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HomeMy WebLinkAboutPOST BUCKLEY SCHUH JERNIGAN PBS J - INSURANCE CERTIFICATE-"�_ DM CERTIFICATE OF LIABILITY INSURANCE 10/02/z 0 ) Z'O ER (305)822-7800 FAX 3058270585 Collinsworth, Alter, Fowler, Dowling & French Group 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 HOLDER. 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 INSURERA: Sentry Insurance a Mutual Company A+ XV INSURERB: Steadfast Insurance Company A XV INSURERC: Lloyds of London A XV INSURER D: INSURER E: 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 JJ& ADDPL AmDATE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE (MMIOD/M POLICY EXPIRATION DATE IMWnnfYYI LIMITS GENERAL LIABILITY 90-15807-03 09/30/2004 09/30/2005 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1,000,000 CLAIMS MADE FX OCCUR MED EXP (Any one person) $ 25,00( A X Contractual Liab PERSONAL &ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00( POLICY X jEC X LOC AUTOMOBILE LIABILITY ANY AUTO 90-15807-04 90-15807-05 09/30/2004 09/30/2005 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 accident) $ X Contractual Liab X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESSIUMBRELLA LIABILITY AUC508762100 09/30/2004 09/30/2005 EACH OCCURRENCE $ 25,000,00 X I 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- I OTH- A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 90-15807-02 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If s, describe under SPECIAL PROVISIONS below NO E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 roessional/ P42304 09/30/2004 09/30/2005 $1,000,000 Limits C Pollution Liability Ea Claim and Annual Aggregate CLAIMS -MADE FORM 11/11/1961 Retrodate DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS !`CCTICIPATC Uf%I 11C0 PAUPCr I ATIAu SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Fort Collins, City of 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn • Katy Carpenter/City Clerk BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P.O. BOX 580 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 Meade Collinsworth EEC ACORD 25 (2001/08) ©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. lil.uKu Zo (ZUUI/Uif)