HomeMy Public PortalAboutTAG Grinding Certificate of Liability Ins. 2020Jul 29 2020 15:34:03 -> J Smith Lanier Page 003
Client#: 67108 50TAGGR I N D IN
UA TR (MMIDDIVYYV)
Ari'll2n r_�RTIFIreTF nF LIABILITY INSURANCE incl A7
THIS CERTIFICATE 1S 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,
is ADDITIONAL INSURED, the pollcypesj must have ADDITIONAL INSURED provisiontis or be endorsed,
IMPORTANT: If the certificate holder an
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
J Smith Lanier & Co Newnan
_NAME Amber Zell _
FAx .._...._ _. _....
LA,,. 6 ex9.770-083_1000 (LA/C hqj 770 83-1010
P. O. Box 71429
DpE-RF azoll�jsmithlamor.com
47 Postal Parkway
INSURER(61 AFPORUING COVERAGE
Newnan, GA 30271-1429
--_
NsuRERA:EverestDenali Insurance Company 16044
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--- ---- -- —
INSUNER a: Stonewood insurance Company 31925
TAG Grinding Services, Inc,
INSURE RC: Evanston Insurance Company 35378
1750 Powder Springs Rd. #190-171
Federal Insurance 20281
Marietta, GA 30064
INSURER E.
N6UFIER F
GOVLKAU=1
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
LTRR
Of
A
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IS TO CERTIFY THAT THE POLICIES OF INSURANCE
NOTWITHSTANOINO ANY REQUIREMENT.
MAY BE ISSUED OR MAY PERTAIN,
AND CONDITIONS OF SUCH POLICIES,
- ', 18V
TYPEOFINSURANCE tlSR
COMMERCIAL GENERAL LIABILITY X
_...I C:I.nIMS.MAUE. X(OC;GUR
-....:
THE
WvQ.
NfYO.
X
LISTED BELOW HAVE BEEN
TERM OR CONDITION OF ANY
INSURANCE AFFORDED BY THE
LIMITS SHOWN MAY HAVE BEEN
-- ----__
lULICV NUMBER
CF3GL00194191
ISSUED TO THE
CONTRACTOR
POLICIES
REDUCED BY
POL GV Eppi�)
SM I IYYVY
9125/2019
INSURED
OTHER DOCUMENT
DESCRIBED HEREIN
PAID CLAIMS.
POI.ICV EXPI
{MMI 1YY_Y
091251202
NAMED ABOVE FOR THE
WITH RESPECT
IS SUBJECT TO ALL
LIMITS
EACH OCCURRCNC'C
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,f7HCN11g�C_RAaurron
MLD EXN (w7 r I1 Lmrwml
POLICY PERIOD
TO WHICH THIS
THE TERMS.
_ _
x 1,000,000
x5 000 _._.__
$ 1,000,000
PERSONAL & ADV INJURY
OEIV'L A(GRF.GATR UK AP -LIES PER
C ENEHAL A(; t. RF GATT -_
42i000iOOO._.... .....
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x21000,000
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X
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CF3CA00171191
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9125/2019
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09125/202
COMDINCD SINGIE LIMIT
elaculln]—
S1,000,000
—
BODILY INJURY (Pe Rema)
x
ANYAUf U '.,
DVJNC'(J 'I IC ()tll FD
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SODILY IN JURY (f N I)
_... ._.......... ._.._....__.___.......
R
AUTO ONLY AlJ17s
---NIRED NON WNOI
X X O
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tl er UcclUe 7[j ,,,
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AUfpS ONLY AIDOS ONLY
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X uMeJELLALIA® X oLLUN
X
EXCESS LIAR OLAIMSMADE
.....__...... _.... __......... ____...._. .................
XC5EX00820191
....._ ___.
9/25/201909125!202
.... _ ___._.._
LAC11oc.cuRRLNVC
A(f WI A7
x1,000000. -
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09/11/202
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B
WORN ERSCDMPF,NSATION
X
67029
9111!2019
1 IER�
AND EMPLOYERS' LIABILITYACiDrNT
ANY PRC)MIE.T'OIVPATiTNFR/LXF:C:LITIVL V 1N
01-FiCER/MEMBER E%( Jt IDETJT ( N I. N/A
CC CAGHC
., ,..._
FL_OI[".rA GMPL 0Y1-
$1,000,000
x12000
IMandaterym NH)
If ye' (le crino u)nl r
F t DI EAS' f UL IC Y 1 1M f
LOOO
x 1 000 000
..E ...
DF'.�RII IIUhL UI ENATION bH4
MMAENV001972
,.,,...._.....................__..
7127/2020
0712712021
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$1 Mil/$2 Mil S5K dad
....t....
C
D
Pollution/Prof
RentedlLeased ECIP
6711154
7/2712020
07127/2021
$750K1 $5K deductible
$500K max per item
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101. Adaiuonal Remorks Senoaula, may De Rnaened It mom space M Mqulma)
GL) Additional Insured applies per Form CO20330413.
(GL) Additional Insured in regards to Completed Operations applies per Form CG20370413.
(GL) Primary & Noncontributory applies per Form CG20010413.
(GL) Waiver of Subrogation applies per Form CG24040509.
(CAU) Additional Insured applies per Form CA20481013.
(See Attached Descriptions)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Gulf Stream THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Rita Taylor ACCORDANCE WITH THE POLICY PROVISIONS,
100 Sea Road
Gulf Stream, FL 33483-0000 AUTHORIZED REPRESENTATIVE
anon Dc^0ATI^KI All rinhrc rPCPNP. d.
ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD SZT
#S4992013/M4991285