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HomeMy WebLinkAboutFolio 2024-2026 Permit - CR 5698 CR 5698 - 9/24/2024 1" fl 0 1• ' ti , :ohs CI7o m o o Dv tn —I rr c I n 3 0 m < 111 CD 0 O O Z Z 3 0 o y_ -v < Om --1 ,rt r— V! z 70 0 C < IT' m 7C7 Oz n n oj v o ( :2 r m • to C O O 'fi' ` , U - zFi Q — m D v) c G) `, � i3D _i z cn —1 FA 5.• C 0D a m - OCtom= ' ' 7) -o o ; ; _ ' m > 0m o 0 p £ ill7/ I N Z n (13 ,... .� r Ii;° Z 0 -P eL tn , r D r— �0 n n f1 v E - I �' oar-- -NZ A hill: 79 m m mm cp o N <cp D Z 07 70 c) �,. = v 73 G) n. m C CD n iv 1 `° O (:)Nom i C7-71 co —'S ACC REP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/3/2024 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 LON I At.I NAME: Certificate Department PHONE 855-499-3861 FAX Evo Insurance LLC (A/C,No,Ext): (A/C,No): 855-509-3861 14800 Quorum Dr Ste 261 ADD DREDRE SS:A certificates@evoinsurance9 p•rou com INSURER(S)AFFORDING COVERAGE NAIC Dallas TX 75254 INSURER A: Obsidian Specialty Insurance Company 16871 INSURED INSURER B: Complete Roofing and Remodeling Services Inc INSURER C: 2413 SW 42nd Ave INSURER D: INSURER E: Fort Lauderdale FL 33317-6943 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. INSR AUUL bUIiN POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR UAMAGE IU HEN I EL) PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A Y SCB-GL-000065329 8/30/2024 8/30/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JE T LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABIUTY COMBINEU SINGLE LIMI I $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPER rY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0 rH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Roofing:0001332894 General Contractor:CGC1530845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Dania Beach Building Department 100 W Dania Beach Blvd AUTHORIZED`� REPRESENTATIVE Dania Beach FL 33004-3643 jV' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD