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HomeMy WebLinkAboutCertificate of Liability Insurance w/Williams Hatfield and StonerMelillo 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, �.�. e Carnthia Williams,— � w cc. Purchasing — Albert Cohen OP ID M DATE (MM/DD/YYVY) ACORQ. CERTIFICATE OF LIABILITY INSURANCE wILLI-2 d 04 17 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lyons Insurance Agency, Inc. � ��� f THE CERTIFICATE %) ONLY LDER.DCONFERS NO RIGHTS T TH S CERTIFICATE DOES NOAMEND, EXTEND OR Powdermill Square H 3844 Kennett Pike, Suite 210 t��.� LTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington DE 19807 Phone:302-658-5508 Fax•302-658-1253 5454�ERSAFFORDING COVERAGE - )(v NAIC# --- 3 INSURED INSUREgA: Hartford Fire Insurance Co. 19682 B: Twin City Fire Insurance Co. 4-)CV1 - Williams, Hatfield & Stoner�,� r �� % Inc. 3bcl\ �INSURERC American Intl. Specialty Lines x(r` 2101 North Andrews Ave Ste 3 b INSURER D Fort Lauderdale FL 33311_--- INSURER E=. rnvcr�nr_ec 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. LTR INSR TYPE OF INSURANCE POLICY EFFECTIVE- PRATE ( EXPIRATION POLICY NUMBER DATE MM/DD/YY DATE MM/DD1YLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISESJEaoccurence) A X X COMMERCIAL GENERAL LIABILITY 44UUNFU3205 10/01/02 10/01/03 $ 300, 000 CLAIMS MADE [X OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 1, 0 0 0, 0 0 0 GENERAL AGGREGATE s2,000,000 PRODUCTS COMP/OP AGG +$ 2 , 0 0 0 , 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECOT LOC AUTOMOBILE . LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A X X ANY AUTO 44UENFU3301 10/011/02 10/01/03 (Ea accident) - ALL OWNED AUTOS J / •J v •mil BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGEdt R� $ (Per accident) GARAGE LIABILITY ��ta e0 AUTO ONLY - EA ACCIDENT $ ANY AUTO Ge� P��ppethc l�� EA ACC OTHER THAN $ FiO ONAGG $ EXCESS/UMBRELLA LIABILITY klm natuf a EACH OCCURRENCE $ 5, 0 0 0, 0 0 0 AGGREGATE A X X OCCUR CLAIMS MADE 44XHUFUO ManaVec 10/01/02 10/01/03 $ 5, 000, 00.0 ,5 DEDUCTIBLE $ RETENTION $011-7 $ WORKERS COMPENSATION AND X TORY LIMITS ER B � EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXEGUTIVE 44WBRMP3350 10/01/02 10/111/03 ElEACH ACCIDENT --- ---- ----- --� $ 1, 000, 0 00 -- ---�-- - B 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 / LOCATIONS I 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 `+TY TAM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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. 88th Ave REPRESENTATIVES. Tamarac FL 33321 AUTHO REPRESENTATIV Z_ — ACORD 25 (2001108) © ACORD CORPORATION 1988 No Text