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Home My Public Portal AboutTAG Grinding Certificate of Liability Insurance 2019Sep 12 2819 88:49:29 ell*_w, a174n61 J Smith Lanier r ATAnnPINln IAI Page 983 ACORD,,, CERTIFICATE OF LIABILITY INSURANCE D9/1212N]O/YYYY) 9/12/2019 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 CER"fIFICA'TE OF INSURANCE DOES NOT CONS'TITUT'E 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 have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies rnay require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Crystal Adams J Smith Lanier & Cc Newnan 1YRUNve�...._........_ FAX tAJ<: No,,,Fxa:_77083 1000 _ �/n NA� 770-683 1010 — _— P. 0. Box 71429 E•n�AIC ca dam sriejsmithlanior.com . 47 Postal Parkway 'Ar��a�a INSURER(S) AF'F�gR01NG COVERAGE NAIC tk Newnan, GA 30271-1429 . V ...a. ... .. ....... NSURER A . Harieysvl_. Mutual 14168 INSURED INSUR6H 6. Federal Insurance 20281 TAG Grinding Services, Inc, ... Evans ... n I ......... ..... ... INSURER c ; ton Insurance Company 35378 Jay Brooks, LLC Stonewood InxNranch C .. .... INSURERD: � .ampany 31925 1750 Powder Springs Rd. #190-171 ...._......._....__._......._............._._......_.......__..._..__..._........._..........................._.......__.................. ...._...._..— Marietta, GA 30064 INsuH! �INSURER .............. .......... 09/25/201 F ; I;U V ItKAkti GCK I II -11.A I C IV V MCCCK: Kcv r. rule NU IVIG C,K: TI11S IS TO CERTIFY THAT THE. POLICIES OF INSURANCE US= 13ELOW HAVE BEEN Iw SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUMEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT \MTH RESPECT' TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE PERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SH0%AIN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ...................—..... ..._............................._ .... OI � NSi< ........... ...... .. ...... ._...... ADfJLi3UHR ..... ........ „_........ ........ _ r'0..1 1 CTF POLI61 C � F TYPE OF INSURANCE IN;f9 WyW POLICY NUMPER (MMIDIYYVY) (MMIDDIYYYYN, LIMITS _ .... .,. A X COMMERCIAL GENERAL LIABILITY X X MPA00000020785L 7/27/2019 09125/201 f Arllnr( IJRr<rNrr %1,000,000 1 L,AIM;;,•MAIJF .X,I (;)t:1'.uR >)i $100,000 }yiit .,l` �i �N�uli;Ylrtrt............ ........ MY U 1 %V (f1nN Y uc,l.?t<lion) 9 5.000 X I X IBA00000020784L C M 600000020786 L t'1'SR:If,)NAt. 4 Af.?V INJL1ItY "I'! "Ap A(? R1 (A'I t, t 2,000.000 f)('JV'L. H(3frFV1'G �; f1lf:' LIMIT APrPt.11 „I FIE1R. .. /2019 09/251201 cOMrwrn INC'i.r..LIMIT „ .............. _._........ _ Y1,000,000__ NCjl..l 1:1,01)HA INJURY (Pei per:on) $ o'rwrrt r=rR t�rFl X 1 �fA;l Jl L C(3 A AUTOMOaILV. LIABILITY X ANY AUTO 11?[.YEI((ICIQillli._.._......... ............. GVJtVIi'?f.) CP•IG2I)IJLEU AUTOS ONLY AUI'0,S .............. .......... 09/25/201 X 1•IIREI') X N01, OWNff;17 ..... r L [>I rA r ra rM�l r>vLc 1,000x000 AU'r0 ; gN1,Y AJ1118 (,)NI,Y X rive Oth Car .......................................... A „ X UM�IRELL/\ LIA(<f F-.... )( ........_...... lft 7/27/2019 09/25/201 EXCESS LIAF3 C X I X IBA00000020784L C M 600000020786 L t'1'SR:If,)NAt. 4 Af.?V INJL1ItY "I'! "Ap A(? R1 (A'I t, t 2,000.000 DESCRIPTION OF OPERATIONS/ LOCATIONS! VEHICLES (ACORD 101, Additional Remarks tSchodule, may oe attaahod if more spaao Is roquirod) (GL) Additional Insured per Forms CG72541210 and CG72631210. (GL) Waiver of Subrogation per Form CG71860904.