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Home My WebLink AboutCertificate of InsuranceA� ® CERTIFICATE OF LIABILITY INSURANCE oaTE/20/20YYYY) os/zo/zo2a 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(tes) 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 s":h endomement(s). PRODUCER CONTACT Stacey Y State Farm Alan E. Wester Insurance Agency PHONE N a Ell: (321) 350-6677 FAX N,I, _ • 577 Bames Blvd, Suite 450 E-MAIL stacey@alanwester.com ADDRESS: y@ _ INSURERS) AFFORDING COVERAGE HAIG4 Rockledge FL 32955 INSURER A: State Fan Mutual Automobile Insurance Company 25178 INSURED INSURER B: Universal Contracting Bf Construction, Inc INSURER C: 9075 Ellis Rd - INSURERD: _ INSURER E: Melbourne FL 32904 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. INSRi —_-. _..-�AD6'SllH _.. "—_". POLICYEFF. _.I POUCYEXFI LTR TYPE OF INSURANCE IINSO WVD POLICY NUMBER fMMloorf'YY. IMMIODIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED- CLAINS'dADE OCCUR PREMISES[Ed0f10proot?'j__ $ -. _ . I ED EXP (Am one Person) S PERSONAL 9 ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ _- ,PRO- POLICY L 29- LOC PRODUCTS - COMPxOP AGG S OTHER — c— AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _.__. Ea acciden S 1,000,000 x ANY AUTO N123623 O6/16/2024 O6/16/2025 DOOR Y INJURN (Pe Person) § OWNED SEDIJI. F F, _ A AUTOS ONLY ❑ AUTCHOS N N BODILY INJUHI rrManl) $ HIRED 11 NON-0WNED YRUYtNIr UFln9AUL AUTOS ONLY II.._ AUTOSONI.Y Weraccidenl) S $ UMBRELLA Me ;OCCUR j EACHOCCURRENCE Is EXCESS LWB 1 ' CLAIMS I' . L: AGGREGATE § DEC RETENTION $ S WORKERS COMPENSATION i PER OTH- s AND EMPLOYERS' LIABILITY !STATUTE ER ANYPROPRIETOR:PARTNER,EXECUTIVE YIN E.L.EACH ACCIDENT $ DESCRIPTION tinder OF OPERATIONS below ' _ _ E 1. DISEASE EA EMPLOYEE] g GFFICEPoMEMBEft EX^L'JOE09 NIA In NH) D gee RIPTION OFO -'-' ' - � EL DISEASE POLICY LIMff § DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD tut, Addlinimil Remerka Schedule, may be attached If more space is required) 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 St AUTHOI1R121ED REPRESENTATIVE Sebastian FL 32958 .rHO�&1.11 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 100149E 132949.14 D4132022 UNIVCON-07 BOYETTA CERTIFICATE OF LIABILITY INSURANCE DA7/isn024 1 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 CONTACT Michele Wise Insurance Office of America PHONE FAX 1855 West State Road 434 INC, No, EXt): (321) 460-1235 (AIC, No): Longwood, FL 32750 E-M AEss: michele.wise@ioausa.com INSURER(S) AFFORDING COVERAGE NAG If _ INSURER A: Clear Blue Specialty Insurance Company 37745 INSURED INSURER a: insurance Company of the West 27847 Universal Contracting & Construction, Inc INSURERC: Evanston Insurance Company _35378 9075 Ellis Road INSURER D: West Melbourne, FL 32904 INSURER E 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. INSR 1 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INypyVVp POLICY NUMBER 110UPQ1YYYYI_tMtVPP .y.1-yJ LIMITS A X COMMERCIAL GENERAL WISILRY 1,000,000 EACH OCCURRENCE G CLAIMS -MADE X OCCUR X AR01-RS-240649"1 6/16/2024 6/16/2025 DAMAGE TO RENTED 100,000 PREMISES (Ea occurrence) S MED EXP (Any one person) S 5,000 PERSONAL 6 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE S 2,000,000 X POLICY JECOT LOG PRODUCTS - COMPIOP ADS S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) S ANY AUTO BODILY INJURY (Per person) S .I AUTEO�S ONLY SCHEDULED BODILY INJURY (Per accident)', $ AUTOS ONLY AUTNOS ONE LYY (ParoCECIid t�AMAGE S S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE S DED i RETENTIONS S B WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERTLIASILITY YIN WFL505928803 2/2712024 2/27/2025 1,000,000 ANY PROPRIETORIPARTNEREXECUiIVE E.L. EACH ACCIDENT S oFFICERR.IEMBER EXCWDFDa NIA 1,000,000 (Mandatory in%V E.L. DISEASE- EA EMPLOYEE S If yes, desambe under 1 1,000,000 DESCRIPTION OF OPERATIONS below F L DISEASF - POLICY LIMIT S _ _ C Equipment Floater 2AA409079 7/12l2024 6116/2025 Scheduled Equipment 755,900 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORO 101, Additional Ramarb Schedule, may be attached it mors a pace la reauiretl) City of Sebastian is granted additional insured status by the General Liability policy as required by written contract or agreement. 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. AUTHORIZED REPRESENTATIVE City of Sebastian Main Street S-12 / Sebastian. FL 32958 ACORD 25 (20161'03) 9)1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD