Loading...
HomeMy WebLinkAboutPOST BUCKLEY SCHUH JERNIGAN PBS J - INSURANCE CERTIFICATE (4)ACORDM CERTIFICATE OF LIABILITY INSURANCE i0/02/2 a) PRODUCER (305)822-7800 FAX 3058270585 Collinsworth, Alter, Fowler, Dowling & French Group p Inc.. P. 0. Box 9315 Miami Lakes, FL 33014-9315 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Post, Buckley, Schuh, & Jernigan, Inc. d/b/a PBS&J 2001 NW 107 Avenue Miami, FL 33172-2507 INSURER A: Sentry Insurance a Mutual Company A+ XV INSURERB: Steadfast Insurance Company A XV INSURERC: Lloyds of London A XV INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVIL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMWDDrYYI POLICY EXPIRATION DATE IMWDD/YYW LIMITS GENERAL LIABILITY 90-15807-03 09/30/2004 09/30/2005 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1 000 r 00 CLAIMS MADE [ OCCUR MED EXP (Any one person) $ 2 5 , 0O A X Contractual Liab PERSONAL & ADV INJURY $ 1,000 00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 P POLICY J( RO- JECT X LOC AUTOMOBILE LIABILITY ANY AUTO 90-15807-04 90-15807-05 09/30/2004 09/30/200S COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X A ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS X BODILY INJURY (Per person) $ X BODILY INJURY (Per aciident) $ X Contractual Liab X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLALIABILITY AUC508762100 09/30/2004 09/30/2005 EACH OCCURRENCE $ 2S,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 25,000,000 B $ $ DEDUCTIBLE X RETENTION $ 10,00 $ WORKERS COMPENSATION AND 90-15807-01 09/30/2004 09/30/2005 X I WC STATU- OTH- A EMPLOYERS' LUIBILTTY ANY PROPRIETOR/PARTNER/EXECUTIVE 90-15807-02 E.L. L".ACH ACCIDENT $ 1,000,000 E.L. DISEASE - FA EMPLOYE $ 1,000,000 OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below NO E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 OTH rlluti P42304 09/30/2004 09/30/200S $1,000,000 Limits C Pollution Liability n Liability Ea Claim and Annual Aggregate CLAIMS -MADE FORM 11/11/1961 Retrodate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ef:RFP P-884 Civil Engineering Annual Fort Collins, City of Attn: Purchasing Department 215 N. Mason Street 2nd Floor Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) FAX: (970)221-6707 ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)