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SUNSLAN-03 CRZACA
<br />ACOR�h
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDNYYY)
<br />7/31/2019
<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(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />C,2AIACT Carol Rzaca - Ext. 233
<br />R V Johnson Agency, Inc.
<br />2041 SE Ocean Blvd
<br />PHONE FAX
<br />A/c, No, Ext): (772 287-3366 A1C, No :(772) 287-4255
<br />Stuart, FL 34996
<br />Wp&Essw crzaca@pdohnson.com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />EACH OCCURRENCE $ 1,000,000
<br />INSURER A:SOuthem Owners Insurance 10190
<br />MED EXP (Any oneperson) 5,000
<br />INSURED
<br />INSURER B: National Indemnity Co. 20087
<br />INSURERC:StarStone National Ins Co. Harborside Financial Ctr
<br />Sunshine Land Design, Inc.
<br />INSURER D: Brid efield Employers Ins. 10701
<br />3291 SE Lionel Terrace
<br />Stuart, FL 34997
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NI)MRFR- RFVICInN NI IMRFR-
<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 />INSRLTR
<br />TY OF INSURANCE
<br />ADDINSp
<br />WVD SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />DDPnnffl
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />Bik Addi Insured
<br />X Blk Waiver
<br />72436125
<br />7/30/2019
<br />7/30/2020
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAGE TO RENTED $ 100,000
<br />E.X
<br />MED EXP (Any oneperson) 5,000
<br />PERSONAL &ADV INJURY 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑X PE� LOC
<br />OTHER:
<br />GENERAL AGGREGATE 2,000,000
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />$
<br />B
<br />AUTOMOBILE
<br />X
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY X AUTOpSy�rN
<br />AUTOS ONLY AUOTOS ONLY
<br />74APB003312
<br />7/30/2019
<br />7/30/2020
<br />COMBINED SINGLE LIMIT 1,000,000 enLI
<br />BODILY INJURY Per arson $
<br />BODILY INJURY Per accident $
<br />PRerr. dZ DAMAGE $
<br />C
<br />X
<br />UMBRELLA LIABX
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />170864191ALI
<br />8/10/2019
<br />7/30/2020
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />DED I X I RETENTION$ 10,000
<br />1,000,000
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N
<br />�FFICERIMEMgER EXCLUDED?
<br />(Mandatory in NH)
<br />If yyes descr be under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />I
<br />t
<br />830-56011
<br />11/1/2018
<br />1111/2019
<br />I
<br />�( PER OTH-
<br />E. L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Certificate holder and owner of the project are Included as additional insured for General Liability
<br />CFRTIFICATF FIr11 r1FR f nAKW or r A1rIf%K1
<br />PROOF OF INSURANCE
<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 />AUTHORIZEDREPRESENTATIVE
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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