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HomeMy WebLinkAbout2024 - 2025 WC® DATE (MM/DDIYYYY) ACC>RCERTIFICATE OF LIABILITY INSURANCE 09/11 /2023 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 I CONTACT JOlyn Ortega NAME: Killingsworth Agency Inc I PHONE Ext): (352) 796-1451 I FA/c, No): (352) 799-5986 19259 Cortez Blvd I E-MAIL )y of n kworthins.com ADDRESS: PO BOX 1750 I INSURER($) AFFORDING COVERAGE NAIC # Brooksville FL 34605-1750 I INSURERA: Ohio Security Ins. Co. 24082 INSURED A. Thomas Const Inc PO Box 3285 I INSURER B INSURER C INSURER D I INSURER E : Fort Pierce FL 34948-3285 I INSURER F : COVERAGES CERTIFICATE NUMBER: 23/24 Annual Cert 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) (MM/DD/YYYY) MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE x OCCUR T DAMAGE TO RENTED I PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 15,000 A I Y BLS54573729 09/12/2023 09/12/2024 I PERSONAL& ADV INJURY $ 13000,000 I 2,000,000 GEN'LAGGP.EGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY IIJECT PRO- ❑ LOC I PRODUCTS -COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS _ HIRED PROPERTY DAMAGE $ HNON-OWNED AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I l RETENTION $ $ WORKERS COMPENSATION PER f STATUTE I I EORH AND EMPLOYERS' LIABILITY IN Y❑ I E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N / A OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PROJECT: ITB 22-01 Concrete Services within City of Sebastian Limits shown are those in effect at policy inception date. City of Sebastian is named as Additional Insured on the above captioned general liability policy. CERTIFICATE HOLDER CANCELLATION 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``" I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD