CONTRACTUAL INSURANCE REQUIREMENTS

The information contained herein is to describe the contractual requirements that ZZ [Inactive] GRYCON, LLC has indicated to myCOI. These contractual requirements should NOT be used to provide inaccurate information regarding current insurance policies. Questions regarding interpretation of this document can be directed to our support team at 317-759-9426.

INSURED

Builder Services Group, Inc. dba Santa Rosa Insulation & Fireproofing 130 NW 74 St. Miami, FL 33166

CARRIER REQUIREMENTS

A- or higher, X




POLICY LINE POLICY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS MADE DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000
X OCCUR MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY X PROJECT LOCATION $
AUTO LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $
X HIRED AUTOS
X NON-OWNED AUTOS
UMBRELLA /EXCESS LIABILITY OCCUR EACH OCCURRENCE $ 5,000,000
Claims Made AGGREGATE $ 5,000,000
WORKERS COMP /EMPLOYEE LIABILITY X WC STATUTORY LIMITS OTHER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
Property Property Causes of Loss Deductibles Building $
Basic Building Personal Property $
Broad Contents Business Income $
Special Extra Expense $
Earthquake Rental Value $
Wind Blanket Building $
Flood Blanket Pers Prop $
Blanket BLDG & PP $
$
$
Boiler and Machine Boiler & Machinery /Equipment Break Down $
$

Certificate Holder


Grycon, LLC C/O: myCOI P.O. Box# 501970, 8710 Bash Street Indianapolis, IN 46256

ADDITIONAL REQUIREMENTS


Division Name: GRY21011 - Doral Atrium, Division Number: 1682843, Division Location: 3900 NW 79th Ave Doral, Florida 33166.
- Contract ID: 1682843 - 8624215.
- 30 Days Notice of Cancellation Required.

General Liability


- Must provide copies of the additional insured endorsement form for ongoing and completed operations (Utilizing CG 2010 11 85 or a combination of CG 2037 and CG 2010 or their equivalent) in addition to the certificate.
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- Must provide a copy of the Waiver of Subrogation Endorsement Form(s) in addition to the certificate.
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- Must include the project # and name on certificate:[Enter Project # and Name here]
- Waiver of Subrogation applies in favor of:GRYCON, LLC, Owner and their Representatives; Doral Atrium Retail Investments, LLC; FIRSTBANK PUERTO RICO; Doral Blvd Finance & Investment, LLC, a Florida limited liability company
- Please confirm on the certificate or by uploading endorsement(s) that Additional Insured applies to this policy.
- Additional Insured Names: GRYCON, LLC, Owner and their Representatives; Doral Atrium Retail Investments, LLC; FIRSTBANK PUERTO RICO; Doral Blvd Finance & Investment, LLC, a Florida limited liability company,
- Additional Insured applies to General Liability.
- Please confirm on the certificate or by uploading endorsement(s) that Waiver of Subrogation applies to this policy.
- Please confirm on the certificate or by uploading endorsement(s) that Primary & Non-Contributory applies to this policy.

Automobile Liability


- Must provide a copy of the Waiver of Subrogation Endorsement Form(s) in addition to the certificate.
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- Must include the project # and name on certificate:[Enter Project # and Name here]
- Waiver of Subrogation applies in favor of:GRYCON, LLC, Owner and their Representatives; Doral Atrium Retail Investments, LLC; FIRSTBANK PUERTO RICO; Doral Blvd Finance & Investment, LLC, a Florida limited liability company
- Please confirm on the certificate or by uploading endorsement(s) that Additional Insured applies to this policy.
- Additional Insured Names: GRYCON, LLC, Owner and their Representatives; Doral Atrium Retail Investments, LLC; FIRSTBANK PUERTO RICO; Doral Blvd Finance & Investment, LLC, a Florida limited liability company,
- Additional Insured applies to Automobile.
- Please confirm on the certificate or by uploading endorsement(s) that Waiver of Subrogation applies to this policy.

Umbrella Excess Liability


- Must include the project # and name on certificate:[Enter Project # and Name here]
- Please confirm on the certificate or by uploading endorsement(s) that Additional Insured applies to this policy.
- Additional Insured Names: GRYCON, LLC, Owner and their Representatives; Doral Atrium Retail Investments, LLC; FIRSTBANK PUERTO RICO; Doral Blvd Finance & Investment, LLC, a Florida limited liability company,
- Additional Insured applies to Umbrella.
- Please confirm on the certificate or by uploading endorsement(s) that Primary & Non-Contributory applies to this policy.

Workers Compensation


- Must provide a copy of the Waiver of Subrogation Endorsement Form(s) in addition to the certificate.
--
- Must include the project # and name on certificate:[Enter Project # and Name here]
- Waiver of Subrogation applies in favor of:GRYCON, LLC, Owner and their Representatives; Doral Atrium Retail Investments, LLC; FIRSTBANK PUERTO RICO; Doral Blvd Finance & Investment, LLC, a Florida limited liability company
- Please confirm that no proprietor/partner/executive/officer/member is excluded. If there are exclusions, please list them on the certificate and indicate whether any of these excluded parties visit the job sites.
- Please confirm on the certificate or by uploading endorsement(s) that Waiver of Subrogation applies to this policy.
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