HomeMy Public PortalAboutGIRMA- COI- Exp 5-1-2020 CERTIFICATE HOLDER CANCELLATION
Amerigas
Attn: Shelly 5117 Augusta Rd.
Garden City, GA 31408
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21761 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage as respects dispensary - Gas ""Propane"" Campground.
CERTIFICATE HOLDER CANCELLATION
BB&T Governmental Finance
P.O. Box 261510
Miami, FL 33126
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21762 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY TY-3 5/1/2019 5/1/2020 $2,000,000 $2,500
EMPLOYEE BENEFIT LIABILITY TY-3 5/1/2019 5/1/2020 $2,000,000 $2,500
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of coverage with respects to Tosihba Ipledge Phone System.
BB&T Governmental Finance is named Loss Payee as their interest may appear.
CERTIFICATE HOLDER CANCELLATION
BB&T Governmental Finance
P.O. Box 261510
Miami, FL 33126
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21763 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
EACH OCCURRENCE $ $
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ $
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $ $
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $ $
LAW ENFORCEMENT LIABILITY $ $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ $
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED SELECTED
VEHICLES $
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of coverage as respects to Toshiba Ipledge Phone system UCC Financing Statement Filed 5.
BB&T Governmental Finance is named Loss Payee, as their interest may appear.
CERTIFICATE HOLDER CANCELLATION
Chatham Parkway Toyota
7 Park of Commerce Way
Savannah, GA 31405
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21764 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY TY-3 5/1/2019 5/1/2020 $2,000,000 $2,500
EMPLOYEE BENEFIT LIABILITY TY-3 5/1/2019 5/1/2020 $2,000,000 $2,500
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of coverage as respects 2011 Toyota Rav4Sport VIN #2T3WF4DVXBW080654 valued at $15,000.
CERTIFICATE HOLDER CANCELLATION
For Informational Purposes Only
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21765 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY TY-3 5/1/2019 5/1/2020 $2,000,000 $2,500
EMPLOYEE BENEFIT LIABILITY TY-3 5/1/2019 5/1/2020 $2,000,000 $2,500
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage
CERTIFICATE HOLDER CANCELLATION
H & E Equipment Services
Attn: Matt Martin & Lynn Williams
7500 Pecue Lane
Baton Rouge, LA 70809
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21766 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of coverage as it relates to Rented/Leased Equipment.
H & E Equipment Services is named Loss Payee as their interest may appear.
ID: 21766 COLL: 9254
Georgia Interlocal Risk Management Agency (GIRMA) is a self-insured pool for Georgia municipalities and authorities,
regulated by the Georgia Insurance Commissioner's Office, Official Code of Georgia Annotated 36-85-1 et seq. When a
city joins GIRMA, they enter into an intergovernmental contract with all other cities and authorities who are pool
members. Therefore, per the contract filed with the State of Georgia, Georgia Insurance Commissioner's Office, GIRMA
is unable to indemnify or name anyone other than a municipality or municipal authority as Additional Insured.
We hope that this information and coverage certificate will be adequate to satisfy your insurance requirements.
However, please do not hesitate to contact our office if you have any questions or require any additional
information after reviewing these materials.
CERTIFICATE HOLDER CANCELLATION
LEAF
c/o Insurance Service Center
P.O. Box 979127
Miami, FL 33197
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21767 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
EACH OCCURRENCE $ $
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ $
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $ $
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $ $
LAW ENFORCEMENT LIABILITY $ $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ $
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED SELECTED
VEHICLES $
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage as respects to Leased/Financed Equipment agreement #1002135156002, equipment. Value: $27,600 2
HP Systems.
LEAF, its successors and/or assigns are named as Loss Payee, as their interest may appear.
CERTIFICATE HOLDER CANCELLATION
LEAF Capital Funding, Its successors and/or assigns
Attn: Ins. Service Center P.O. Box 979127
Miami, FL 33197
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21768 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage as respects Samsung CLX-9352NA Color Copier Printer, SIN - Z94UB1ED500022N and KIP 7100 Color
Copy Print, Large Format, SIN - 12411937. Total Replacement Value $34,545.00. LEAF Capital Funding, Its successors
and/or assigns, is name
CERTIFICATE HOLDER CANCELLATION
Proof of Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21769 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of coverage with respects to 2014 Ford F550 VINL 1FDOW5HT2FEA41781, valued at $171,209.
