Loading...
HomeMy WebLinkAboutInspire Placemaking COI 2026/2027ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 12/23/2025 (321) 445-1117 (321) 445-1076 30104 Inspire Placemaking Collective, Inc. 4767 New Broad Street Orlando, FL 32814 16510 A 1,000,000 X 21 SBA AV4H7E 1/1/2026 1/1/2027 1,000,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000A X 21 SBA AV4H7E 1/1/2026 1/1/2027 5,000,000A X 21 SBA AV4H7E 1/1/2026 1/1/2027 10,000 5,000,000 B Professional Liab C38DAA250101 1/1/2026 Per Claim 2,000,000 B Professional Liab C38DAA250101 1/1/2026 1/1/2027 Aggregate 2,000,000 Any person or organization where required by written contract is an Additional Insured with respect to General Liability and is primary & non-contributory per form #SL30320621, additional insured with respect to Hired/Non-Owned Auto Liability per form # SL30320621, and additional insured with respect to Umbrella Liability and is primary & non-contributory per form # SL30320621. Waiver of subrogation is in favor of the additional insured with respect to General Liability per form # SL00001018, with respect to Hired/Non-Owned Auto Liability per form # SL30320621, with respect to Workers Compensation per form #WC000313 and with respect to Umbrella Liability per form #SL30320621. 30 days’ notice of Cancellation with 10 days’ notice for non-payment of premium in accordance with the policy provisions. SEE ATTACHED ACORD 101 City of Sebastian 1225 Main St Sebastian, FL 32958 INSPPLA-01 ADELANO JCJ Insurance Agency, LLC 2208 Hillcrest Street Orlando, FL 32803 certs@jcj-insurance.com Hartford Underwriters Ins. Co. Beazley America Insurance Company, Inc. 1/1/2027 X X X X X X X FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. JCJ Insurance Agency, LLC INSPPLA-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance SEE P 1 Inspire Placemaking Collective, Inc. 4767 New Broad Street Orlando, FL 32814 SEE PAGE 1 ADELANO 1 Description of Operations/Locations/Vehicles: RE: Consultant Projects City of Sebastian is an Additional Insureds with regards to General, Auto and Umbrella Liability when required by written contract. 7 + , 6 ( 1 ' 2 5 6 ( 0 ( 1 7 & + $ 1 * ( 6 7 + ( 3 2 / , & < 3 / ( $ 6 ( 5 ( $ ' , 7 & $ 5 ( ) 8 / / < ) R U P 6 / 3 D J H R I © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) % / $ 1 . ( 7 $ ' ' , 7 , 2 1 $ / , 1 6 8 5 ( ' % < & 2 1 7 5 $ & 7 This endorsement modifies insurance provided under the following: % 8 6 , 1 ( 6 6 / , $ % , / , 7 < & 2 9 ( 5 $ * ( ) 2 5 0 Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. $ The following is added to Section & : + 2 , 6 $ 1 , 1 6 8 5 ( ': $ G G L W L R Q D O , Q V X U H G V : K H Q 5 H T X L U H G % \ : U L W W H Q & R Q W U D F W : U L W W H Q $ J U H H P H Q W 2 U 3 H U P L W The person(s) or organization(s) identified in Paragraphs D. through I. below are additional insureds when you have agreed, in a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision that such person or organization be added as an additional insured on your Coverage Part, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under this provision only for that period of time required by the contract, agreement or permit. However, no such person or organization is an additional insured under this provision if such person or organization is included as an additional insured by any other endorsement issued by us and made a part of this Coverage Part. The insurance afforded to such additional insured will not be broader than that which you are required by the contract, agreement, or permit to provide for such additional insured. The insurance afforded to such additional insured only applies to the extent permitted by law. The limits of insurance that apply to additional insureds are described in Section ' / , $ % , / , 7 < $ 1 ' 0 ( ' , & $ / ( ; 3 ( 1 6 ( 6 / , 0 , 7 6 2 ) , 1 6 8 5 $ 1 & (. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section ( / , $ % , / , 7 < $ 1 ' 0 ( ' , & $ / ( ; 3 ( 1 6 ( 6 * ( 1 ( 5 $ / & 2 1 ' , 7 , 2 1 6. D 9 H Q G R U V Any person(s) or organization(s) (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products-completed operations hazard". The insurance afforded to the vendor is subject to the following additional exclusions: This insurance does not apply to: D "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; E Any express warranty unauthorized by you; F Any physical or chemical change in the product made intentionally by the vendor; G Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; H Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; I Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; 7 + , 6 ( 1 ' 2 5 6 ( 0 ( 1 7 & + $ 1 * ( 6 7 + ( 3 2 / , & < 3 / ( $ 6 ( 5 ( $ ' , 7 & $ 5 ( ) 8 / / < ) R U P 6 / 3 D J H R I © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) J Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or K "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: L The exceptions contained in Paragraphs G or I ; or L L Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. E / H V V R U V 2 I ( T X L S P H Q W Any person or organization from whom you lease equipment; but only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after you cease to lease that equipment. F / H V V R U V 2 I / D Q G 2 U 3 U H P L V H V Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. With respect to the insurance afforded to these additional insureds, this insurance does not apply to: D Any "occurrence" which takes place