shorofc-01 d2jtrad certificate of liability insurance · american bankers insurance company of...

ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?

INSR ADDL SUBRLTR INSD WVD

PRODUCER CONTACTNAME:

FAXPHONE(A/C, No):(A/C, No, Ext):

E-MAILADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBERPOLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY

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

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $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-STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)

$

$

$

$

$

The ACORD name and logo are registered marks of ACORD

D2JTRAD

01/22/2019

SHOROFC-01

BPPP744000305-PPP7451902

A

CWP9770461

CWDY-D587616-00

A

CWP9770461

D 41-LX-093863633-0

500,000

500,000

500,000

025,000,000

25,000,000

2,000,000

1,000,000

2,000,000

1,000

150,000

1,000,000

1,000,000

X

X

X

X

X

X X

XX

License # L077730

10/10/2018 05/15/2019

05/15/2018 05/15/2019

05/15/2018 05/15/2019

05/15/2018 05/15/2019

05/15/2018 05/15/2019

For Information Only

AssuredPartners, Lake Mary300 Colonial Center Parkway, Suite 270Lake Mary, FL 32746

(407) 982-4451

Shorewood Community Association, Inc.5505 N Atlantic Avenue #207Cocoa Beach, FL 32931

Shorewood Community Association, Inc.5505 N Atlantic Avenue #207Cocoa Beach, FL 32931

Westfield Insurance CompanyGreenwich Insurance CompanyMassachusetts Bay Insurance CoLexington Insurance Company

2411222322

1943722306

[email protected]

SEE REMARKSProperty

FORM NUMBER:

EFFECTIVE DATE:


ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

AssuredPartners, Lake Mary

SHOROFC-01

SEE PAGE 1

1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

License # L077730

1

SEE P 1

Shorewood Community Association, Inc.5505 N Atlantic Avenue #207Cocoa Beach, FL 32931Brevard

SEE PAGE 1

D2JTRAD

3

Additional Coverages:_____________________________________________________________________________________General Liability policy includes separation of insureds provision._____________________________________________________________________________________PROPERTY COVERAGE Insurer: Lexington Insurance Company Policy #: 41-LX-093863633-0Effective: 5/15/2018-5/15/2019

Location 1: 602 Shorewood Drive, Cape Canaveral, FL 32920 (24 Units)Building Limit: $5,978,479Contents Limit: $10,000







Location 8: 607 Shorewood Drive, Cape Canaveral, FL 32920 Clubhouse Building Limit: $335,386Clubhouse Contents Limit: $75,000

Location 9: Shorewood Drive, Cape Canaveral, FL 32920Guard House Limit: $21,483Guard House Contents Limit: $5,000Entry Gates (2) Limit: $13,888Swimming Pool Limit: $111,656Spa Limit: $14,100Lighting Limit: $24,304Tennis Courts (2) Limit: $47,368Pool Fencing Limit: $16,070Perimeter Fencing Limit: $53,816

FORM NUMBER:

EFFECTIVE DATE:


ADDITIONAL REMARKS


FORM TITLE:

Page of


ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:


POLICY NUMBER

CARRIER NAIC CODE



SHOROFC-01

SEE PAGE 1

2

SEE PAGE 1


License # L077730

1

SEE P 1


SEE PAGE 1

D2JTRAD

3

Gazebo Limit: $9,800Shuffleboard Courts (2) Limit: $6,500Boardwalk Limit: $25,000Fountains Limit: $23,000

Deductibles:$5,000 All Other Perils, Per Occurrence2% Hurricane, Per Building, Per Annual Aggregate Subject to $25,000 Minimum Per Occurrence$15,000 All Other Wind/Hail, Per Occurrence3% Sinkhole, Per Occurrence$5,000 Equipment Breakdown, Per Occurrence

Special Form Replacement Cost

Coinsurance: Agreed Amount

Sinkhole IncludedEquipment Breakdown Included

Ordinance or LawCoverage A: IncludedCoverage B&C Combined: $1,000,000

Walls-Out Coverage (No Coverage for Interior of Unit)____________________________________________________________________________________

CRIME COVERAGEInsurer: Hanover InsurancePolicy #: BDJ-D596655-00Effective: 5/15/2018-5/15/2019

Employee Theft Limit: $2,250,000 Deductible: $10,000Forgery or Alteration Limit: $2,250,000 Deductible: $10,000Computer Fraud Limit: $2,250,000 Deductible: $10,000Funds Transfer Fraud Limit: $2,250,000 Deductible: $10,000Funds Transfer Fraud – False Pretenses Limit: $25,000 Deductible: $5,000Investigative Expense Limit: $10,000 Deductible: $0

Property Manager Included as Employee_____________________________________________________________________________________

DIRECTORS & OFFICERSInsurer: Travelers Casualty & Surety Company of AmericaPolicy #: 106182526Effective: 10/10/2018-10/10/2019

Aggregate Limit: $1,000,000

FORM NUMBER:

EFFECTIVE DATE:


ADDITIONAL REMARKS


FORM TITLE:

Page of


ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:


POLICY NUMBER

CARRIER NAIC CODE



SHOROFC-01

SEE PAGE 1

3

SEE PAGE 1


License # L077730

1

SEE P 1


SEE PAGE 1

D2JTRAD

3

Retention: $1,000_____________________________________________________________________________________

25570058172018

American Bankers Insurance Company of FloridaAmerican Bankers Insurance Company of FloridaAmerican Bankers Insurance Company of FloridaScottsdale, AZ 85261-4337Scottsdale, AZ 85261-4337

Standard PolicyStandard Policy

These Declarations are effectiveas of: 06/01/2018 at 12:01 AM

Revised Declaration

For payment status, call: (800) 423-4403For payment status, call: (800) 423-440302/27/2018 To 02/27/201901/01/2000

RCBAP

ProduProducer Ncer Name aame and Mnd Mailinailing Addg Address:ress:ASSUREDPARTNERS OF FLORIDA, LLC300 COLONIAL CENTER PARKWAY, STE 270LAKE MARY, FL 32746

570058170210111

Agent/Agency #: 10464-00219-000Flood Service CenterP.O. Box 8695 Kalispell MT 59904-8695(407)440-1466

SHOREWOOD COMMUNITY ASSN INC5505 N ATLANTIC AVE STE 207COCOA BEACH, FL 32931-5116

601 SHOREWOOD DRCAPE CANAVERAL, FL 32920-5089

YInsured

Other ResidentialThree or More FloorsSlab On GradeHigh RiseMain HouseBLDG G

X12 5094 0363 G N/A

CAPE CANAVERAL, CITY OF NNo Includes Addition(s) and Extension(s)Includes Addition(s) and Extension(s)

Post-Firm ConstructionPost-Firm Construction $6,661,000Regular 24

DiscouDiscountnt6,000,000 1.290 / .071 1,250 13- 6,381.00 6,381.00

5.00

319.00

910.00

250.00

2,000.00.00

.00

9,227.00CoverCoverage Liage Limitatimitations Maons May Appy Apply. Sly. See Yoee Your Polur Policy Foicy Form form for Detr Details.ails.

American Bankers Insurance Company of Florida25570058172018 06/10/2018 ASULOG_AGT_MS_ _000000914563

jennica.mandarano

AssuredPartners

14160249532018




Renewal


RCBAP


141602495310111

Agent/Agency#: 10464-00219-000Flood Service CenterP.O. Box 8695 Kalispell MT 59904-8695(407)440-1466

SHOREWOOD COMMUNITY ASSN, INC5505 N ATLANTIC AVE STE 207COCOA BEACH, FL 32931-5116

604 SHOREWOOD DR BLDG BCAPE CANAVERAL, FL 32920-5085

NInsured

Other ResidentialThree or More FloorsBasementHigh RiseMain House

X12 5094 0363 G N/A

CAPE CANAVERAL, CITY OF NNo Includes Addition(s) and Extension(s)Includes Addition(s) and Extension(s)


DiscouDiscountnt6,000,000 1.580 / .096 1,250 13- 8,344.00 8,344.00

6.00

418.00

1,190.00

250.00

2,000.00.00

.00

11,372.00CoverCoverage Liage Limitatimitations Maons May Appy Apply. Sly. See Yoee Your Polur Policy Foicy Form form for Detr Details.ails.


jennica.mandarano

AssuredPartners

14160252032018




Renewal


RCBAP


141602520310111

Agent/Agency#: 10464-00219-000Flood Service CenterP.O. Box 8695 Kalispell MT 59904-8695(407)440-1466

SHOREWOOD COMMUNITY ASSNC/O KEYS PROPERTY MANAGEMENT C5505 N ATLANTIC AVE STE 207COCOA BEACH, FL 32931-5116

605 SHOREWOOD DRCAPE CANAVERAL, FL 32920-5088

NInsured

Other ResidentialThree or More FloorsElevated Without EnclosureHigh RiseMain HouseBUILDING E

AE12 5094 0363 G 2

CAPE CANAVERAL, CITY OF YNo Includes Addition(s) and Extension(s)Includes Addition(s) and Extension(s)


DiscouDiscountnt9,000,000 .550 / .046 1,250 13- 5,010.00 5,010.00

6.00

752.00

640.00

250.00

2,000.00.00

.00

7,154.00

THIS IS AN ELEVATED BUILDING. COVERAGE IS LIMITED BELOW THELOWEST ELEVATED FLOOR. SEE PROPERTY NOT COVERED IN STANDARDFLOOD INSURANCE POLICY.

CoverCoverage Liage Limitatimitations Maons May Appy Apply. Sly. See Yoee Your Polur Policy Foicy Form form for Detr Details.ails.


jennica.mandarano

AssuredPartners

14160204302018




Revised Declaration


RCBAP


141602043010111

Agent/Agency #: 10464-00219-000Flood Service CenterP.O. Box 8695 Kalispell MT 59904-8695(407)440-1466

SHOREWOOD COMMUNITY ASSN INC5505 N ATLANTIC AVE STE 207COCOA BEACH, FL 32931-5116

606 SHOREWOOD DR BLDG CCAPE CANAVERAL, FL 32920-5084

YInsured

Other ResidentialThree or More FloorsElevated Without EnclosureHigh RiseMain House

AE12 5094 0364 G 2

CAPE CANAVERAL, CITY OF YNo Includes Addition(s) and Extension(s)Includes Addition(s) and Extension(s)


DiscouDiscountnt8,000,000 .550 / .045 1,250 13- 4,471.00 4,471.00

5.00

671.00

571.00

250.00

2,000.00.00

.00

6,626.00

THIS IS AN ELEVATED BUILDING. COVERAGE IS LIMITED BELOW THELOWEST ELEVATED FLOOR. SEE PROPERTY NOT COVERED IN STANDARDFLOOD INSURANCE POLICY.

CoverCoverage Liage Limitatimitations Maons May Appy Apply. Sly. See Yoee Your Polur Policy Foicy Form form for Detr Details.ails.


jennica.mandarano

AssuredPartners

How to Request a Certificate of Insurance

The proceeding pages of this document include a generic certificate of insurance showing proof

of coverage. Should a lender require that the individual unit is listed on the certificate, please

provide the following information to our team via email at [email protected].

Name of the Association

Unit Owners Name(s)

Owners Address & Unit number (if applicable)

Loan Number

Mortgagee Clause that Includes the Name and Address of Bank

Please note that the expected turn around time is 24‐48 hours for the certificate to be issued.

Should you have any issues, please contact our team at [email protected] for

assistance.

shorofc-01 d2jtrad certificate of liability insurance · american bankers insurance company of...

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