CERTIFICATE HOLDER CANCELLATION
SunTrust Equipment Finance & Leasing Corp. its successors
and/or Assigns
P.O. Box 4418
Atlanta, GA 30302
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21770 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of coverage with respects to Agreement #09517 and Agreement #443-4009517-001 for 2014 Motor Grader Noram
65E, serial 65ET-9766; valued at $112,000 AND 2014 John Deere Backhoe 310SK: 1T0310SKKEE270072, valued at $76,400.
SunTrust Equipment Finance & Leasing Corp. its successors and/or assigns are named Loss Payee as their interest may
appear.
CERTIFICATE HOLDER CANCELLATION
SunTrust Equipment Finance & Leasing Corp. its successors
and/or Assigns
300 East Joppa Road, 7th Floor
Towson, Maryland 21286
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21771 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage with respects to 2014 Viper E911 System IWS-911; valued at $134,552.
CERTIFICATE HOLDER CANCELLATION
SunTrust Equipment Finance & Leasing Corp. its successors
and/or Assigns
211 Perimeter Center Parkway
Suite 100
Atlanta, GA 30346
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21772 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage with respects to Agreement #09517 and Agreement #443-4009517-001 for 2014 Motor Grader Noram
65E, serial 65ET-9766; valued at $112,000 and 2014 John Deere Backhoe 310SK; 1T0310SKKEE270072, valued at $76,400.
CERTIFICATE HOLDER CANCELLATION
Yancey Brothers Company
1465 E. Highway 80 Attn: Mike Ashdown
Pooler, GA 31322
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
By: Willis Insurance Services of GA, Inc.
DISCLAIMER
This Certificate of Coverage does not constitute a contract between the issuing insurer(s), authorized representative or administrator, and
the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
GMAwpp v6.11.10rm
CERTIFICATE OF COVERAGE
ISSUE DATE
5/1/2019
ADMINISTRATOR: 404-224-5000 FAX 404-224-5001 meghan.murray@willis.com THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Willis Insurance Services of GA, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Concourse Corporate Center Five CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
18th Floor AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30328 Company Affording Coverage
NAMED MEMBER
City of Tybee Island COMPANY A: Georgia Interlocal Risk Management Agency (GIRMA)
403 Butler Avenue
PO Box 2749 COMPANY B:
Tybee Island, GA 31328
ID: 21773 COLL: 9254
THIS IS TO CERTIFY THAT THE COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE AGR EEMENT 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH
AGREEMENT. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS
DEDUCTIBLE
GENERAL LIABILITY
TY-3 5/1/2019 5/1/2020
EACH OCCURRENCE $2,000,000 $2,500
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $2,000,000 $2,500
X OCCURRENCE MED EXP (Any one person) EXCLUDED
X GEN’L AGGREGATE LIMIT APPLIES per POLICY PERSONAL & ADV INJURY $2,000,000 $2,500
GENERAL AGGREGATE UNLIMITED
PRODUCTS-COMP/OP AGG $10,000,000 $2,500
LAW ENFORCEMENT LIABILITY $2,000,000 $2,500
AUTOMOBILE LIABILITY
TY-3 5/1/2019 5/1/2020
COMBINED SINGLE LIMIT $2,000,000 $2,500
X ALL AUTOS BODILY INJURY (per person) $ $
X GEORGIA FLEET BODILY INJURY (per accident) $ $
X HIRED AND NON-OWNED PROPERTY DAMAGE (per accident) $ $
AUTOMOBILE PHYSICAL DAMAGE
TY-3 5/1/2019 5/1/2020
ALL VEHICLES $ NO COVERAGE
NO VEHICLES OWNED X SELECTED
VEHICLES $2,500
PUBLIC OFFICIALS LIABILITY $ $
EMPLOYEE BENEFIT LIABILITY $ $
CRIME
TY-3 5/1/2019 5/1/2020
X BLANKET BOND $500,000 $2,500
X DEPOSITORS FORGERY
$500,000 $2,500
X MONEY & SECURITIES $500,000 $2,500
PROPERTY
TY-3 5/1/2019 5/1/2020
X BUILDINGS & CONTENTS, including EDP As per Schedule
with GIRMA $10,000
X MOBILE EQUIPMENT
Actual Cash
Value $10,000
X BOILER AND MACHINERY As per Schedule
with GIRMA $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage as respects leased/rented equipment. 2012 CAT ID:EM2011505, Serial: 0M9D00913, Model: 140M2,
Motorgrader 140 M with scarfier valued at $311,111. Certificate holder is named Loss Payee as their interest may
appear.