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HomeMy WebLinkAboutInsurance Certificate: Brown & Brown Inc Etal BROWN-3 OP ID: JW /Y) F ATE 0 D1/06/2014 CERTIFICATE OF LIABILITY INSURANCE vosola 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(ies) 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 endorsements . PRODUCER CONTACT Phone: 386-252-9601 NAME: SANDRA RAKAUSKAS #14009 Brown & Brown of Florida, inc. Fax: 386-239-5729 PHONE 386-239-5750 AX No:386-323-9134 Daytona Beach Office M. No 1 P.O Box 2412 E-MAIL Daytona Beach, FL 32115-2412 ADDRESS: SRAKAUSKAS@BBDAYTONA.COM M. Decker Youngman INSURER(S) AFFORDING COVERAGE NAIC if INSURER A: Travelers Pro & Cas of Amer 25674 INSURED BROWN & BROWN INC ETAL INSURERS: National Sure Corporation 21881 P O BOX 2412 DAYTONA BEACH, FL 32115 INSURER c:Charter Oak Fire Ins 25615 INSURER D:Travelers Indemnity 25658 INSURER E:XLSpecialty Ins Inc. 37885 INSURER F: Executive Risk Indemnity 35181 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 DDL SUBS POLICY EFF POLICY UP Lm TYPE OF INSURANCE POLICY NUMBER (MMMDNYYY) MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE E 1,000,00 A X COMMERCIAL GENERAL LIABILITY X C2JGLSA9527B87414 01/0112014 01101/2015 PREMISES Ea occunerax E 1,000,00 CLAIMS-MADE FxIOCCUR MED EXP (Any one Person) Y 5,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE E 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG E 2,000,00 POLICY PRO- LOC E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea acn m) II A ANY AUTO C2JCAP9527B86214 0110112014 01/0112015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per eccitlenq Y X HIRED AUTOS Jt NON-OWNED PROPERTY DAMAGE E AUTOS Peracoidenl S UMBRELLA LIAB X OCCUR EACH OCCURRENCE E 10,000,00 B Excess LIAB CI-AIMS-MADE 50000057895708 0110112014 0110112015 AGGREGATE $ DED RETENTIONS E WORKERS COMPENSATION X VYC STATU- OTH- AND EMPLOYERS' LIABILITY I- R YIN C ANY PROPRIETOR/PARTNER/EXECUTIVE F-- C20UB9517B58014 0110112014 0110112015 E.L. EACH ACCIDENT E 1,000,00 OFFICE EMBER EXCLUDED? N/A D (Mandatory in NH) RKUB951 SB76114 0110112014 01101/2015 E.L. DISEASE - EA EMPLOYEE E 1,000,00 0 yes, deacriEe under DESCRIPTION OF OPERATIONS belw E.L. DISEASE - POLICY LIMIT S 1,000,00 E INS AGENTS E&O ELU13229314 - 01101/2014 01/0112015 LIMIT 10,000,00 F EMP DIS/FIDELITY 82220236 01/01/2014 01/01/2015 BLANKET 25,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Ansel, ACORD 101, Additional Remarks ScNedVle, If more space is required) RE NAMED INSURED: BEECHER CARLSON INSURANCE _ SERVICES, INC.; ON POINT UNDERWRITING, INC.; BROWN 6 BROWN OF ARIZONA, INC.; BROWN S BROWN OF OREGON, INC. CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL CERTIFICATE HOLDER CANCELLATION CITYASI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. KARIOLSON 90 N MOUNTAIN AVENUE AUTHORIZED REPRESENTATIVE ASHLAND, OR 97520 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CITYASI BROWN-3 PAGE2 INSUREVS NAME BROWN & BROWN INC ETAL OP ID: JW DATE 01/06114 INSURED TO THE GENERAL LIABILITY PER FORM #CGD248 08-05