AGREEMENT between BROWARD COUNTY and Cummings ...

Exhibit 1 – Sample Certificate of Insurance for Enrolled Contractors
Exhibit 2
Page 141 of 379
ACORD© CERTIFICATE OF INSURANCE ISSUE DATE: CURRENT DATE
PRODUCER
Insurance Agent’s Name
And Address
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW
TELEPHONE #
COMPANIES AFFORDING COVERAGE
INSURED COMPANY A INSURANCE CARRIER
LETTER
COMPANY
Subcontractor’s Name and Address and contract number B INSURANCE CARRIER
LETTER
Sample Certificate for Enrolled Contractors COMPANY C INSURANCE CARRIER
LETTER
Required Insurance
COMPANY D
LETTER
COVERAGES
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.
CO
LT
R
A
TYPE OF
INSURANCE
POLICY NO. POLICY EFF.
DATE
POLICY
EXP. DATE
MM/DD/YY MM/DD/YY
GENERAL LIABILITY
COMMERCIAL GEN.
LIABILITY
Policy Number
CLAIMS MADE OCCUR.
SPONSOR'S &
CONTRACTOR'S PROT.
PER PROJECT
AGGREGATE
ENDORSEMENT
ALL LIMITS
GENERAL AGGREGATE $2,000,000
PRODUCTS-COMP/OPS
$2,000,000
AGGREGATE
PERSONAL & ADVERTISING $1,000,000
INJURY
$1,000,000
EACH OCCURRENCE
FIRE DAMAGE (Any one fire) $
MEDICAL EXPENSE (Any one $
person)
A
B
A
C
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
EXCESS LIABILITY
UMBRELLA
OTHER THAN UMBRELLA
FORM
WORKER’S COMPENSATION
AND
EMPLOYER'S LIABILITY
OTHER:
Policy Number
Policy Number
Policy Number
Policy Number
COMBINED SINGLE LIMIT $1,000,000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
EACH OCCURRENCE
AGGREGATE
STATUTORY LIMITS FL
(Each accident) $1,000,000
(Disease-policy limit) $1,000,000
(Disease-each employee) $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS:
Broward County Board of Commissioners, its commissioners, officers, directors, agents, employees, related entities, authorized representatives, servants, and
assigns are Additional Insureds on a Primary and Non-Contributory basis for General Liability, Automobile Liability and Excess/Umbrella coverage. Waiver of
Subrogation in favor of Certificate Holder and all Contractors and Subcontractors applies to all policies. General Liability and Worker’s Compensation apply Off-
Site(s).
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE
Broward County Board of County Commissioners
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
c/o Aon Risk Services, Inc.
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
400 International Parkway, Suite 100
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Heathrow, Florida 32746
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
Attention: Diana Schrader REPRESENTATIVES.
Fax: 407.804.1077
AUTHORIZED REPRESENTATIVE
Email: Diana.Schrader@aon.com By: original signature
ACORD 25-S (3/93) © ACORD CORPORATION 1993