- General Liability Enhancement Endorsement (CAU) Additional Insured and Waiver of Subrogation per Form CA72001214- Commercial Auto Broad Form Endorsement City of Gulf Stream Attn: Rita "Taylor 100 Sea Road Gulf Stream, FL 33483-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THF POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE (i) 1988-2016 ACORD CORPORATION. All riahts reserved ACORD 25 (2016103) 1 of i The ACORD name and logo are registered marks of ACORD #S4488043/M4487722 SZ'T .. /2019 09/251201 cOMrwrn INC'i.r..LIMIT „ .............. _._........ _ Y1,000,000__ .....CJF•r��l....._X�.!V.I?;IfcNllt)N:_G,10000................... ....... WORKERSCOMPF.NSATION .. 1:1,01)HA INJURY (Pei per:on) $ 09/11/202 r=rR t�rFl X 1 �fA;l Jl L C(3 .................... .._ ..... ................. 1301:)II..Y IN,.II.I I'YY (Far Cx•a.idrcnr) .............. _..... $ I>k01>I rtY C:IAAIA(t�F Y 11?[.YEI((ICIQillli._.._......... ............. ........... r I F!M1( fd f t (Ijjl".NT $1,000,000 ......... ... /2019 .............. .......... 09/25/201 ......................._.............._.......... 1. Lal"IUC1,UR,I NC;L. .... .... ......... $5,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS! VEHICLES (ACORD 101, Additional Remarks tSchodule, may oe attaahod if more spaao Is roquirod) (GL) Additional Insured per Forms CG72541210 and CG72631210. (GL) Waiver of Subrogation per Form CG71860904.- General Liability Enhancement Endorsement (CAU) Additional Insured and Waiver of Subrogation per Form CA72001214- Commercial Auto Broad Form Endorsement City of Gulf Stream Attn: Rita "Taylor 100 Sea Road Gulf Stream, FL 33483-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THF POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE (i) 1988-2016 ACORD CORPORATION. All riahts reserved ACORD 25 (2016103) 1 of i The ACORD name and logo are registered marks of ACORD #S4488043/M4487722 SZ'T .. ...... Y ........ D .....CJF•r��l....._X�.!V.I?;IfcNllt)N:_G,10000................... ....... WORKERSCOMPF.NSATION .. .................... .._........ _.. ........_ ....,....,.. 87029 9111/2019 09/11/202 r=rR t�rFl X 1 �fA;l Jl L C(3 AND EMPLOYERS LIAf91411 \ YIN ANY 1VL' r I F!M1( fd f t (Ijjl".NT $1,000,000 f.l'il(kli/MIMIl-f�F'X1l,tJ1)t„U'% I, J'.!N/A (MondMory in NH) ..... r L [>I rA r ra rM�l r>vLc 1,000x000 if YFR, tIPor,C fIP4 UnrlFf 1)t C NII 11C7N nt C?4 F f2A l tl�N . hE unv , ., _� ., f I tiI I A ( f (tn Y I IM1T J 1 OOU,000 ,. ... ,,. ,,,,,,, B Rented/Leasedq .... 6711154 7/27/2019 09/25/201 $750,000 Lmt/$5,000 Ded C Pollution/Profes MMAENV001090 7/2712019 09/2512019 $1,000,0001$2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS! VEHICLES (ACORD 101, Additional Remarks tSchodule, may oe attaahod if more spaao Is roquirod) (GL) Additional Insured per Forms CG72541210 and CG72631210. (GL) Waiver of Subrogation per Form CG71860904.