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HomeMy WebLinkAbout2024-2025I DATE (MM/DD/YYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 09/09/2024 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 WAIVEb, 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 Brendan McAuley NAME: Killingsworth Agency Inc PHONE (352) 796-1451 I FAX (352) 799-5986 �AMiULo1 Extl: (A/C, No): 19259 Cortez Blvd ADDRESS: brendan@kworthins.com PO Box 1750 INSURER(S) AFFORDING COVERAGE NAIC # Brooksville FL 34605-1750 I INSURERA: Ohio Security Ins. Co. 24082 INSURED I INSURER B : Ohio Casualty Ins, Co 24074 A. Thomas Const Inc PO Box 3285 INSURER C : INSURER D : INSURER E : Fort Pierce FL 34948-3285 I INSURER F : COVERAGES CERTIFICATE NUMBER: 24/25 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) I LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY © PRO ❑ LOC JECT OTHER: AUTOMOBILE LIABILITY Y BLS54573729 ANY AUTO OWNED SCHEDULED _ AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB OCCUR B EXCESS LIAB HCLAIMS-MADE DED I XI RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIP' (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below US054573729 09/12/2024 09/12/2025 09/12/2024 09/12/2025 DESCRIPTION OF OPERATIONS / LOCATIONS / 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. EACH OCCURRENPE $ 1,000,000 DAMAGE TO REN-f ED PREMISES (Ea occurrence) 300,000 $ MED EXP (Any one person) $ 15,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG I $ 2,000,000 Schedule Mod Factor 1 I $ COMBINED SINGLE LIMIT (Ea accident) I $ BODILY INJURY (Per person) I $ BODILY INJURY (Per accident) I $ PROPERTYDAMAGE (Per accident) I$ is EACH OCCURRENCE I $ 1,000,000 AGGREGATE I $ 1,000,000 I I$ PER STATUTE I I OTH- ER E. L EACH ACCIDENT I $ E.L. DISEASE - EA EMPLOYEE I $ E.L. DISEASE -POLICY LIMIT I$ 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 �m Sebastian FL 32958 ✓ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD