HomeMy WebLinkAboutCertificate of InsuranceClient#: 17916 ATLADEV
ACORD,,, CERTIFICATE OF LIABILITY INSURANCE FDATE (MWDDNYYY)
I 4122J201 5
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 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
Lanier Upshaw, Inc. NAME: —
PHONE
1115 US Hwy 98 South (AIC, No. Ext): 863 686-2113 2__
E-MAIL
P.O. Box 468 ADDRESS:
Lakeland, FL 33802 INSUREII AFFORDING COVERAGE NAjC 8
INSURER A: Westfield Insurance Company 24112
INSURED RIB: Bridgefield Employers Insurance-- f0701
Atlantic Development of Cocoa In -
2185 West King Street
Cocoa,FL 32926
INSURERC:
INSURER E:
COVERAGES rFRTIFIrATF PJIIURF:D- —1 --
THIS IS TO CERTIFY THAT THE POLICIES
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
EXCLUSIONS AND CONDITIONS OF SUCH
OF
POLICIES.
ADOLSUB
I
INSURANCE
WVD
LISTED BELOW HAVE BEEN ISSUED TO
TERM OR CONDITION OF ANY CONTRACTOR
THE INSURANCE AFFORDED BY THE POLICIES
LIMITS SHOWN MAY HAVE BEEN REDUCED
POLICY NUMBER POLICY EFF
CMM4774145 D4123/2015
THE INSURED
OTHER DOCUMENT
DESCRI13ED
BY PAID CLAIMS
POLICY EXP
NAMED ABOVE FOR THE POLICY PERIOD
WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS.
LIMITS
EACH OCCURI $1,000,000
INSR
LTR
TYPE OF INSURANCE
•
GENERAL LIABILITY
04123/2016
X: COMMERCIAL GENERAL LIABILITY
:::PCLAIMS -MADE IF_V_]
A I OCCUR
RRE1M%1jS1 I IED $500,000
(E. cur""'
MED EXI (An, one person) $5,000
PERSONAL & ADV INJURY $1,000,000
X PD Ded:5,000
I —
GENERAL AGGREGATE s2,000,000
r GEN'L AGGREGATE LIMIT APPLIES PER:
LOC
-PRODUCTS - COMPIOP AGG s210001000
CMM4774145 D4123/2015
042=01 6
$
_05M61WED INGLE LIMIT
(Ea accident? _$1,000,000
BODILY INJURY (Per person) $
• AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED I SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS AUTOS
XPIP
BODILY INJURY (Per accident) $
PROPER' AMAGE $
(Per acc."ZlD
PIP $10,000
UMBRELLA LIAB
EACH OCCURRENCE $
AGGREGATE S
EXCESS LIAB -MADE
LDED J_A_!!ETENTION$
B WORKERS COMPENSATION
AND EMPLOYERS* LIABILITY YIN
ANY PROPRIETOR/PARINERIEXECUTIVE -
OFFICER/MEMBER EXCLUDED? NJNIA
$
'
P083044743
111411IM0115
04/18/2016
OTH-
X
E.L. EACH ACCIDENT $500,000
(Mandatory in fill
It yes. desrribe under
——-DESCRIPTION OF OPERATIONS below
E.L DISEASE - FA EMPLOYEEI $500,000
E L. DISEASE - POLICY LIMIT 1 s500,OOO
A Rented/Leased
CMM4774145
04123/2015
0412312011
Limit $300,000
Equipment
Died $5,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
n''
Cape Canaerval City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
105 Polk Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Cape Canaveral, FL 32920
AUTHORIZED REPRESENTATIVE
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
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