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2016-163
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2016-163
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Last modified
10/11/2016 1:21:02 PM
Creation date
10/11/2016 1:21:01 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
10/04/2016
Control Number
2016-163
Agenda Item Number
8.M.
Entity Name
Southeastern Surveying and Mapping Corp.
Subject
Professional Surveying and Mapping Services
Project Number
1605
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A`� CERTIFICATE OF LIABILITY INSURANCE DATE(MAVDD/YYl^n <br /> 9/14/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Amanda Bonventre <br /> NAME: <br /> Gentry Insurance Agency PHONE (407)886-3301 ac No:(407)886-9530 <br /> 175 East Main Street E-MAIL amanda@ en ins.com <br /> ADDRESS: g try <br /> PO Box 2046 INSURER(S) AFFORDING COVERAGE NAIC 9 <br /> APOPKA FL 32704-2046 INSURER Phoenix Insurance Company 25623 <br /> INSURED INSURERB:The Travelers Indemnity Company 25658 <br /> Southeastern Surveying and Mapping Corporation INSURER CAdmiral Insurance Company 24856 <br /> 6500 All American Blvd INSURER D: <br /> INSURER E: <br /> Orlando FL 32810 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:2016 Prof Update REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDLTYPE OF INSURANCE 1M D POLICY NUMBER MMIDDI EFF MP POLICY EXP LIMITS <br /> LTR <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS-MADE ❑R OCCUR DAMAGE T RENTED 300,000 <br /> PREMISES Ea occurrence $ <br /> X 680745OPS40 4/24/2016 4/24/2017 MED EXP(Any one person) $ 5,000 <br /> PERSONAL 8 ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> RPOLICY�JECOT- F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea acddent <br /> A X AN AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED X BA418M5952 4/24/2016 4/24/2017 BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> X HIRED AUTOSX AUTOS Per accident <br /> $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 <br /> B 1=XCESSLIAB CLAIMS-MADE COP78022090 4/24/2016 4/24/2017 AGGREGATE $ 5,000,000 <br /> DED I X I RETENTION$ 10,000 $ <br /> WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY STAME ER <br /> Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 <br /> A (MandatoryEMBER in NH)EXCLUDED? N❑ N/A IIB3742T340 6/25/2016 6/25/2017 E.E.L.DISEASE-EA EMPLOYE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB 1$ 1,000,000 <br /> C Professional Liability E0000035004-01 9/19/2016 9/19/2017 Each Claim $2,000,000 <br /> Aggregate $2,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> RE: Master Agreement for Annual Professional Surveying and Mapping Services IRC Project No. 1605 <br /> Indian River County is included as additional insured as respects General Liability and Auto Liability on <br /> a primary and non-contributory basis per contract. 30 day notice of cancellation applies. <br /> CERTIFICATE HOLDER CANCELLATION <br /> dschryver@ircgov.com <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Indian River Country THE EXPIRAT10N DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 1801 27th Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Vero Beach, FL 32960-3388 <br /> AUTHORIZED REPRESENTATIVE <br /> D Liebknecht/AMANDA <br /> fl1988-2014ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> INS025 rgnumi <br />
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