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2021-085D
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Entry Properties
Last modified
7/19/2021 3:09:40 PM
Creation date
7/19/2021 3:06:38 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
06/15/2021
Control Number
2021-085D
Agenda Item Number
8.E.
Entity Name
JSR Enterprises East Coast, LLC.
dba JSR Fueling Technologies, LLC
Subject
Fleet Facility Fuel Island Canopy Refurbishment
Project Number
IRC-2025
Bid Number
2021024
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® <br />�'►�!�� CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />TYPE OF INSURANCE <br />4/9/2021 <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 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 />Nexus Partners Insurance <br />5745 North Scottsdale Road, Suite B120 <br />Scottsdale, AZ 85250 <br />CONTPRODUCER <br />NAME: Tiffany Meyer <br />HCo"N Ext): 800-409-8958 AIC No <br />E-MAIL <br />ADDRESS: certs vensure.com <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />EACH OCCURRENCE $ <br />INSURER A: StarStone National Insurance Company 25496 <br />MED EXP (Any one person) $ <br />INSURED <br />National Employer Services, LLC <br />L/C/F AVANTI HUMAN CAPITAL LLC <br />INSURER B: <br />INSURERC: <br />INSURER D: <br />2600 W. Geronimo Place Suite 100 <br />INSURER E: <br />Chandler AZ 85224 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 6119R154 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 <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />COMMERCIALGENERALLIABILITY <br />CLAIMS -MADE DOCCUR <br />R. Kramer Cole <br />EACH OCCURRENCE $ <br />DAMAGE ToRENTED <br />PREM SES Ea occurrence) $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />P <br />POLICY EI PRO- ❑ LOC <br />OTHER: <br />GENERAL AGGREGATE $ <br />PRODUCTS-COMP/OP AGG $ <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY L AUTOS ONLY <br />COMBINED SINGLE LIMIT $ <br />Ea accident <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Per accident <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED I I RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR/PARTNER/EXECUTIVE YIN <br />OFFICER/MEMBEREXCLUE F <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />T80210001-838 <br />1/1/2021 <br />1/1/2022 <br />�/ STATUTE EORH <br />E.L. EACH ACCIDENT $1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1 000 000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Coverage provided for all leased employees but not subcontractors of: <br />AVANTI HUMAN CAPITAL LLC Eff Date: 1/1/2021 <br />CERTIFICATE HOLDER CANCELLATION <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />61128154 1 VHR I Master Certificate I Paula Ochoa 1 4/9/2021 8:11:55 AM (MDT) I Page 1 of 1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Indian River County <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />1801 27th Street <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Vero Beach FL 32960 <br />AUTHORIZED REPRESENTATIVE <br />41,4LJodie <br />!/ <br />R. Kramer Cole <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />61128154 1 VHR I Master Certificate I Paula Ochoa 1 4/9/2021 8:11:55 AM (MDT) I Page 1 of 1 <br />
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