Insurance & LicenseACORU® CERTIFICATE OF LIABILITY INSURANCE
F7EIMMIDDfYYYY)
5/2019
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
CONTACT Denise Larson
NAME:
Brown & Brown of Florida, Inc.
?H cNr o Est : (386) 239-8864 AX Na : (386) 323-9122
P.O. Box 2412
E-MAIL diarson@bbdaytona.com
ADDRESS:
INSURER($) AFFORDING COVERAGE NAIC #
Daytona Beach FL 32115-2412
INSURERA: Atlantic Specialty Insurance Company 27154
INSURED
INSURER B
AVI Integrators, Inc. dba Security 101
INSURER C:
1520 N. Powerline Road
INSURER D:
INSURER E:
Pompano FL 33069
INSURER F:
=Wau1AQora1 .]- TJL�r iAaIurr A-i-�.
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
LTR
TYPE OF INSURANCE
ADUL
IVSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MMIDDIYYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F OCCUR
EACH OCCURRENCE $ 1,000,000
PREMISES Ea occurrence $ 1,000,000
MED EXP (Any one person) $ 10,000
PERSONAL &ADV INJURY $ 1,000,000
A
711016469
11/16/2019
11/16/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY I I PRO ❑
JECT LOC
ROTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS-COMP/OPAGG $ 2,000,000
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
X
ANY AUTO
BODILY INJURY (Per person) $
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
711016469
11/16/2019
11/16/2020
BODILY INJURY (Per acc)dent) $
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE $
Per accident
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE $ 4,000,000
A
EXCESS LIAB
CLAIMS -MADE
711016469
11/16/2019
11/16/2020
AGGREGATE $ 4,000,000
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
N / A
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
A
Tech E&O Coverage
Claims Made; Retro 11/16/18
760010504
11/16/2019
11/16/2020
Liability $1,000,000
Aggregate $1,000,000
Retention $10,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SEE NOTES FOR POLICY COVERAGE FORMS RE: LICENSE EG13000307 CITY OF OKEECHOBEE IS ADDITIONAL INSURED AND A WAIVER OF
SUBROGATION APPLIES AS REQUIRED BY WRITTEN CONTRACT.
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF OKEECHOBEE ACCORDANCE WITH THE POLICY PROVISIONS.
55 SE THIRD AVENUE I AUTHORIZED REPRESENTATIVE
OKEECHOBEE FL 34974
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
LOC #:
ACCOR& ADDITIONAL REMARKS SCHEDULE
Page of
AGENCY
Brown & Brown of Florida, Inc.
NAMED INSURED
AVI Integrators, Inc. dba Security 101
POLICY NUMBER
CARRIER
NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes
CURRENT BLANKET POLICY FORMS:
GENERAL LIABILITY
1) VCG 207 0709 - @VANTAGE FOR GENERAL LIABILITY TECHNOLOGY COMPANIES (ADDITIONAL INSURED - ONGOING OPERATIONS,
ADDITIONAL INSURED - LESSOR OF EQUIPMENT, ADDITIONAL INSURED - MANAGER OR LESSOR OF PREMISES, ADDITIONAL INSURED -
BROAD FORM VENDOR, WAIVER OF SUBROGATION)
2) CG2037 0413 -ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS (ADDITIONAL INSURED -
COMPLETED OPERATIONS)
3) CG2001 0413 - PRIMARYAND NONCONTRIBUTORY- OTHER INSURANCE CONDITION - (PRIMARY NONCONTRIBUTORY)
AUTO LIABILITY
1) VCA201 0109 - @VANTAGE FOR AUTOMOBILE (N/A SC) (ADDITIONAL INSURED, WAIVER OF SUBROGATION)
2) VCA219 0316 - PRIMARY AND NONCONTRIBUTORY OTHER INS CONDITION WHEN REQUIRED BY CONTRACT (PRIMARY
ACORD 101 (2006/01) @ 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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