after you cease to lease that land or be a tenant in that premises; or E Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. G $ U F K L W H F W V ( Q J L Q H H U V 2 U 6 X U Y H \ R U V Any architect, engineer, or surveyor, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: D In connection with your premises; E In the performance of your ongoing operations performed by you or on your behalf; or F In connection with "your work" and included within the "products-completed operations hazard", but only if: L The written contract, written agreement or permit requires you to provide such coverage to such additional insured; and L L This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products-completed operations hazard". With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services, including: L The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or L L Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the “bodily injury”, “property 7 + , 6 ( 1 ' 2 5 6 ( 0 ( 1 7 & + $ 1 * ( 6 7 + ( 3 2 / , & < 3 / ( $ 6 ( 5 ( $ ' , 7 & $ 5 ( ) 8 / / < ) R U P 6 / 3 D J H R I © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) damage”, or “personal and advertising injury” arises out of the rendering of or the failure to render any professional service. H 6 W D W H 2 U * R Y H U Q P H Q W D O $ J H Q F \ 2 U 6 X E G L Y L V L R Q 2 U 3 R O L W L F D O 6 X E G L Y L V L R Q , V V X L Q J 3 H U P L W Any state or governmental agency or subdivision or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit. With respect to the insurance afforded to these additional insureds, this insurance does not apply to: D "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or E "Bodily injury" or "property damage" included within the "products-completed operations hazard". I $ Q \ 2 W K H U 3 D U W \ Any other person or organization who is not in one of the categories or classes listed above in Paragraphs D. through H. above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: D In the performance of your ongoing operations performed by you or on your behalf; E In connection with your premises owned by or rented to you; or F In connection with "your work" and included within the "products-completed operations hazard", but only if: L The written contract, written agreement or permit requires you to provide such coverage to such additional insured; and L L This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products-completed operations hazard". With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: D The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or E Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the “bodily injury”, “property damage”, or “personal and advertising injury” arises out of the rendering of or the failure to render any professional service described in Paragraphs I D or I. E above. ) R U P 6 / 3 D J H R I © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer’s share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 7 U D Q V I H U 2 I 5 L J K W V 2 I 5 H F R Y H U \ $ J D L Q V W 2 W K H U V 7 R 8 V D 7 U D Q V I H U 2 I 5 L J K W V 2 I 5 H F R Y H U \ If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. E : D L Y H U 2 I 5 L J K W V 2 I 5 H F R Y H U \ : D L Y H U 2 I 6 X E U R J D W L R Q If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. ) / , $ % , / , 7 < $ 1 ' 0 ( ' , & $ / ( ; 3 ( 1 6 ( 6 ' ( ) , 1 , 7 , 2 1 6 "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purpose of this definition: D Notices that are published include material placed on the Internet or on similar electronic means of communication; and E Regarding web sites, only that part of a web site that is about your goods, products or services for the purpose of attracting customers or supporters is considered an advertisement. "Advertising idea" means any idea for an "advertisement". "Asbestos hazard" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. "Auto" means: D A land motor vehicle, trailer or semi-trailer designed for travel on public roads, including any attached machinery or equipment; or E Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance or motor vehicle registration law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". "Bodily injury" means physical: D Injury; E Sickness; or F Disease sustained by a person and, if arising out of the above, mental anguish or death at any time. "Coverage territory" means: D The United States of America (including its territories and possessions), Puerto Rico and Canada; E International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in D above; F All other parts of the world if the injury or damage arises out of: Goods or products made or sold by you in the territory described in D above; The activities of a person whose home is in the territory described in D above, but is away for a short time on your business; or THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 00 03 13 Printed in U.S.A. Process Date:11/11/21 Policy Expiration Date:12/22/22 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number:21 WEC AJ8L13 Endorsement Number: Effective Date:12/22/21 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:7Twelve Marketing Solutions 724 W MONTROSE ST STE C CLERMONT FL 34711 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Any person or organization for whom you are required by contract or agreement to obtain this waiver from us. Endorsement is not applicable in KY, NH, NJ or for any MO construction risk