jECT RO- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y CA20929391102 11/2/2025 11/2/2026 COMBINED SINGLE LIMIT $ Ea accident 1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident A UMBRELLA LAB X OCCUR Y Y 00138713-3 11/2/2025 11/2/2026 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION Y WC20945261102 11/2/2025 11/2/2026 )( PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) 1,8 T E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under Aby DESCRIPTION OF OPERATIONS below """ E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing: Contact Name shown above. When required by written contract,those parties listed in said contract, including the Certificate Holder,are added as additional insureds with respect to the General Liability including ongoing and completed operations,Auto Liability,and Excess Liability as afforded by the policy and/or endorsements. When required by written contract,waiver of Subrogation is granted with respect to the General Liability,Auto Liability,Workers Compensation,and Excess See Attached... 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 1100 Simonton Street Suite 2-213 AUTHORIZED REPRESENTATIVE Key West FL 33040 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PEDROFALCO LOC#: ACOOR 0 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Bowen, Miclette& Britt of Florida, LLC Pedro Falcon Electrical Contractors, Inc. dba Pedro Falcon Contractors, Inc POLICY NUMBER 31160 Avenue C Big Pine Key FL 33043-4516 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Liability to those parties listed in said contract, including the Certificate Holder. The General Liability and Excess Liability certified herein are primary and non-contributory to other insurance available, but only to the extent required by written contract. Monroe County Board of County Commissioners is included as Additional Insured&Loss Payee with respect to the property described herein. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: P0000003090 Effective Date: 11/02/2025 Expiration Date: 11/02/2026 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization s : Locations Of Covered Operations Where required by written contract or written agreement All operations of the Named Insured Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" 11property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions;or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed;or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ Policy Number: P0000003090 Effective Date: 11/02/2025 Expiration Date: 11/02/2026 COMMERCIAL GENERAL LIABILITY CG20370704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Where required by written contractor written All operations of the Named Insureds agreement Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury"or"property damage"caused,in whole or in part, by 'your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 ❑ COMMERCIAL INLAND MARINE THIS ENDORSEMENT AMENDS YOUR POLICY. PLEASE READ THIS CAREFULLY. All Other"Terms"and Conditions Remain Unchanged. INSTALLATION FLOATER - SPECIFICALLY DESIGNATED ADDITIONAL NAMED INSUREDS COVERAGE ENDORSEMENT Named Insured PEDRO FALCON ELECTRICAL CONTRACTORS INC Effective Date 11/02/2025 The coverage afforded through this endorsement is effective on the date stated above at 12:01 A.M. Standard Time, unless otherwise amended by endorsement attached to the policy. This endorsement is subject to the "terms", conditions and exclusions of the "Installation Floater" Coverage Form and is a part of the Coverage Form to which it is attached. This endorsement modifies the following forms: INSTALLATION FLOATER COVERAGE FORM The following specifically named individuals or entities are designated as additional named insureds under this coverage form. If specific jobsites are listed in the Jobsite column next to their name(s), then the designee is only considered an additional named insured specifically for those jobsites. If no jobsites are listed in the Specific Jobsites column, then the designee is considered an additional named insured for all jobsites covered under this coverage form. Designated Additional Named Insured Specific Jobsites MONROE COUNTY BOARD OF COUNTY FLORIDA KEY MARATHON INTERNATIONAL AIRPORT COMMISSIONERS, 1100 SIMONTON ST, KEY WEST, FL 33040 IM 99 23 10 15