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HomeMy WebLinkAboutFolio 2024-2026 Permit - CR 5739 CR 5739 - 9/24/2024 1 j 3•.-ice.•. a • . , _ 0• a -r"t�uP1' v x 7 m 71 'CI N D AV___TrD° cr co rp (A < O .I . c\.),"\----.) o '* ai 7 c < x -0 Z n 0, c o •` D m ' o Z > , ,.�' i? O z 0 to non to •-a n . 1 , Z N rm r..r Z1 v !D o retr - m O : m -< o m ' y,. , _ — m D m D C o0O " �ji -0 O C N m m a, •• -1 3 O �, + rr, C > 0 o o 0 v m m C Z ,ill' m N Z �1 3 3 D n ,I 03 m 70 v D r.) < C n ',t. .� -I 0 "'� +Ilia m Z '0 0 ,"' p ,_ 'r1 3 O a � � 70 -.1 ' w CO —Iz D `' i I 2 m m m y `° o ai 0 o 3 1 0 Z 0 D =• 3 c 0 r- r ,_ , D to to rn 3 O. n D ° 0 Z o > c c. -1Z O r v� m m 70 c) "' m N 70 0 3 o m C N c 74 3 v 0 Z c:3-7 0. 4 . A�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/8/2023 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 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 CONTACT NAME: Frank H. Furman, Inc. PHONE (954)943-5050 FAX IA/C.No.Eat): (A/C,No): (954)942-6310 1314 East Atlantic Blvd. AE-MDREAIL SS: Lexietfurmaninsurance.com D P. O. Box 1927 INSURER(S)AFFORDING COVERAGE NAIC# Pompano Beach FL 33061 INSURERA:Summit Specialty Insurance Company 16889 INSURED INSURERB:Bridgefield Casualty Ins Co 10335 Pioneer Roofing Company, LLC; Pioneer Grant Street, LLC) INSURERC: Pioneer Roofing Holdings, LLC INSURER D: 2026 Grant Street INSURER E: Hollywood FL 33020 INSURER F: COVERAGES CERTIFICATE NUMBER:23-24 November 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. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/D D/YYYY) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY SCGL004000008900 11/13/2023 11/13/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- GENERAL AGGREGATE $ 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ -- ALL OWNED SCHEDULED AUTOS __ AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) $ A __ UMBRELLA LIAB X OCCUR SXC5004000002100 11/13/2023 11/13/2024 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ B WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY 196-56459 11/13/2023 11/13/2024 X PER QTH- YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? y N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCA/IONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) . EE Theft incl/Cyb - not on cert CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AOVE DESCRIBED BE CANCELL Dania Beach Building Department THE EXPIRATION DATE THE EOF,NOTICE WILLCIES BE DELIVERED INSD BEFORE 100 W Dania Beach Blvd ACCORDANCE WITH THE POLICY PROVISIONS. Dania Beach, FL 33004 AUTHORIZED REPRESENTATIVE I Tina Mangum/EF /.- /%4.7,., ACORD 25(2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INS025(2o1ao1)