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HomeMy WebLinkAboutCertificate of Insurance 7-6-17 MEADHU1OPID:JT1 DATE(MM/DD/YYYY) CERTIFICATEOFLIABILITYINSURANCE 07/06/2017 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificateholderinlieuofsuchendorsement(s). CONTACT PRODUCER PhilHausmann,CIC NAME: Hausmann-JohnsonInsuranceInc FAX PHONE 608-257-3795608-257-4324 (A/C,No): (A/C,No,Ext): 700RegentSt.,POBox259408 E-MAIL Madison,WI53725-9408 ADDRESS: PhilHausmann INSURER(S)AFFORDINGCOVERAGENAIC# TravelersCasualty&Surety19038 INSURERA: INSURED Mead&Hunt,Inc. INSURERB: M&HArchitecture,Inc. INSURERC: Mead&HuntCompanies,Inc. Mead&HuntInternational,Inc INSURERD: 2440DemingWay INSURERE: Middleton,WI53562-1562 INSURERF: COVERAGESCERTIFICATENUMBER:REVISIONNUMBER:2017 THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS. ADDLSUBR POLICYEFFPOLICYEXP INSR TYPEOFINSURANCELIMITS POLICYNUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIALGENERALLIABILITY AX 1,000,000 EACHOCCURRENCE$ DAMAGETORENTED X P6305C656013TIL1612/01/201612/01/2017 300,000 CLAIMS-MADEOCCUR$ PREMISES(Eaoccurrence) 10,000 MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER:GENERALAGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS-COMP/OPAGG$ JECT $ OTHER: COMBINEDSINGLELIMIT AUTOMOBILELIABILITY $ 1,000,000 (Eaaccident) BODILYINJURY(Perperson)$ AX P8106C161444COF1612/01/201612/01/2017 ANYAUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTYDAMAGE $ XX 1,000DEDUC HIREDAUTOS (Peraccident) AUTOS $ UMBRELLALIAB X 9,000,000 X EACHOCCURRENCE$ OCCUR EXCESSLIAB PSMCUP6C16147ATIL1612/01/201612/01/2017 9,000,000 A CLAIMS-MADEAGGREGATE$ 0 X $ DEDRETENTION$ PEROTH- WORKERSCOMPENSATION X STATUTEER ANDEMPLOYERS'LIABILITY Y/N 5C679708-WI12/01/201612/01/2017 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE A E.L.EACHACCIDENT$ N/A N OFFICER/MEMBEREXCLUDED? 5C679733-OTHERSTATES12/01/201612/01/2017 1,000,000 (MandatoryinNH) E.L.DISEASE-EAEMPLOYEE$ Ifyes,describeunder 1,000,000 E.L.DISEASE-POLICYLIMIT$ DESCRIPTIONOFOPERATIONSbelow DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES(ACORD101,AdditionalRemarksSchedule,maybeattachedifmorespaceisrequired) RE:Engineering&SurveyingServices.Whenspecifiedinwrittencontract, theCertificateHolderislistedasAdditionalInsuredwithrespectto CommercialGeneralLiability&CommercialAutoLiability. CERTIFICATEHOLDERCANCELLATION CITCAPE SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN CityofCapeCanaveral ACCORDANCEWITHTHEPOLICYPROVISIONS. 105PolkAve CapeCanaveral,FL32920 AUTHORIZEDREPRESENTATIVE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD COMMERCIALGENERALLIABILITY THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY. BLANKETADDITIONALINSUREDWRITTEN CONTRACTS(ARCHITECTS,ENGINEERSAND SURVEYORS) Thisendorsementmodifiesinsuranceprovidedunderthefollowing: COMMERCIALGENERALLIABILITYCOVERAGEPART 1.SECTIIThefollowingisaddedtoIONWHOISpliesonlytosuch"bodilyinjury"or"property ANINSURED: damage"thatoccursbeforetheendofthepe- riodoftimeforwhichthe"writtencontractre- Anypersonororganizationthatyouagreeina quiringinsurance"requiresyoutoprovide "writtencontractrequiringinsurance"toincludeas suchcoverageortheendofthepolicyperiod, anadditionalinsuredonthisCoveragePart,but: whicheverisearlier. a.Onlywithrespecttoliabilityfor"bodilyinjury", 2.4.a.SEC-ThefollowingisaddedtoParagraphof "propertydamage"or"personalinjury";and TONIVICOMMERCIALGENERALLIABILITY b.If,andonlytotheextentthat,theinjuryor CONDITIONS: damageiscausedbyactsoromissionsof Theinsuranceprovidedtotheadditionalinsured youoryoursubcontractorintheperformance isexcessoveranyvalidandcollectible"otherin- of"yourwork"towhichthe"writtencontract surance",whetherprimary,excess,contingentor requiringinsurance"applies.Thepersonor