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HomeMy Public PortalAboutTAG Grinding Certificate of Liability Ins. 2021Client#: 643718 TAGGRINDI ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE 3/2020 (MMIDD/YYYY) 910(MM/DD 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh & McLennan Agency LLC P. O. Box 71429 47 Postal Parkway Newnan, GA 30271-1429 CONTACT NAME: Amber Zell PHONE 770-683-1000 FAX 770-683-1010 (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: azell@jsmithlanier.com INSURER(S) AFFORDING COVERAGE NAIC N an Everest Denali Insurance Company INSURER A : P Y 16044 INSURED TAG Grinding Services, Inc. 1750 Powder Springs Rd. #190-171 Marietta, GA 30064 INSURER B : Stonewood Insurance Company 11828 Evanston Insurance Company INSURER C : P Y 35378 Federal Insurance Com an INSURER D : P Y 20281 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF /Y (MMIDDYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X CF3GL00194191 09/25/2019 09/25/2020 EACH $1,000,000 �ES {OCCURRENCE PREMISEa occurrrence) $100,000 CLAIMS -MADE Xj OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PRO - JECT PER: LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIREDNON-OWNED AUTOS ONLY X v SCHEDULED AUTOS AUTOS ONLY X X CF3CA00171191 09/25/2019 09/25/2020 (Ea COMBIaccideNEDnt)SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ 09/25/2019 09/25/2020 EACH OCCURRENCE $1,000,000 A x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XC5EX00820191 AGGREGATE $1,000,000 $ DED RETENT ON $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A X WC10000870292020A I 09/11/2020 09/11/2021 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C D Pollution/Prof CL Equipment MMAENV001972 6711154 07/27/2020 07/27/2020 07/27/2021 07/27/2021 $1 Mil/$2 Mil $5K ded $750K/ $5K deductible ($500K max per item) DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL) Additional Insured applies per Form CG20330413. (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) CERTIFICATE HOLDER CANCELLATION 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 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 1 of 2 #56385792/M6383806 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JJSXT Client#: 643718 TAGGRIND1 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/28/2020 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh & McLennan Agency LLC P. O. Box 71429 47 Postal Parkway Newnan, GA 30271-1429 INSURED CNAME:ONTACT Amber Zell PHONE(A/C,No, Ext): 770-683-1000 E-MAIL ADDRESS: azell@jsmithlanier.com INSURER(S) AFFORDING COVERAGE INSURER A : Everest Denali Insurance Company FAX (A/C, No): 770-683-1010 NAIC # 16044 TAG Grinding Services, Inc. 1750 Powder Springs Rd. #190-171 Marietta, GA 30064 INSURER B : Evanston Insurance Company 35378 INSURER C : Federal Insurance Company 20281 INSURER D : Stonewood Insurance Company 11828 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. R INTYPE LTRLIMITS OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) 09/25/2020 09/25/2021 EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY X X CF3GL00194201 PREMISES (Ea RENTED $100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PRO - JECT PER: LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO X X SCHEDTOSULED AU NON -OWNED AUTOS ONLY X X CF3CA00171201 09/25/2020 09/25/2021 (Ea acBcideDt, INGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XC5EX00820201 09/25/2020 09/25/2021 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ DED RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X WC10000870292020A 09/11/2020 09/11/2021 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 B C Pollution/Prof CL Equipment MMAENV001972 6711154 07/27/2020 07/27/2020 07/27/2021 07/27/2021 $1 Mil/$2 Mil $5K ded $750K/ $5K deductible ($500K max per item) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL) Additional Insured applies per Form CG20330413. (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) CERTIFICATE HOLDER CANCELLATION Town of Gulf Stream 100 Sea Road Gulf Stream, FL 33482-0000 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 ACORD 25 (2016/03) 1 of 2 #S6459668/M6454267 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JJSXT