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HomeMy WebLinkAboutCertificate of InsuranceM DDY,vYI A 0® CERTIFICATE OF LIABILITY INSURANCE I DA 09114/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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(les) 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 INPMECT House Agent C F Insurance Services. No. i PHONEu Pm. (407) 884-7843 I laic ..(407) 0045014 P.O. Box 1189 AADDREss: INSURERS)AFFORpNG COVERAGE I N.C. Apopka FL 32704-1108 INSURERA: FmnkWnston Cmmlowmnw Co. INSURED INSURER B: ADIGWN Insulae' ContestLandscapinEBC: Landscaping, Inc. IINSUR 706 S Easy SI I INSURER D: IINSURERE: SeDB¢(an FL 32950INSURER F: COVERAGES CERTIFICATE NUMBER: CL195/a269 4 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO PMICH 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 POUCIE L LIM TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IVINPDIICT EFF CT EAP LTr IYPEOF INSUMNLE Iuxo cave POLICY NUMBER IMM9m IMAWM'1YYI UMTS CGMMERCMLOENERAL W BIUTY1,000,000 FACH OCCURRENCE Eu S CLAMS -MADE ©OCCUR(PREMISES IE4 AmeMut f 100'000 MEOEXP(Ah'vM ami I5 5,000 A GIFLIN47804 05/132019 05/13/2020 I PERSONALaAW IwuRY s 1,000,000 GEN'LAGGREGATE LIMITAPPLIESPER. POMCY ❑ JELo-T F-� LOC MITER AUTOMOBILE LIABILITY ANYAUTO B HIRED �/I SCHEOULEO Y COAUOB1059 08202019 0028/2020 AUTOS ONLY (III--JyIIHA lUT05 HIRED NONOV,NEO _ AUTOS ONLY AUTQSONLY UMBRE"me OCCUR EXCESIS LMIB CWMSMACE DED ) ) RETENTION S WdRiKERS ' ENSATION AND EMPLOYERS'LIABILITY YIN ANY PRORBETORRAWNENE%ECUTNE❑ NIA OFFICERAIEMBER E%CLUDEOi Iwne.mrym NHl Nyb. dr.. DESC RIPTON OF OPERATIONS show OFSJRPnON OF DPEMlI0N4/ LOCATIONS IVERLLE$ IALOROIef.Xe4NbnPl Remrb S[Ilaeulo. nlPyaoEmtl,M N man P.Ap MrpWM1 City Of Sebastian a added as an Additional Insured in miscount to the Automobile Liab irry CERTIFICATE HOLDER CANCELLATION GENERALAGGREWTE a z4000,000 PRODUCTS - COMPIOP AGO f 2.000,000 I Sa —M.-51HOLE LIMIT f 1.000.000 BOWLYINJURYIPIMPram) f BODLYINJURYIPrccesava f PROPERTY WMAGE lete. .' f f SACROCCURRENCE s I AomesoA E $ STAME I ERH EL EACH ACCIpEm s EL dsesse - EA EMPLMEE E ELO EASE-PIXICYMMT S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cay of Sebastian ACCORDANCE WITH THE POLICY PROVISIONS. 1225 Mein Street Sebastian FL 32058 1 0 1988-2015 ACORD CORPORATION. All rl8hts reserved. ACORD 25 (2016103) Tho ACORD name and logo are registered marks of ACORD A� ® CERTIFICATE OF LIABILITY INSURANCE 04os11aaMm� eYn THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: Vthe certificate holder Is an ADDITIONAL INSURED, the pollry(les) must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, subject to Na torme and conditions of Na policy, certain policies may require an endorsement A elamment on this certificate does not confer rights to the certificate holder In lieu of such endonement(s). PeoWQA I"Lt HOYse ABem rance C F Insu5emroa, 1. I Muma P„1 (407) 884-7843 HO 848 801. iNC.xm. PO. 0.1189 .mesas. WY0.EWBIRPFIXIOWO COVEMOE ass, Apopka FL 390411/19 Iwwlaq A: Fmnk WxMoo Cruminsucence Co. �� IWaugEge: Depectoo nau.ce Company 42587 Conlon Landacapirg. inc. I ..Be Toe S Eesy St Wsuram.: I rvNumma: Shanahan FL 329811 Iscu mPe COVERAGES aaCCPTeeFFAATT���1111FF.���CCE,EFnn���nnYY EE��pppp��\\ CLI05142BQN REVISION NUMBER: THIS 15 TO CERTIFY THATTHE POLICIESUFINSLIRAN MAKOWHAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENC TERM OR CONDITION OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURAMCEAFFORDED BY ME POLICIES DESCRIBED HEREIN IS SUMCTTOAu-ME TERMS, E%CWSIONSANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. L1RI TYPa OFIxaffeact xan vxn FIXILVaceseqIyYgpryYYYI IYMmd wn '.To WMMERCNL GENERAL LIABILITY EAP EACNCCCU0.Rfs 1.000,BW 100,090wMSWe a5,000�E " A I GIFL10W7804 OWIM019 05/132020 PERaoxnuAW lwugv 1 "000.000 GENLAOGREWTEUMITAPPLIERPEq. GENERLLAGOgEGAiE a 2.000.000 POLICY ❑sR- 71. I RIOWCT9-LOMPNPAQa Ia 2.000.000 .Ea. YOBrtt LMeuTV ceeam,.F..G lwn Is 1.000,000 M ANYAuiO ackcal WFY1P.pomnl li g OWNED acHEWLEO Y ACP5975230801 (TWI2018 08282019 I Rea uuem lPrav<anb f AUTOS ONLV AUEOB 080NIY AMTDsoNT,` I�:.m:,N ad A H"�I`: H=— I IAGFAEWTEgENfF Is BxE We «.Lpq H=M- su e I I oto ! �xa�i. xnox s I s AN.N. se6Y TIOn I n� I I recantl IKFCEIIMEY gEWMCq 7X)16 M� Y❑N/A I ELOLREVE-ADIIkRU Is ELasEAsl:-u EMPLGyEE 1. oEsmmnox of [WEYw1mNS lLounonlvwnEa IACgmgpl,AySP,W pamlka SeM1auY, A.r e. Monts. u,.... wsM�.q„I�.el airy of Setwslan H edOM es an A14IUrbHnwred n reapetl m ab AUlwmbde L4lutiry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF ME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ME EXPIRATION OATS THEREOF, NOTICE WILL BE OELNERED IN Ciry O( Sebaven ACCORDANCE MH ME POLICY PROVISIONS. 1225 Main S0ee1 AUMORIDD REPREaENTATIVE Sebastian FL 32958 019882015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are fegiatefed marks of ACORD CERTIFICATE OF LIABILITY INSURANCE Date 12/13/2016 Producer: Plymouth Insurance Agency This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. 9 y rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Holiday, FL 34691 727 938-5562 Insurers Affording Coverage NAIL # Insured: South East Personnel Leasing, Inc.& Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 K Insurer B: Insurer C: Holiday. FL 34691 Coverages The policies of insurance listed below have been Issued to the insured named above for the policy period indicated. Notvdlhstanding any requirement, lean or Wnldibbn of any contract or other document with respect to which this comficate may be Issued or may pertain, the insurance afforded by the polices described death is subject to all me tonna, exclusions, and conditions of such polices. Aggregate lints shown may have been reduced by paid claims - INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date Policy Expiration Date Limits (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each occurrence $ Commercial General Liability Claims Made 13 Occur Damage to rented premises IEA occurrence) s Med Exp $ Personal Adv Injury $ General aggregate limit applies per: Policy ❑ Project ❑ LOC General Aggregate $ Protlucts- Comp/Op Agg $ AUTOMOBILE LIABILITY Combined Single Limit Any Auto All Owned Autos Scheduled Autos (EA Accident) s Bodily Injury (Per Person) 5 Bodily Injury iiired Auloa- - - Nom Owned Autos (Per Acadent) S Property Damage (Per Accident) S EXCESS/UMBRELLA LIABILITY Each occurrence Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2017 01/01/2018 X WC statu- I OTH- Employers' Liability tory Limits ER E.L. Each Accident I! 2221,DoO Any proprietor/partner/executive officer/member excluded? NO E.L Disease - Ea Em I st.000.000 E.L. Disease - Policy Limits Isi,oci If Yes, describe under special provisions below. Other Lion Insurance Company is A.M. Best Company rated A- Excellent). AMB # 12616 Descriptions of Operations/Locations/Vehicies/Exclusions added by Endorsement/Special Provisions: Client ID: 31-66-012 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": Conlon Landscaping, Inc. Coverage only applies to injuries Incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list Of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: FAX: 772-228.9677 & 772.581-0149 / ISSUE 09-25-08 (SD) / RENEWAL 12-17-09 (SH) / REISSUE 11-01-10 (TD) / REISSUE 09-15-11 (SD)Reissued 12/10/12 (SH) / REISSUE 08-07-13 (TLD) / Reissued 12/9/13 (SH)/ REISSUE 03-25-14 (TLD) soon Date 6/11/2007 CERTIFICATE HOLDER CANCELLATION CITY OF SEBASTIAN Should any of the above described policies be cance0ed before the expiration date menet Ina ATTN: JEAN TARVELL issuing insurer#rill endeavor to mall 30 days smitten notice to the certificate hostler named to the Ian, but failure to do so shell impose no obligation or (lability of any and upon Me Insurer, is 1225 MAIN STREET agents or representatives. SEBASTIAN, FL 32958