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2018-038B
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Last modified
12/21/2020 12:47:22 PM
Creation date
3/15/2018 11:41:37 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
02/20/2018
Control Number
2018-038B
Agenda Item Number
8.T.
Entity Name
Hinterland Group, Inc.
Subject
Culvert Replacement
Area
Blue Cypress Lake Road
Project Number
1748
Bid Number
2018033
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CERTIFICATE OF LIABILITY INSURANCE <br />F DATE(MM/DD/YYYY) <br />01/30/2018 <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 <br />South Shore Insurance Inc. <br />901 SW Martin Downs Blvd <br />Palm City FL 34990 <br />CONTACT Jennie Duke <br />PH772 426-9973 (AICFAX <br />ONE 772 221-1960 <br />E-MAIL jennie@southshore-insurance.com <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURERA: Hartford Casualty Insurance Com an 29424 <br />INSURED <br />Hinterland Group Inc. <br />992 W. 15th Street <br />Riviera Beach, FL 33404 <br />INSURER B: Property 8: Casualty Ins Comp of The Hartford 34690 <br />INSURER C: The Hartford Insurance Co of the Southeast 38261 <br />INSURER D: Hartford Fire Insurance Company 19682 <br />INSURER E: The North River Insurance Company 21105 <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 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 <br />LTR <br />TYPE OF INSURANCE _1= <br />ADDLSUB <br />wynPOLICY <br />NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 1 OCCUR <br />EACH OCCURRENCE $1,000,000 <br />DAMAGE TO RENTED $ 300,000 <br />2ES (Ea occurrence) <br />MED EXP (Any oneperson) $5,000 <br />X XCU Coverage Included <br />x <br />21 UEA HF5360 <br />01/31/2018 <br />01/31/2019 <br />PERSONAL & ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY C JECT I LOC <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $1,000,000 <br />BODILY INJURY (Per person) $ <br />B <br />X <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />x <br />21 UEA HF5507 <br />01/31/2018 <br />01/31/2019 <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />de <br />X <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />$ <br />x <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $10,000,000 <br />AGGREGATE $10,000,000 <br />E <br />EXCESS LIAB <br />CLAIMS -MADE <br />582-109804-8 <br />01/31/2018 <br />01/31/2019 <br />DED RETENTION <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITYFR <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />OFFICERIMEMBEREXCLUDED? YY <br />(Mandatory in NH) <br />NIA <br />x <br />21 WBAABOMTJ <br />01/31/2016 <br />01/31/2019 <br />X PER UT, OTH- <br />E.L. EACH ACCIDENT $1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $1,000,000 <br />Installation Floater $2,000,000 <br />D <br />Inland Marine <br />21UUMHF5845 <br />01/31/2018 <br />01/31/2019 <br />Rented/Leased Equi $300,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />Should any of theabove policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written <br />notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its <br />agents or representatives. Certificate holder is listed as an additional insured only if required by written contract/agreement with the <br />insured executed prior to accident or loss. A Waiver of Subrogation is provided only if required by written contractlagreement with the <br />insured executed prior to accident or loss. <br />Indian River County <br />1800 27th Street <br />Vero Beach, FL 32960 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />
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