J. Raymond Construction - Washington Prime

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

06/27/2018

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). 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.

NAME: CONTACT

Julie Kwack

PRODUCER

(A/C, No): FAX

E-MAIL ADDRESS: (A/C, No, Ext): PHONE

Brown & Brown of Florida, Inc. 2290 Lucien Way Suite 400 Maitland

(407) 660-8282

(407) 660-2012

jkwack@bborlando.com

INSURER(S) AFFORDING COVERAGE

NAIC #

FL 32751

American Insurance Co. Amerisure Mutual Insurance Co Travelers Cas & Sur Co of Am. Travelers Prop Cas Co of Amer

INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A :

23396

INSURED

J. Raymond Construction Corp. 465 West Warren Avenue

25674

Longwood

FL 32750

CL1862715537

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.

ADDL INSD

SUBR WVD

LTR INSR

(MM/DD/YYYY) POLICY EFF

(MM/DD/YYYY) POLICY EXP

TYPE OF INSURANCE

LIMITS

POLICY NUMBER

1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000

COMMERCIAL GENERAL LIABILITY

MED EXP (Any one person) PREMISES (Ea occurrence) EACH OCCURRENCE DAMAGE TO RENTED

$

CLAIMS-MADE

OCCUR

$

Contractual Liability per GL Form

$

A

GL20118151701

07/01/2018 07/01/2019

PERSONAL & ADV INJURY

$

GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC

GENERAL AGGREGATE

$

PRODUCTS - COMP/OP AGG

$ $ $ $ $ $

OTHER:

COMBINED SINGLE LIMIT

1,000,000

OWNED ANY AUTO AUTOMOBILE LIABILITY

(Ea accident)

PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person)

AUTOS ONLY AUTOS NON-OWNED SCHEDULED

B

CA20013891602

07/01/2018 07/01/2019

AUTOS ONLY HIRED AUTOS ONLY

(Per accident)

$

15,000,000 15,000,000

EXCESS LIAB UMBRELLA LIAB

OCCUR CLAIMS-MADE

EACH OCCURRENCE

$

C

ZUP-51M63343-18-NF

07/01/2018 07/01/2019

AGGREGATE

$

0

DED

RETENTION $

$

E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER

Leased or Rented Equipment Valuation - Legal Liability up to RC WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE

Y / N

1,000,000 1,000,000 1,000,000 $350,000 $350,000

$ $ $

B

N

WC20221681402

07/01/2018 07/01/2019

N / A

Any One Item

D

QT-660-5G037350-TIL-18

07/01/2018 07/01/2019

Max Amount of Payment

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

*FOR INFORMATIONAL PURPOSES ONLY*

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.

J. Raymond Construction Corp. *FOR INFORMATION ONLY* 464 West Warren Avenue

AUTHORIZED REPRESENTATIVE

Longwood

FL 32750

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ACORD 25 (2016/03)

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