DATE (MM/DD/YYYY)
2/2/2021
CERTIFICATE OF LIABILITY INSURANCE
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER USI Southwest 9811 Katy Freeway, Suite 500 Houston TX 77024 CONTACT NAME: Shelly Brandman/Michelle Weweh
PHONE (A/C, No, Ext): 713-490-4600 FAX (A/C, No):
EMAIL ADDRESS: shelly.brandman@usi.com
INSURED PIERCGOO Pierce Goodwin Alexander & Linville, Inc. PGAL, Inc.; PGAL, LLC 3131 Briarpark Drive, Suite 200 Houston TX 77042 INSURER B : Valley Forge Insurance Company 20508
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Continental Insurance Company 35289
INSURER c : Berkley Insurance Company 32603
INSURER D : Transportation Insurance Company 20494
INSURER E : Continental Casualty Company 20443
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1597009478 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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.
INSUR LTR TYPE OF INSURANCE ADD/SUBR INSID WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS
E X COMMERCIAL GENERAL LIABILITY 6043241358 8/12/2020 8/12/2021 EACH OCCURRENCE $1,000,000
☐ CLAIMS-MADE ☒ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000
MED EXP (Any one person) $15,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY X PROJECT X LOC PRODUCTS - COMP/OP AGG $2,000,000
OTHER: $ $
A AUTOMOBILE LIABILITY 6043241330 8/12/2020 8/12/2021 COMBINED SINGLE LIMIT (Ea accident) $1,000,000
ANY AUTO BODILY INJURY (Per person) $
OWNED OWNED AUTO ONLY SCHEDULED AUTO NON-OWNED BODILY INJURY (Per accident) $
A X UMBRELLA LIAB X OCCUR 6043241361 8/12/2020 8/12/2021 EACH OCCURRENCE $14,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $14,000,000
DED X RETENTION $ 10,000 $
PER PER N / A E.L. DISEASE - EA EMPLOYEE $1,000,000
X HURE AUTO ONLY X PROPERTY DAMAGE (Per accident) $
B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 643241344 8/12/2020 8/12/2021 X PER STATUTE OTHER
PER PER N / A E.L. EACH ACCIDENT $1,000,000
PER PER N / A E.L. DISEASE - POLICY LIMIT $1,000,000
C Professional Liability Work Comp - CA AEC903876906 8/12/2020 8/12/2021 $5,000,000 $5,000,000 See Description Per Claim Anni Aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Job Name: Sarasota ConRAC
Job #: 1005297
California Workers Compensation:
Each Accident Limit: $1,000,000
Policy Limit: $1,000,000
Each Employee Limit: $1,000,000
All policies listed (except for Work Comp and Professional Liab) include an automatic Additional Insured See Attached...
CERTIFICATE HOLDER CANCELLATION
Sarasota Manatee Airport Authority 6000 Airport Circle Sarasota FL 34243 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