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HomeMy Public PortalAbout2018 Certificate of InsuranceProject Manual for Fernwood Road Lighting Improvements Village of Key Biscayne ITB 2018-01-03 SECTION 00650 CERTIFICATE OF INSURANCE THIS IS TO CERTIFY THAT THE Frank H. Furman, Inc. (Insurance Company) Address 1314 E. Atlantic Blvd. of Pompano Beach, FL 33060 has issued policies of insurance, as described below and identified by a policy number, to the insured named below; and to certify that such policies are in full force and effect at this time. It is agreed that none of these policies will be canceled or changed so as to affect the interest(s) of the Village of Key Biscayne (hereinafter sometimes called the Owner) until thirty (30) days after written notice of such cancellation or change has been delivered to the Village Clerk, copy to EAC Consulting, Inc. Insured AUM Construction Inc. Address 8950 NW 119th St., Hialeah Gardens, FL 33018 Status of Insured: X Corporation Partnership Individual Location of Operations Insured Florida Description of Work: FERNWOOD ROAD LIGHTING IMPROVEMENTS Village of Key Biscayne, Florida INURANCE POLICIES IN FORCE: FORMS OF COVERAGE POLICY NUMBER EXP. DATE * Worker's Comp. / Employers Liability 0521 1 1590 06/18/2018 + Comprehensive Automotive Liability BA2H953803 07/03/2018 O Comprehensive General Liability NN833365 12/01/2018 + Excess Liability EBU034237698 12/01/2018 Other (Please specify type: 00650- 1 Project Manual for Fernwood Road Lighting Improvements Village of Key Biscayne ITB 2018-01-03 POLICY INCLUDES COVERAGE FOR: 1. Additional Insured: Owner & Engineer Yes 2. *Liability under the United States Longshoremen's and Harbor Worker's Compensation Act 3. +AII owned, hired, or non -owned automotive equipment used in connection with work done for the Owner Yes 4. o Contractual Liability 5. o Damage caused by explosion, collapse or structural injury, and damage to underground utilities. 6. o Products / Completed Operations Yes 7. o Owners and Contractors Protective Liability 8. o Personal Injury Liability Yes 9. + Excess Liability applies excess of: (a) Employers Liability (b) Comprehensive General Liability (c) Comprehensive Automobile Liability Excess over General Liability TYPES OF POLICY Policy Number Exp. Date Worker's Compensation Bodily Injury $ Statutory Employers Liability Bodily Injury $ 1,000,000 Each Accident Disease $ 1,000,000 Each Person Disease $ 1,000,000 Policy Limit Comprehensive Auto Liability Combined Single Limit DI/PD $ 1,000,000 Each Accident Comprehensive General Liability Bodily Injury $ Each 00650- 2 Project Manual for Fernwood Road Lighting Improvements Village of Key Biscayne ITB 2018-01-03 Occurrence $ Aggregate Property Damage $ Each $ Aggregate OR Combined Single Limit BI/PD Occurrence $ 1,000,000 Each $ 2,000,000 Aggregate Excess Liability Combined Single Limit BI/PD $5,000,000 Aggregate Other The Insurance Company hereby agrees to deliver, within ten (10) days, two (2) copies of the above policies to the Engineer when so requested. NOTE: Entries on this certificate are limited to the Authorized Agent or Insurance Company Representative. Date 05/16/2018 Issued at Insurance Agent or Company 00650- 3 (SEAL) Frank H. Furman, Inc. Insurance Company Authorized Representative A� LF CERTIFICATE OF LIABILITY INSURANCE DATE(MWDOtYYYY) 5/15/2018 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 15 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 endorsement(s). PRODUCER Frank H. Furman, Inc. 1314 East Atlantic 81vd. P. 0. Box 1927 Pompano Beach FL 33061 CONTACT Sandra LaRue NAM PHONE WC. No. Ed): (954)943-5050' FAX No): (954)942-6310 E-MAIL ADDRESS: sandra@furmaninsurance.com INSURER(S) AFFORDING COVERAGE NAICft INsuRER ANautilus Insurance Co 17370 INSURED AVM Construction /nc 8950 NW 119th St Hialeah Gardens FL 33018 INSuRERB:Travelers Casualty Ins Co of 19046 INSURERC:Commerce & Industry Insurance Co 19410 INsuRERU:Business£first Insurance Co 11697 INSURER E: INSURER F• COVERAGES CERTIFICATE NUMBER:A: 2017 ALL Policies 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 TYPE OF INSURANCE ADDL INSD 8We BR VD POLICY NUMBER POLICY EFF MIDOIYYY ODIYYYYI (M Y) POLICY EXP (MMI LIMITS A X COMMERCIAL GENERALLIABILITY X 1111833365 12/1/2017 12/1/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE X LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALLOWNED _ X SCHEDULED AUTOS NON -OWNED AUTOS 81211953803 7/3/2017 7/3/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per eccldent) $ PROPERTY DAMAGE (Per accident) $ c X UMBRELLA LIAB EXCESSUAB X OCCUR CLAIMS -MADE EBU034237698 12/1/2017 12/1/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ OED I RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EMBER EXCLUDED? (Mandato ry In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N N/A 052111590 6/18/2017 6/18/2018 X 1 STATUTE I0»! EL. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 EL DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 11 more space Is requl ed) Project: Fernwood Road Lighting Improvements, /TB 2018-01-03 The Village of Key Biscayne is included as Additional Insured with respects to General Liability as required by written contract with the Named Insured. CERTIFICATE HOLDER CANCELLATION Village of Key Biscayne 88 W. McIntyre St. Suite 2200 Key Biscayne, FL 33149 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Dirk DeJong/SL .eazOor--- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) Policy Number: NN833365 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY AUTOMATIC STATUS WHEN REQUIRED IN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 - Who Is An Insured Is amended to include as an additional Insured any personor organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization Is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising Injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured, but only for "occurrences" or coverages not otherwise excluded in the Coverage Part to which this endorsement applies. