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HomeMy WebLinkAboutCertificate of InsuranceSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 7/9/2019 Cobb Strecker Dunphy &Zimmermann 225 South Sixth Street STE 1900 Minneapolis MN 55402 Sarah Edwards 612-349-2407 sedwards@csdz.com Old Republic Insurance Company 24147 CEREENVI Ceres Environmental Services,Inc. 6968 Professional Pkwy E Sarasota,FL 34240 1242389051 A X 1,000,000 X 300,000 X XCU 10,000 X Contr Liab 1,000,000 2,000,000 X A5CG11261802 9/1/2018 9/1/2019 2,000,000 A 2,000,000 X X Comp $5,000 X Coll $5,000 A5CA11261802 9/1/2018 9/1/2019 Hired Auto Phy Damage 50,000 A X N A5CW11261802 9/1/2018 9/1/2019 1,000,000 1,000,000 1,000,000 All Work Performed Additional Insured only if required by written contract with respect to General Liability,Automobile Liability and Umbrella/Excess Liability applies on a primary basis and the Insurance of the Additional Insured shall be Non-Contributory:Certificate Holder,Project Owner and Others as required by written contract. Waiver of Subrogation only if required by written contract with respect to General Liability,Automobile Liability,Workers Compensation and Umbrella/Excess See Attached... City of Sebastian 1225 Main Street Sebastian FL 32958 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: CEREENVI 1 1 Cobb Strecker Dunphy &Zimmermann Ceres Environmental Services,Inc. 6968 Professional Pkwy E Sarasota,FL 34240 25 CERTIFICATE OF LIABILITY INSURANCE Liability applies in favor of:Certificate Holder,Project Owner and Others as required by written contract. The following supersedes the cancellation wording:Should any of the above described policies be cancelled before the expiration date,30 Days written notice (10 Days for Non-Payment)will be delivered to the certificate holder. ``i h® CERTIFICATE OF LIABILITY INSURANCE DA E(MNVDD 8/5/2016 ) 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 pollcy(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 Christensen Group Insurance 11100 Bran Road West Minnetonka MN 55343 CONTACT Nelly Preston PHONE (952) 653-1000 FAXMIC. Noll (9 52) 653-1101 E-MAILAppgsn-kpreston@christensengroup.com INSURER(S) AFFORDING COVERAGE NAIC0 INSURERA:Old Republic General Insurance 24139 INSURED CERES ENVIRONMENTAL SERVICES, INC. 6968 Professional Pkwy Sarasota FL 34240 INSURER B: INSURER C: INSURER O: NSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 - LLAB - FL - 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. Iexp LTR TYPE OF INSURANCE L U BR POLICY NUMBER MM/DDr MEFF MIIDDNYYY UNITS A GENERA -LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx—] OCCUR lk5CGI1261600 /18/2016 /18/2017 EACHOCCURRENCE $ 1,000,000 PRM(Ea oaurrence S 300,000 MED EXP (Any one son $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE POLICY UNIT APPLIES PER: RO- Loc X PIFQT PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITYEa X ANY AUTO ALL OWNED SCHEDULED AlfT05 AUTOS NON -OWNED HIREDAUTOS HAUTOS CA11261600 /18/2016 /18/2017 UMIT 2,000,000 (Ea BODI LY INJURY (Per Person) $ BODILY INJURY IF" aaidmt) S PROPERTY DAMAGE S Pwacadent S UMBRELLA LIAR EXCESS LIAB O�DR CLAIMS -MADE EACHOCCURRENCE $ AGGREGATE $ DED I I RETENTIONS Is A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOIVPARTNERIEXECUTIVE Y� OFFICERAIEMSER EXCLUDED? (Mandatoryin NH) If Yes, describe under DESCRIPTION OF OPERATIONS Del o.Y MIA CW11261600 /18/2016 /18/2017 y WC STATU- OTH- E.L EACH ACCIDENT S 1,000,000 E.L DISEASE - EA EMPLOYE S 1,000,00 E.L DISEASE - POLICY UMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AMach ACORD 101, AddRional Remarks Schedule, If mora apace Is mquimd) City of Sebastian is included as an Additional Insured under the Cosuaercial General Liability 6 Auto Liability when required by written contract. City of Sebastian City Hall 1225 Main Street Sebastian, FL 32958 ACORD 25 (2010105) INS025 (zotol5)c1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EulrmlrTgrra�sixad, Valr�� Tyler Simmons/KP The ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserved.