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- Amos Jordan
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21 Bid #:4290DG Bid Name: Elevator Preventative Maintenance and Repair Service Vendor Name: Located in: Item # Qty. Manufacturer Location State ID Description Rise/Length Openings Emergency Elevator Phone Equipment Spee d Capacity * Preventative Maintenance Annual Cost 1 1 Schindler Carver Middle School 1200 N. Beecher St. - Leesburg, FL Elevator 2F/0R (352) Hydro Schindler Cecil E. Gray Middle School 205 E. Magnolia St.- Groveland, FL Elevator 2F/0R (352) Hydro Kone East Ridge High School Excalibur Rd - Clermont, FL Elevator 2F/0R (352) Hydro Thyssen East Ridge High School Excalibur Rd - Clermont, FL Elevator 2F/0R (352) Hydro Thyssen East Ridge Middle School Excalibur Rd - Clermont FL Elevator 3F/0R (352) Hydro Thyssen Eustis Heights Elem 250 W Atwater Eustis FL Elevator 2F/OR (352) Hydro Schindler Eustis High 1300 E. Washington Ave. - Eustis FL Elevator 2F/0R (352) Hydro Dover Eustis High 1300 E. Washington Ave. - Eustis FL Elevator 2F/0R (352) Hydro Wheel-o-Vator Eustis High Curtright Campus E. Bates Ave. - Eustis FL Chair Lift 2F/0R No Phone Wheelchair Wheel-o-Vator Eustis Middle School E. Bates Ave. - Eustis, FL Chair Lift 2F/0R No Phone Wheelchair Porch Lift Eustis Middle School E. Bates Ave. - Eustis, FL Chair Lift 2F/0R No Phone Wheelchair Schindler Eustis Middle School E. Bates Ave. - Eustis, FL Elevator 2F/0R (352) Hydro Schindler Grassy Lake Elementary 1100 Fosgate Rd. - Minneola, FL Elevator 2F/0R (352) Hydro Schindler Groveland Elementary 930 Parkwood St. - Groveland, FL Elevator 2F/0R (352) Hydro Thyssen Lake Minneola High School 101 North Hancock Rd. - Minneols, FL Elevator 2F/0R (352) Hydro
22 16 1 Porch Lift 17 1 Genesis 18 1 Genesis Harmar 19 1 Summit 20 1 Concord 21 1 Schindler 22 1 Schindler 23 1 Schindler 24 1 Schindler 25 1 Thyssen 26 1 Schindler 27 1 Schindler 28 1 Schindler 29 1 Schinder 30 1 Schindler 31 1 Thyssen 32 1 Schindler 33 1 Mowery Lake Minneola High School 101 North Hancock Rd. - Minneols, FL Chair Lift 2F/0R No Phone Wheel chair Lake Minneola High School 101 North Hancock Rd. - Minneols, FL Chair Lift 2F/0R No Phone Wheel chair Lake Minneola High School 101 North Hancock Rd. - Minneols, FL Chair Lift 2F/0R No Phone Wheel chair Lake County School bus Gararge Hwy Clermont, FL Chair Lift 2F/OR No Phone Wheel chair Learning Resource Center 510 South Palm Ave. - Howey-in-the-Hills, Fl Chair Lift 2F/0R (352) Wheel chair Leesburg High School 1401 Yellow Jacket Way - Leesburg, FL Elevator 2F/0R (352) Hydro Leesburg High School 1401 Yellow Jacket Way - Leesburg, FL Elevator 2F/0R (352) Hydro Lost Lake Elementary 1901 Johns Lake Rd. - Mascotte, FL Elevator 2F/0R (352) Hydro Mascotte Elementary 460 Midway Ave. Mascotte, FL Elevator 2F/0R (352) Hydro Minneola Elementary 300 Pearl St. Minneola, FL Elevator 2F/0R (352) Hydro Mount Dora High School 700 N. Highland Ave Mount Dora, FL Elevator 2F/0R (352) Hydro Mount Dora High School 700 N. Highland Ave Mount Dora, FL Elevator 2F/0R (352) Hydro Mount Dora Middle School 700 N. Highland Ave Mount Dora, FL Elevator 2F/0R (352) Hydro Mt Dora Middle School 1405 Lincoln Ave Mt Dora FL Elevator 2F/OR (352) Hydro Pine Ridge Elementary CR Clermont, FL Elevator 2F/0R (352) Hydro Sawgrass Bay Elementary Superior Blvd. - Clermont, FL Elevator 2F/0R (352) Hydro Sorrento Elementary Superior Blvd. - Clermont, FL Elevator 2F/0R (352) Hydro South Lake High School Silver Eagle Rd. - Groveland, FL Elevator 2F/0R (352) Hydro
23 34 1 Porch Lift 35 1 Schindler 36 1 Schindler 37 1 Schindler 38 1 Schindler 39 1 Genesis 40 1 Schindler 41 1 Schindler 42 1 Schindler South Lake High School Silver Eagle Rd. - Groveland, FL Chair Lift 2F/0R No Phone Wheelchair South Lake High School Silver Eagle Rd. - Groveland, FL Elevator 2F/0R (352) Hydro Tavares Elementary 720 E. Clifford St. Tavares, FL Elevator 2F/0R (352) Hydro Tavares High School 603 N. New Hampshire Ave Tavares, FL Elevator 2F/0R (352) Hydro Tavares High School 603 N. New Hampshire Ave Tavares, FL Elevator 2F/0R (352) Hydro Tavares High School 603 N. New Hampshire Ave Tavares, FL Chair Lift 2F/0R No Phone Wheelchair Tavares Middle School Lane Park Cut Off Tavares, FL Elevator 2F/0R (352) Hydro Triangle Elementary 1707 Eudora Rd Mount Dora, FL Elevator 2F/0R (352) Hydro Umatilla High School 320 N. Trowell Ave. Umatilla, FL Elevator 2F/0R (352) Hydro Replacement of required Decals/Signage as needed Unit Cost Yearly Preventative Maintenance Total 32, Description Item # Qty Hourly Rates & Materials Total Rate 44 8 *Hourly rate for services not included in the preventative quarterly maintenance during regular business hours , **Hourly rate for services not included in the preventative quarterly maintenance, after regular business hours, weekends or 45 8 holidays , Percentage discount off MSRP for OEM(original Equipment Manufacturer) parts. OEM and Non OEM parts will be reimbursed at invoice price after approval of Maitenance Department. Estimated quantity of (Entering percentage discount will calculate dollar amount.) 5% *Preventative Maintenance cost shall include the cost of third-party inspections. **Field Labor hourly rates will commence and end at the Lake County Schools, Tavares, Florida, or specified job site as needed. At the job site, the contractor shall check in and out at the school office. Hourly Rate & Materials Total Grand Total 3, ,875.00
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49 ACORDTM PRODUCER INSURED CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: PRODUCER CUSTOMER ID #: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : 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 ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) UMBRELLA LIAB EXCESS LIAB GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG PRO- POLICY JECT LOC AUTOMOBILE LIABILITY X X BA7E23026A 06/16/ /16/2017 COMBINED SINGLE LIMIT (Ea accident) X ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A (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 / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) DATE (MM/DD/YYYY) 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). Harmon Dennis Bradshaw, Inc P.O. Box Montgomery, AL C A B X X X INSURER(S) AFFORDING COVERAGE NAIC # CLAIMS-MADE OCCUR MED EXP (Any one person) NON-OWNED AUTOS CERTIFICATE OF LIABILITY INSURANCE Mowrey Elevator Co., Inc. Mowrey Elevator Company of Florida, Inc Lafayette St. Marianna, FL PERSONAL & ADV INJURY GENERAL AGGREGATE OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE DEDUCTIBLE X 0 Leased & Rented Equipment X Client#: /16/2016 Julie Faulkner FAX (A/C, No): jfaulkner@hdbinsurance.com MOWEL Navigators Specialty Insurance AGCS Marine Insurance Co. Travelers Property Cas. Co of A ,000,000 GA16EXC803428IC 04/01/ /01/2017 5,000,000 5,000,000 SML MOWEL 04/01/ /01/ ,000 Per Occurence 25,000 Per Item The School Board of Lake County Florida is named as Additional Insured on the Automobile Liability policy as their interest may appear in regard to work performed or services provided by the named insured for referenced project where required by written contract subject to the policy terms and conditions. CERTIFICATE HOLDER The School Board of Lake County Florida 201 West Burleigh Blvd. Tavares, FL 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) 1 of 1 #S357606/M Oc ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TJK
50 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/16/2016 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 Hub International NE 1 Bridge Pl N Ste 445 Fort Lee NJ INSURED Mowrey Elevator Company of Florida, Inc Lafayette Street Marianna FL 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 13UENOJ6191 4/1/2016 4/1/2017 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) 300,000 X DED/SIR 0 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : Melissa Mirijanian INSURER(S) AFFORDING COVERAGE MED EXP (Any one person) 10,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 4,000,000 PRODUCTS - COMP/OP AGG 4,000,000 Max Annual Agg 10,000,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) FAX (A/C, No): Hartford Underwriters Ins. Co NAIC # UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A EACH OCCURRENCE AGGREGATE PER STATUTE E.L. EACH ACCIDENT GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY X JECT LOC X OTHER: Contractual Liab OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER The School Board of Lake County, Florida 201 West Burleigh Boulvard Tavares FL 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
51 08/16/2016 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. PRODUCER Marks Insurance Agency, Inc Village Square Blvd Tallahassee, FL CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: Tammy Wise FAX (A/C, No): tammy@marksinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Bridgefield Employers Insurance Company INSURED Mowrey Elevator Company of Florida, Inc. DBA Mowrey Elevator Company Inc. INSURER B : INSURER C : Bridgefield Casualty INSURER D : 4518 Lafayette St INSURER E : Marianna, FL INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 707 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 (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE WORKERS COMPENSATION A /01/ /01/2017 MED EXP (Any one person) PERSONAL & ADV INJURY OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE DED RETENTION PER OTH- X AND EMPLOYERS' LIABILITY STATUTE ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT DATE (MM/DD/YYYY) 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). 1,000,000 1,000,000 1,000,000 B Work Comp /01/ /01/2017 Worker's Compensati 1,000,000 B Work Comp /01/ /01/2017 Worker's Compensati 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER The School Board of Lake County, Florida 201 West Burleigh Blvd. Tavares, FL 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) (TJW) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by TJW on August 16, 2016 at 03:37PM
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53 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/17/2017 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 Hub International NE 1 Bridge Pl N Ste 445 Fort Lee NJ INSURED TMOWREY-01/ Mowrey Elevator Company of Florida, Inc Lafayette Street Marianna FL 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GLP /1/2017 4/1/2018 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) 300,000 X Contractual Liab OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-OWNED AUTOS ONLY CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : Tracey Arnold INSURER(S) AFFORDING COVERAGE MED EXP (Any one person) 10,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 4,000,000 PRODUCTS - COMP/OP AGG 4,000,000 Max.Annual Agg 10,000,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) FAX (A/C, No): Great American Insurance Company NAIC # UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A EACH OCCURRENCE AGGREGATE PER STATUTE E.L. EACH ACCIDENT GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY X JECT LOC OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER The School Board of Lake County, Florida 201 West Burleigh Blvd Tavares FL 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
54 04/17/2017 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. PRODUCER Marks Insurance Agency, Inc Village Square Blvd Tallahassee, FL CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: Tammy Wise FAX (A/C, No): tammy@marksinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Bridgefield Employers Insurance Company INSURED Mowrey Elevator Company of Florida, Inc. DBA Mowrey Elevator Company, Inc. INSURER B : INSURER C : Bridgefield Casualty INSURER D : 4518 Lafayette St. INSURER E : Marianna, FL INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 838 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 (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE WORKERS COMPENSATION A /01/ /01/2018 MED EXP (Any one person) PERSONAL & ADV INJURY OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE DED RETENTION PER OTH- X AND EMPLOYERS' LIABILITY STATUTE ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT DATE (MM/DD/YYYY) 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). 1,000,000 1,000,000 1,000,000 B Work Comp /01/ /01/2018 Worker's Compensati 1,000,000 B Work Comp /01/ /01/2018 Worker's Compensati 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER The School Board of Lake County, Florida 201 West Burleigh Blvd. Tavares, FL 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) (TJW) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by TJW on April 17, 2017 at 03:22PM
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UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE DATE (MM/DD/YYYY) 11/7/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF I
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