HomeMy WebLinkAboutCertificate of Liability Insurance for Williams Hatfield and StonerMemo
To:
City Clerk's Office
From:
Carenthia Williams
CC:
Risk Management
Date:
July 3, 2003
Re:
Williams, Hatfield, & Stoner
Please attach the Williams, Hatfield, and Stoner Certificate of Liability Insurance form to
Resolution No. R-2003-88 and Resolution No. R-2003-91 to accompany the formal
agreement. We were not sure if you received the certificate from the initiating department.
Respectfully,
l
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Carenthiar�--
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cc. Purchasing -- Albert Cohen
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ACORQ. CERTIFICATE OF LIABILITY INSURANCE OP ID M DATE(MM/DD/YY
WILI,I-2 d 04 17 03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lyons Insurance Agency, Inc. �r � , t ONLY THIS CERTIFICATE 1GHTS UPON THE CERTIFICATE
DOES NOT AMEND, EXTEND OR
Powdermill Square G. �t
3 i44 Kennett Pik807Suite 210 TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
lmington
Phone:302-658-5508 Fax•302-658-1253 1NAERS AFFORDING COVERAGE NAIC#
INSURED Q INSUREgA: Hartford Fire Insurance Co. 19682 --
Williams, Hatfield & Stoner, /
Inc. �(\
2101 North Andrews Ave Ste 30
Fort Lauderdale FL 33311
COVERAGES
B:
Ik INSURER C:
INSURER D:
INSURER E.
Twin City Fire Insurance Co. -i-,XV'
American Intl. Specialty Li es �4
Xv.
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
- " - POLICY EFFECTIVE Fy L CY EXPIRATION
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MMIDD/YY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
•
X
X COMMERCIAL GENERAL LIABILITY
4 4UUNFU3 2 0 5
10/01/02
10/01/03
$ 300, 000
DA��-
PREMISES (Ea occurence)
CLAIMS MADE X OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000, 000
GENERAL AGGREGATE
s2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000, 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X jR O LOG
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$ 1,000,000
A
X
X
ANY AUTO
44UENFU3301
10/01/02
� 0/01/03
1
(Ea accident)
--
ALL OWNED AUTOS
•
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
BODILY INJURY
X
HIRED AUTOS
f
$
X
NON -OWNED AUTOS
(Per accident)
fke
PROPERTY DAMAGE
$
�tg
(Per accident)
GARAGE LIABILITY
pc�a
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
t8D`S
cep �\G\e+
P
�eio�l
OTHER THAN FA ACC
$
N� pBrf�C\B
AUTO ONLY: AGG
$
EXCESS/UMBRELLA LIABILITY
_
--
$
W
EACH OCCURRENCE
s5,000,000
A
X
X OCCUR CLAIMS MADE
U,
44XHUFUO0.?..nagel
10s/01/02
10/01/03
AGGREGATE
$ 5, 000, o00
_
R
$
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
WC STATU-
X TORY LIMITS ER
B
EMPLOYERS' LIABILITY
44WBRMP3350
10/01/12
10/01/03
{...---- ...... .—_...._.......
1 EL EACH ACCIDFNT
_. ..............--
$ 1,000,000
B
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
44NMP3351
10/01/02
10/01/03
---- -
E.L. DISEASE - EA EMPLOYEE
-- - - ----- -
$ 1,000,000 _
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$1,000,000
OTHER
C
Profess./Pollution
1952583
10/01/02
10/01/03
Se Below For Limits
E&O Legal Liab.
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
LIMITS:$2,000,000 Ea. CL./$2,000,000 Agg. and $250,000 Retention Ea. Cl.
CLAIMS MADE FORM: Maximum for all claims during the policy year.
Re Gen Consulting Services WHS Project #5590 Waiver of Subrogation applies
to Workers Compensation coverage only.
CERTIFICATE HOLDER CANCELLATION
CTY TAM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Tamarac IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P. Tomaszewski
7525 N. W. 8 8 th Ave REPRESENTATIVES,
Tamarac FL 33321 AUTHO REPRESENTATIV
ACORD 25 (2001/08) O ACORD CORPORATION 1988
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