onanyotherbasis,thatisavailabletotheaddi- organizationdoesnotqualifyasanadditional tionalinsuredforalosswecover.However,ifyou insuredwithrespecttotheindependentacts specificallyagreeinthe"writtencontractrequiring oromissionsofsuchpersonororganization. insurance"thatthisinsuranceprovidedtothead- Theinsuranceprovidedtosuchadditionalinsured ditionalinsuredunderthisCoveragePartmust islimitedasfollows: applyonaprimarybasisoraprimaryandnon- c.IntheeventthattheLimitsofInsuranceofcontributorybasis,thisinsuranceisprimaryto thisCoveragePartshownintheDeclarations"otherinsurance"availabletotheadditionalin- exceedthelimitsofliabilityrequiredbythesuredwhichcoversthatpersonororganizationas "writtencontractrequiringinsurance",thein-anamedinsuredforsuchloss,andwewillnot suranceprovidedtotheadditionalinsuredsharewiththat"otherinsurance".Butthisinsur- shallbelimitedtothelimitsofliabilityrequiredanceprovidedtotheadditionalinsuredstillisex- bythat"writtencontractrequiringinsurance".cessoveranyvalidandcollectible"otherinsur- Thisendorsementshallnotincreasethelimitsance",whetherprimary,excess,contingentoron ofinsurancedescribedinSectionIIILiitsanyotherbasis,thatisaailetotheadditmvlabional OfInsurance. insuredwhenthatpersonororganizationisan additionalinsuredunderany"otherinsurance". d.Thisinsurancedoesnotapplytotherender- ingoforfailuretorenderany"professional3.SECIONIVThefollowingisaddedtoTCOM- MERCIALGENERALLIABILITYCONDITIONS: services"orconstructionmanagementerrors oromissions. DutiesOfAnAdditionalInsured e.Thisinsurancedoesnotapplyto"bodilyin- Asaconditionofcoverageprovidedtotheaddi- jury"or"propertydamage"causedby"your tionalinsured: work"andincludedinthe"products- a.Theadditionalinsuredmustgiveuswritten completedoperationshazard"unlessthe noticeassoonaspracticableofan"occur- "writtencontractrequiringinsurance"specifi- rence"oranoffensewhichmayresultina callyrequiresyoutoprovidesuchcoverage claim.Totheextentpossible,suchnotice forthatadditionalinsured,andthentheinsur- shouldinclude: anceprovidedtotheadditionalinsuredap- CGD4140408 2008TheTravelersCompanies,Inc.Page1o2f COMMERCIALGENERALLIABILITY i.How,whenandwherethe"occurrence" anyproviderofotherinsurancewhichwould oroffensetookplace; covertheadditionalinsuredforalosswe cover.However,thisconditiondoesnotaffect ii.Thenamesandaddressesofanyinjured whetherthisinsuranceprovidedtotheaddi- personsandwitnesses;and tionalinsuredisprimarytothatotherinsur- iii.Thenatureandlocationofanyinjuryor anceavailabletotheadditionalinsuredwhich damagearisingoutofthe"occurrence"or coversthatpersonororganizationasa offense. namedinsured. b.Ifaclaimismadeor"suit"isbroughtagainst 4.DEIIONSThefollowingisaddedtotheFINTSec- theadditionalinsured,theadditionalinsured tion: must: "Writtencontractrequiringinsurance"meansthat i.Immediatelyrecordthespecificsofthe partofanywrittencontractoragreementunder claimor"suit"andthedatereceived;and whichyouarerequiredtoincludeapersonoror- ii.Notifyusassoonaspracticable. ganizationasanadditionalinsuredonthisCover- Theadditionalinsuredmustseetoitthatwe agePart,providedthatthe"bodilyinjury"and receivewrittennoticeoftheclaimor"suit"as "propertydamage"occursandthe"personalin- soonaspracticable. jury"iscausedbyanoffensecommitted: c.Theadditionalinsuredmustimmediatelysend a.Afterthesigningandexecutionofthecontract uscopiesofalllegalpapersreceivedincon- oragreementbyyou; nectionwiththeclaimor"suit",cooperatewith b.Whilethatpartofthecontractoragreementis usintheinvestigationorsettlementofthe ineffect;and claimordefenseagainstthe"suit",andoth- c.Beforetheendofthepolicyperiod. erwisecomplywithallpolicyconditions. d.Theadditionalinsuredmusttenderthede- fenseandindemnityofanyclaimor"suit"to Page2o2f 2008TheTravelersCompanies,Inc.CGD4140408