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CERTIFICATE OF LIABILITY INSURANCE
<br />F DATE
<br />07/01/2020YY)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER 1-414-443-0000
<br />Hays Companies
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />A/C No Ext : A/C, No :
<br />E-MAIL
<br />1200 North Mayfair Road, Suite 100
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: GREAT AMER E&S INS CO
<br />37532
<br />Milwaukee, WI 53226
<br />INSURED
<br />INSURERB: TRAVELERS PROP CAS CO OF AMER
<br />25674
<br />REV Ambulance Group Orlando, Inc.
<br />d/b/a Wheeled Coach Industries
<br />INSURERC: AXIS SURPLUS INS CO
<br />26620
<br />2737 N. Forsyth Road
<br />INSURER D:
<br />INSURER E :
<br />INSURER F:
<br />Winter Park, FL 32792
<br />COVERAGES CERTIFICATE NUMBER: 59713969 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />PL 3403401
<br />07/01/20
<br />07/01/21
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />F__�
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RETE
<br />PREMISES Ea occur ence
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICYEl JECT LOC
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />TC2J-CAP-9P529106-TIL-20
<br />07/01/20
<br />07/01/21
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$
<br />2,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />L
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />P-001-000123735-02
<br />07/01/20
<br />07/01/21
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />B
<br />AND EMPSYERS'LSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory In NH)
<br />N I A
<br />UB-6P677889-20-51-K (AOS)07/O1/20
<br />UB-5P807980-20-51-RAZ,MA,6I/01/20
<br />07/01/21
<br />07/01/21
<br />X STATUTE ERH
<br />E,L,EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Garagekeepers
<br />TJ-BAP-9P529118-TIL-20
<br />07/01/20
<br />07/01/21
<br />Limit
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The Automobile Liability policy for the State of Florida includes personal injury protection (PIP) in the amount of
<br />$10,000 aggregate limit per person. 16 Dealer plates are provided under this coverage.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Department of Highway Safety
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />and Motor Vehicles
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Neil Kirkman Building MS-65
<br />Room A312
<br />AUTHORIZED REPRESENTATIVE
<br />Tallahassee, FL 32399
<br />USA
<br />w�
<br />ACORD 25 (2016/03)
<br />npielmeier
<br />59713969
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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