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HomeMy WebLinkAboutSSS Brevard COI - Exp. 03/01/2021Client#: 75192 SCGPA ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/15/2021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Michelle Kalicharan NAME: Acrisure dba Gulfshore Ins SWF PHONE FAX A/c, No, Ext): 239 435-7143 (A/C, No): 239 213-2803 4100 Goodlette Road N -MAIL mkaliharan@gulfshoreinsurance.com Naples, FL 34103 ADDRESS: @9 INSURER(S) AFFORDING COVERAGE NAIC # 239 261-3646 INSURER A: Pennsylvania Manufacturers Assn Ins Com 12262 INSURED INSURER B : Evanston Insurance Company S1123 SSS Brevard Opco, LLC INSURER C dba Down to Earth Melbourne INSURER D : 2800 Allen Hill Avenue Melbourne, FL 32940 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 CONTRACTOR 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 EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY 3020751268333 08/22/2020 03/01/20211 EACH OCCURRENCE $110001000 CLAIMS -MADE �X OCCUR PREMISES (Ea RENTED $ 500,000 X BI/PD Ded:100000 MED EXP (Any one person) $10,000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY XI JECT LOC OTHER: A AUTOMOBILE LIABILITY 1520751268333 X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY B UMBRELLA LAB X OCCUR MKLV7EUL11604 X EXCESS LIAB H CLAIMS -MADE DED I XI RETENTION$O WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F7 N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below GENERAL AGGREGATE $5,000,000 PRODUCTS - COMP/OPAGG $2,000,000 08/22/2020 03/01120211 COMBINED SINGLE LIMIT (Eaaccident) $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) 08/22/2020 03/01/20211 EACH OCCURRENCE AGGREGATE $5,000,000 $5,000,000 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Sebastian is included as Additional Insured on a primary and noncontributory basis with regards to General Liability Only as required by contract per form CG2001 1219, Ongoing Operations per form CG2010 0413 and Completed Operations per form G2037 0413. Waiver of Subrogation per form CG2404 1219. Additional Insured in regards to Auto Liability as required by written contract per form CA2048 1013 and Waiver of Subrogation per PCA0531 0414.Additional Insured in regards to Auto Liability on a primary and noncontributory basis per form CA0449 1116 when required by written contract. CERTIFICATE HOLDER CANCELLATION City of Sebastian SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1225 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Sebastian, FL 32958 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S 1647294/M 1647276 MAK