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. Status as an additional insured for the person or organization to which this endorsement applies: 1. Commences during the policy period and after such written contract or agreement has been executed; and 2. Ends when: a. Your ongoing operations for that additional insured are completed; b. The contractor's contract or agreement is terminated; or c. Your policy cancels or expires; whichever occurs first. C. With respect to the insurance afforded to the additional Insured, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage", "personal and advertising injury" or medical payments arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering, or surveying services. L805 (01/17) Includes copyrighted material from Insurance Services Office, Inc., with Its permission. Page 1 of 2 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished In connection with such work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the Injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to the insurance afforded to the additional insured, the following is added to Section 111 - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of Insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. The following is added to 4.a. of Other Insurance of Section IV - Commercial General Liability Conditions: If required In a written contract. the Coverage Part to which this endorsement applies is primary and noncontributory in the event of an "occurrence" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured. All other terms and conditions remain unchanged. L805 (01/17) Includes copyrighted material from Insurance Services Office, Inc., with its permission. Page 2 of 2 ACORL' CERTIFICATE OF LIABILITY INSURANCE DATE (MMJDD/YYYY) 5/15/2018 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 endorsement(s). PRODUCER Frank H. Furman., Inc. 1314 East Atlantic Blvd. P. O. Box 1927 Pompano Beach FL 33061 INSURED AUM Construction Inc 8950 NW 119th St Hialeah Gardens FL 33018 CONTACTSandra LaRue NAME: PHONE (954) 943-5050 lA�c.,Xo East1: E-MAILADDRESS: sandra@furmaninsurance.com FAX (954)942-6310 (A/C. No): INSURER(S) AFFORDING COVERAGE INSURER A Nautilus Insurance Co NAIC N 17370 INSURER B :Travelers Casualty Ins Co of INSURER C :COmmeroe & Industry Insurance Co INSURER D :Businessfirst Insurance Co 19046 19410 11697 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:A: 2017 ALL Policies 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 LTR TYPE OF INSURANCE ADM INSD SUBR WVD POLICY NUMBER POLICY EFF I POLICY EXP (MM/DD/YYYYI IMM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RE PREMISES Ea occurrence) $ 100, 000 X NN833365 12/1/2017 12/1/2018 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 128: LOC PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS RA2H953803 7/3/2017 7/3/2018 BODILY INJURY (Per accident) $ X HI)REDSAUTOS X NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAEI X OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAR CLAIMS -MADE AGGREGATE $ 5,000,000 DED RETENTON$ EBU034237698 12/1/2017 12/1/2018 $ WORKERS COMPENSATION X PER STATUTE OTH- ER 'ANY AND EMPLOYERS' LIABILITY ECUTIVE Y/N E.LEACH ACCIDENT $ 1,000,000 NYICEOPRIETORPARTNER/E O13 (Mandatory in NH) J N/A 052111590 6/18/2017 6/18/2018 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Project: Fernwood Road Lighting Improvements, ITB 2018-01-03 The Village of Key Biscayne is included as Additional Insured with respects to General Liability as required by written contract with the Named Insured. CERTIFICATE HOLDER CANCELLATION Village of Key Biscayne 88 W. Mc:_ntyre St. Suite 2200 Key Biscayne, FL 33149 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Dirk DeJong/SL ACORD 25 (2014/011 INS025:?,:Icr: © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: NN833365 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY - AUTOMATIC STATUS WHEN REQUIRED IN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured, but only for "occurrences" or coverages not otherwise excluded in the Coverage Part to which this endorsement applies. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. Status as an additional insured for the person or organization to which this endorsement applies: 1. Commences during the policy period and after such written contract or agreement has been executed; and 2. Ends when: a. Your ongoing operations for that additional insured are completed; b. The contractor's contract or agreement is terminated; or c. Your policy cancels or expires; whichever occurs first. C. With respect to the insurance afforded to the additional insured, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage", "personal and advertising injury" or medical payments arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring, of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering, or surveying services. L805 (01/17) Includes copyrighted material from Insurance Services Office, Inc., with its permission. Page 1 of 2 2. "Bodily injury" or "property damage" occurring after a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. D. With respect to the insurance afforded to the additional insured, the following is added to Section 111- Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. The following is added to 4.a. of Other Insurance of Section IV - Commercial General Liability Conditions: If required in a written contract, the Coverage Part to which this endorsement applies is primary and noncontributory in the event of an "occurrence" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured. All other terms and conditions remain unchanged. L805 (01/17) Includes copyrighted material from Insurance Services Office, Inc., with its permission, Page 2 of 2