2012-148A - Laserfiche WebLink

Home Browse Search

OP ID : AR CERTIFICATE OF LIABILITY INSURANCE °ATE (MM'09/111 /12/12 ' 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(les) 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 772-461 -3171 NAME CT Ann Rise Flowers-Yates Insurance, Inc. PHONE FAX 780 West Midway Road 772-4613405 A/c No Ext : 772461 -3171 A/c No): 772-461 -3405 PO Box 12310 E-MAIL Fort Pierce, FL 34979-2310 ADDRESS: PRODUCER gEALE-1 Ann Rise CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Beale Holdings, Inc. INSURERA : Auto Owners Insurance Company 09703 8r Joseph E Beale Jr 3 Seahorse Lane INSURER B Vero Beach , FL 32960-5231 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER : REVISION NUMBER: THIS IS TO CERTIFY THAT 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 , LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 11000100 A X COMMERCIAL GENERAL LIABILITY X 05468272718448 05/15/12 05/15/13 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 10100 PERSONAL & ADV INJURY $ 11000900 GENERAL AGGREGATE $ 2,000100 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 21000900 17 POLICY 7 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION O STATULIMITS O R AND EMPLOYERS' LIABILITY Y / N R ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N / A E. L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required) LOC 001 BLDG 001 1225 5Th St Sw Vero Beach , FL 32962 - 1565 Certificateholder is landlord ( owner of property) and listed as additional insured . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Indian River County 180127 Street Vero Beach , FL 32960-3388 AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION . All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD