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Home My WebLink AboutCertificate of InsuranceFrom: IEL 2 Fax: (941) 421-0106 To: 17726893131@tcfax.cc Fax: +17725883131 Page 5 of 7 09/22/2014 11:20 CERTIFICATE OF LIABILITY INSURANCE 84 Q4TEtfd19/2Y01 I TYPE OF INSURANCEADOI 9/ 19/29 4 4 THIS.OERTIFICAT.E IS ISSUED AS A MATTER. OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE GERTIFICAITE HOLIDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR. NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANC9 DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED, the pallcy(les) must be artddrSed It SUBROGATION I$ WAIVED, subjec. to - - the terms and cO ltlons of the policy, certain policies may require an endorsement. A statemeid on Ihls certificate dons net confer rights to the certificate holder in lieu of such endorsement(s).. PRODUCER Integrity Risk Management, Inc. 3626 Tamiami Trall Port Charlotte, FL. 33952 Phone (941) 766-1411 Fax (941) 766-1084 C0 TACT— I FAX A -MAI' INSLUM jA) PFOn DING COVERRAGENACC i) — INSURERA: Guarantee Insurance Compan 2300 INSURED Integrity Employee Leasing IV, Inc. 3626 Tamlami Trail Port Charlotte, Florida 33952 Phone (941) 625-0623 Fax (941) 62510123 INSURER a. INSURERC• INSURERD: _ NsLIRERE: 1 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Excl- IONS.AND Coma NJS OF SUCH POLIC(FS, UwIf.S SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS. WSRT LTR I TYPE OF INSURANCEADOI INSR,IMVO UB I -_ -_POLICY EJM13ER _ POLICY EFF MMID POLICY EXP LIMITS GENERAL LVtMLITY El;COMMERCIAL 'GU4UAILIABNLITY ❑ ❑ cLAIMS-MADE ❑ 0=11, ❑ EACH OCCURRENCE i DAMACiE70FTEtnETarAm S MED EXP (Any one tLln S PERSONAL 6 ADV INJURY S ❑ GENERAL AGGREGATE S GERI.AGGREGATE UMITAPPLIESPER; ❑ POLICY ❑ P ❑ LOC PRQDUS'r5•COMPIDPACiCr S ; l $ - AUTUMbBLE LIABILITY _ MSM s LIMB ❑ 'ANY AUTO ALL OWNED SCHEDULED ❑ `ALr1DS ❑ AUTOS ❑ HIRED AUTOS ❑ AAUUTTO mowmm BODILY INJURY (Par parcer.o S BODILYINJURY(Persrdd S A 4 I $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS t.IAe ❑ CL/0166-MAIJE I EACH OCCURRENCE 5 AGGREGATE 5 DED ❑ RETENTIDN9 WORKL3 U MPENSATIQH --- — AND EWLOVERS' LIABILITY YIN j MY FFICERPROPRIETORIPARTIJOE7CE-CurtvE WCP500010004GIC ' 10/01/14 10/01/15 A oFFlcLzurrE�leER EILCLUDED'r NIA (Mttndatcry In Nfi) C WNyyee datcdhecaider 641VIIONOrOPERATIONSDetaw _ -i WCSTATU- OTH- _fiLAACHACCVENT S 1000,000.00 E.L VSEASE- EA EMPLOYE S 1,000 QQ0.00 E.LDGEASE-POLCYL1MIT S 1.000iQQQ•Q x Employers Liability DESDRP TIDN OF OPERATTON8 r LOCATIONS r VBi;cl ES (Attach ACORD tet, Addntmal Ftwuarks Schadula, Itmorn space Is Icyuirad) - Workers' Compensatlon coverage Is for leased employees of but not subcontractors of: Capp Custom Builders, Inc. 9610'Rivervlew Dr, Sebastian, FL 32958 Fax: (772)589-3131 CERTIFICATE HOLDER .....,.�....._.. City of Sebastian 1225 Main Street SHOULD ANY -.OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sebastian Florida 32958 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEPM IN 30 days r ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEWNTATItT Toby Starr 8468 CAPPC-1 OP ID: IL . 164 R CERTIFICATE OF LIABILITY INSURANCE �'' 1110712ATE Y4 11!0712014 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 INSUREII AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 Ryan Weaver Insurance, Inc. CenterState Bank Bldg. 855 21 st Street - 2nd Floor Vero Beach, FL 32960 NAME: CONTACTRyan M. Weaver PHONE772,56711930 AIC Ne ; 772-567931 c No E E-MAIL ADDRESS: 72073229 Ryan M. Weaver INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: Auto Owners Insurance Co. 18988 PREMISES Ea occurrence $ 300,000 INSURED Capp Custom Builders Inc 735 Commerce Center Dr #13 Sebastian, FL 32958 INSURER B: INSURERC: GEN'L AGGREGATE LIMIT APPLIES PER. P PRO. LOC POLICY ❑ PRO. ❑ OTHER: GENERAL AGGREGATE $ 2,000,000 INSURER D: INSURER E : A 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. I TR TYPE OF INSURANCE INSO WV0 POLICY NUMBER MMIDOrYY MMIDDrYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR Sebastian, FL 32958 72073229 11/0912014 11/09/2015 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. P PRO. LOC POLICY ❑ PRO. ❑ OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 172486304 11/0912014 11!0912015 COMBINED SINGLE LIMIT $ 1r000,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident A X UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE 932862300 11/09/2014 1110912D15 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 5000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVEa OFFICERIMEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below N 1 A STATUTE ER E.L. EACH ACCIDENT $ E L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Sebastian ACCORDANCE WITH THE POLICY PROVISIONS. 1225 Main Street AUTHORIZED REPRESENTATIVE Sebastian, FL 32958 Ryan M. Weaver 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD