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19-22053
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19-22053
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Last modified
2/18/2021 11:04:08 AM
Creation date
2/17/2021 11:30:49 AM
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Building Department
Company Name
HIDDEN RIVER
Building Department - Doc Type
Permit
Permit #
19-22053
Building Department - Name
FUENTES,GAMALISA & RAFAEL
Address
3208 KRESTERBROOKE LN
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bESCRIPTIONS (Continued from Page 1) <br /> Per Project Aggregate status is granted as respects to General Liability as per"Architects,Engineers and <br /> Surveyors General Liability Extension Endorsement"Form#CNA74858 01115. <br /> Contractual Liability as respects to General Liability as per Commercial General Liability Coverage Form <br /> form#CG0001 04113. <br /> *Additional Insured status is granted with respects to Automobile Liability policy on a primary basis with <br /> regard to the operations of the named insured if required by written contract per endorsement"Business <br /> Auto Coverage Form"form#CA0001 10113. <br /> *Waiver of Subrogation status is granted with respects to General Liability if required by written contract <br /> per"Architects,Engineers and Surveyors General Liability Extension Endorsement'Form#CNA74858 01/15. <br /> *Waiver of Subrogation status is granted with respects to Workers Compensation if required by written <br /> contract per Waiver of Our Rights to Recover from Others Endorsement,form#WC000313. <br /> *Waiver of Subrogation status is granted with respects to Automobile Liability if required by written <br /> contract per"Business Auto Coverage Form"form#CA0001 10/13. <br /> With regard to General Liability,when required by written contract,30 Days Notice of Cancellation <br /> applies per form"Changes-Notice of Cancellation or Material Restriction Endorsement'form#CNA74702 01115. <br /> With regard to Automobile,when required by written contract,30 Days Notice of Cancellation applies per <br /> form"Notice of Cancellation or Material Change-Designated Person or Organization"form#CNA72315 02/13. <br /> With regard to Workers Compensation,when required by written contract,30 Days Notice of Cancellation <br /> applies per form"Notice of Cancellation or Material Change Endorsement'form#CNA87380 11/16. <br /> Excess policies follow form of the underlying policies. <br /> EXCESS LIABILITY COVERAGES: <br /> Excess Liability Policy over General Liability: <br /> National Surety Corporation(NAIC#21881) <br /> Policy#SSE58214255 <br /> Policy term 1-1-2019 to 1.1-2020 <br /> Provides an additional$9,000,000 per Occurrence,$9,000,000 per Aggregate,excess liability layer above <br /> the underlying$1,000,000 occurrence liability limits/$2,000,000 aggregate liability limit provided by <br /> primary General Liability policy with Travelers Indemnity Company of America,policy#P6603G518961TIA18. <br /> Excess Liability Policy over Auto Liability: <br /> Endurance Assurance Corporation(NAIC#11551) <br /> Policy#EXC30000530701 <br /> Policy term 1-1-2019 to 1-1-2020 <br /> Provides an additional$1,000,000 excess automobile liability layer above the underlying$1,000,000 <br /> liability limits provided by primary automobile policy with National Fire Insurance of Hartford <br /> #6076841120. <br /> (Aggregate Limit where applicable.) <br /> Excess Liability Policy over Auto Liability: <br /> Landmark American Insurance Company(NAIC#33138) <br /> Policy#LHA085007 <br /> Policy term 1-1-2019 to 1-1-2020 <br /> SAGITTA 25.3(2016103) 2 of 3 <br /> #S22722824/M22586184 <br />
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