HomeMy WebLinkAboutArchangel Engineering Co. Insurance 2015-16ARCE003 OP ID: CV
DATE. (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 7T
10/19/2015
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.
PURTAINIT: iff-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 Neu of such endorsement(s).
PRODUCER i C*NTACT tt M. Steele
J.W. Edens & Company NAME: Sco
PHONE FAX
Commercial Ins of Brevard, Inc (AJC No Extj,321-725-7000 21-725-7856
325 Fifth Avenue, Suite 108 f_Mkjr
ADDRESS:
Indiailantic, FL. 32903
Scott M. Steele INSURER(S) AFFORDIIINJGCOVERAGE NAIC
INSURED Archangel Engineering &
Construction, Inc.
Attn: Robert Chasin
485 Gus Hipp Blvd.
Rockledge, FL 32955
r-r)VFPAr.FR r;=PTIPI('ATP Mil IMRPP-
INSURER A: American Interstate Ins. Co. 31895
INSURER B: Southern Owners Insurance Co. 110190
INSURER C:
THIS IS 1-0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR OLICY 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- -- - '- AMCISLIBR POLICY -EW -1 --
LTR TYPE OF INSURANCE I POLICY NUMBER (MMIDDIYYYY 1 MM/DDIVVVV�! LIMITS
B X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $
1,000,000
CLAIMS -MADE 11 x OCCUR
DAMAGE TO RENTED
1112382-72038860-15 1 10/1712015 10117/2016 1
50,000
PREMISESSEa occurren�-
MED EXP (Any one person) $
5,000
PERSONAL & ADV INJURY $
1,000,000
�_GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE $
2,000,000
PRO
POLICY LOC
I PRODUCTS -COMP/OPAGG $
2,000,000
OTHER
$
I AUTOMOBILE LIABILITY
C—OMBINED SINGLE —LIMIT $
�Ea. accident)______
ANY AUTO
BODILY INJURY (Per person) $
—7 ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident) $
I NON -OWNED
�-PFaiREFTYbAWA��L--$
HIRED AUTOS AUTOS
I r accident) -- ---
s
UMBRELLA LIAB OCCUR
EACHOCCURRENCE s
EXCESS LIAB L I CLAIMS -MADE
AGGREGATE $
DIED RETENTION$
i WORKERS COMPENSATION
PER OHH
I AND EMPLOYERS' LIABILITY Y/N
_STATUTE -1---- ER-
A !ANY PROPRIETOR/PARTNER/EXECUTIVE.
!AVWCFL2442732015 10/19/2015 10/19/2016 EL EACH ACCIDENT is
100,000
1 OFFICER/MEMBER EXCLUDED? !N/A
El
i -- --- -- -- -
in NN)
1� E I- PICIASP - EA IMIlLr)YEE
lon�@00
If yes describe under
DESCRIPTION OF OPERATIONS below
E L. DISEASE - POLICY LIMIT $
500,000
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
City of Cape Canaveral
105 Polk Avenue
Cape Canaveral, FL 32920
ACORD 25 (2014/01)
MINKAIM
mom
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
5�10–w— ff, 3&wl
Oc 1988-2014 ACORD CORPORATION. AII rights reserved.
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