- General Liability Enhancement Endorsement (CAU) Additional Insured and Waiver of Subrogation per Form CA72001214- Commercial Auto Broad Form Endorsement City of Gulf Stream Attn: Rita "Taylor 100 Sea Road Gulf Stream, FL 33483-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THF POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE (i) 1988-2016 ACORD CORPORATION. All riahts reserved ACORD 25 (2016103) 1 of i The ACORD name and logo are registered marks of ACORD #S4488043/M4487722 SZ'T Sep 12 261.9 00:49:13 -> J Smith Lanier Page 001 J. Smith Laniew & Co, Imfuring People. and Businers Siw r 1868 Date: 09/12/19 08:48:32 AM To: From: <starragano@jsmithlanier,com> Pages (w/cover): 3 Fax #: 5617370188 Re: Proof of Insurance Coverage This fax and any documents accompanying this transmission may contain proprietary, privileged and/or confidential information and is intended solely for the addressee(s) named above. IF you are not the intended addressee/recipient, you are hereby notified that any use of, disclosure, copying, distribution, or reliance on the contents of this information is strictly prohibited and could result in legal action against you. Please reply to the sender advising of the error in transmission and immediately delete/destroy the message and any accompanying documents. Sep 12 20'_9 00:49:19 -> J Smith Lanier Page 002 Please see anacbed documents f^car prOOf Of i.nsura.nce sent. from ,1, Sntith L,an.i.er & Co. If'you have any questions 8tMt YOUr proof of insurance, please contact your J, Smith Lanier & Co, representative. 'This proof of hisura.nce supersedes A previously issued ceilif(cates. Please: include Nartied Insured details with gill corre,q) ndence. This irinall r•.Yr111 all), (Jocultion1s ur.:'i:rrarfT?!:rrtpprl fhl.y p'arlsmissh".)n aarai c.'c n(plrl J?r°rr/?rYe^Yul t , /.?rlvNk;t+<':1 rarlrt'rar 4 prff'icJc::raUtll lr�lr,'tr'lgirf!(?77 carol Lf lr9lf r1r:16'r:i.ec.?lc,.l)' liar tFrti adclresaee.(s) Helti rd abOvc. 1fJ c,rt are not the intended addre+s•sees'iecripie nt. you are herc?hJ• nexified that (ury use c?f disolca twe, c:oppin,:?, disrr•ihution, of- rehance cin the i:i>rotc.nY.c 4)0111.-N igffi1'rrlt10pri 1s 8lnv( y J i,ohil)tli,d (.fora n.-mi'd rev'rdl rrr le..kal ac:tRln it rftrls'1 pnrt. )/'prrW ar'e k1of the tt•rtc:ndc:cl,:rl.1r.(r'F.rs<sE i'eu; (/ylr:r7(; +rrrrnCiilc.rle'^!) iJGle(iz�Glia•d'c'ry (ho lrten,t<;t.r:? e•'rrrd only eu:eUntplrOainti; dfrchalot iatit g, Thi;; ,>10 ,azly ia,Ctac:haY'acCnl': th otit OV�y'::00tairl irvh0(tttafion thM is eot pttletvmL*,a;i;r,Rr,':trfrl: (ri.,ryy disc oskite undes appiicahlce lav aro:) is, int;c;rttie.c3 sakoy for the. use of tlu.- individcreal(s) to whon'a it. warn interick-cf to by rarddre•.�ssPd, 3t y�ota havci' recelvead t kr c:•a•nail by mistake., or you ;arcs not. the infe:ndre9 recipient. any dis;crk?mare!, dissrrninstic,n, disfribution, ccapyi?irk of c.•t,haer use or retention of thrix cornmunicsat:ion :.r :5ut,,'.Aa tc.ir is p?tc?hitaited, if you havo r o—c--lived th k, cotYarna,mir,; aRfon in 00,05'. 011rf..acfieatcly reply to thea author +ria c?...rr?iai{ that you 1'coolved thic; t+y ttli,'a41 w and alr;;0 p alYY1W'Wr+tly de low !at(:; 00'( nol Fuld. i it oopioF+ of th1`i paa't11i( and any aRfW11,11c,111 f, f101'1'1 Y011' r,:�stt'rtacatr;l'. Please note thirlt <'I:>vt:?rage. csann,,t. S:1e;; t?osand of Altrarod fly se,rle:I ng an Yc! u mu"A ""psafe N- 7dh or ic:r:oive vii R.tean fuc,r firrnatir>ca f -OM is liven; =,d n*,pl n,elll abvo nP oc.ar firm lu put. covt-m-a ;Ica in forc':c or make chon;)esto your oxisfinl) 1:nogiwn. Thank you.