Certificates of Insurance
PRODUCER
Serial # 506690
DATE (MM/DDNY)
07103/2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
REVISED
ACORD
H"
CERTIFICATE OF LIABILITY INSURANCE
Aon Risk Services, Inc, of New York
199 Water Street
New York, NY 10038
PHONE: 866-266-7475
FAX: 866-467-7847
I COM~ANY AMERICAN CASUALTY CO. OF READING PA (NAIC #20427)
COM;ANY XL INSURANCE AMERICA, INC. (NAIC #24554)
INSURED
PB AMERICAS, INC.
ONE PENN PLAZA
NEW YORK, NY 10119
COMPANY
C
I-~~~PANY
, D
TRANSPORTATION INSURANCE COMPANY (NAIC #20494)
COVERAGE$
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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y 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.
CO POLI~~-;FFECTIVE--~~L1CY EXPIR~~ON I
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDlYV) DATE (MM/DDIYY) LIMITS
A GENERAL LIABILITY GL 2077470945 11/01/2006 11/01/2007 IG~~~~AL~~GR~~~T~ $ 5,i)00,0I)0
X lCOMMERCIALGENERALUABIUTY GENERAL LIABILITY (A/S) PRODUCTS - COMP/OP AGG $ 5,000,000
C ___u____
':] CLAIMS MADE I xl OCCUR GL 2077470959 PERSONAL & ADV INJURY $ 1,000,000
,OWNER'S & CONTRACTOR'S PROT I GENERAL LIABILITY -STOP GAP EACH OCCURRENCE $ _1-'.~00,0~~
--
X BLANKET CONTRACTUAL L1AB.I~?-= ! FIRE DAMAGE (Anyone fire} $ 300,000
-----
MED EXP (Anyone person) '$ 5,000
A AUTOMOBILE LIABILITY BUA 2077469066 11/01/2006 11/01/2007 __~_ _ 2,000,000
)(--1, ANY AUTO COMBINED SINGLE LIMIT
COMMERCIAL AUTO L.. ------..-
8, ~~""~= BUA 2077469116 PO ,BODILY INJURY
SCHEDULED AUTOS AUTO PHYSICAL DAMAGE ~"P'~O')
__.__ .__m__._____ ___n_
HIRED AUTOS $500 OED COMP BODILY INJURY
$
NON-OWNED AUTOS $1,000 OED COLL : (Peraccidenl)
---...- --..-
-------- ---I $
GARAGE LIABILITY $
.=:J ANY AUTO --
OTHER THAN AUTO ONLY:
,. -----
I EACH ACCIDENT $
--., -- ---- \\/,; " ..
AGGREGATE $
B EXCESS LIABILITY USOOO07463L106A 11/01/2006 11/01/2007 EACH OCCURRENCE $ __ 1,000,000
f--- --
X UMBRELLA FORM IAGGREGATE $ 1 ,000,000.
OTHER THAN UMBRELLA FORM $
A WORKER'S COMPENSATION AND WC 2077470878 AOS 11/01/2006 11/01/2007
A I EMPLOYERS' LIABILITY WC 2077470900 CA ONLY 11/01/2006 11/01/2007 1,000,000
EL EACH ACCIDENT $
C THEPROPRIETORl _iJINCL WC 2077470914 RETRO (OR,VA,WI) 11/01/2006 11/01/2007 EL DISEASE - POLICY LIMIT $ 1,000,000
: PARTNERS/EXECUTIVE
OFFICERS ARE . EXCL : i EL DISEASE. EA EMPLOYEE $ 1,000,000
OTHER
DESCRIPTION OF OPERATlONS/LOCATlONSIVEHICLES/SPECIAL ITEMS
(PB #173668) CARD SOUND ROAD BRIDGES REHABILITATION, MONROE COUNTY, FL. EXCLUDING WORKERS COMPENSATION, MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS ARE INCLUDED AS AN ADDITIONAL INSURED WITH RESPECT TO LIABILITIES ARISING OUT OF PB'S
OPERATIONS. THIS INSURANCE IS PRIMARY AND NONCONTRIBUTORY TO ANY OTHER INSURANCE HELD BY THE ADDITIONAL INSURED. A
WAIVER OF SUBROGATION APPLIES IN FAVOR OF THE ADDITIONAL INSURED.
CERTlFlCATEHOLDER CANCa.1.A1'lON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~9_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
ATTN: DAVIS S. KOPPEL, P.E.
1100 SIMONTON STREET
KEY WEST, FL 33040
OF ANY KIND UPON THE COMPANY,
AUTHORfi~NCJ'~
ITS AGENTS OR REPRESENTATIVES.
(Ie: fiV\.~~
ACORD 25-8 (1195)
PARSON 2000 ?Fi'S FP~PARSONS LIABILITY 06-0TFPFi
10242936
C> ACORD CORPORATION 1988
Page 1
POLICY NUMBER: GL 2077470945 A/S COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
(if no entry appears above, information required to complete this
endorsement will be shown in the Declarations as applicable to this
endorsement. )
WHO IS AN INSURED (Section II) is amended to include as an insured
the person or organization shown in the Schedule, but only with
respect to liability arising out of "your work" for that insured by
or for you.
PB #173668
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984
Serial #: 506690
Page 2
ADDITIONAL INSURED
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO COVERAGE FORM
THE PROVISIONS AND EXCLUSIONS THAT APPLY TO LIABILITY COVERAGE ALSO APPLY TO
THIS ENDORSEMENT.
ANY PERSON OR ORGANIZATION THE NAMED INSURED IS OBLIGATED TO PROVIDE
INSURANCE WHERE REQUIRED BY A WRITTEN CONTRACT OR AGREEMENT.
IS AN INSURED, BUT ONLY WITH RESPECT TO LEGAL RESPONSIBIIL TY FOR ACTS OR
OMISSIONS OF A PERSON FOR WHOM L1ABIL TV COVERAGE IS AFFORDED UNDER THIS
POLICY.
THE ADDITIONAL INSURED IS NOT REQUIRED TO PAY FOR ANY PREMIUMS STATED IN THE
POLICY OR EARNED FROM THE POLICY. ANY RETURN PREMIUM AND ANY DIVIDEND, IF
APPLICABLE DECLARED BY US SHALL BE PAID TO YOU.
YOU ARE AUTHORIZED TO ACT FOR THE ADDITIONAL INSURED IN ALL MATTERS PERTAINING
TO THIS INSURANCE
THE ADDITIONAL INSURED WILL RETAIN ANY RIGHT OF RECOVERY AS A CLAIMANT UNDER
THIS POLICY.
ADDITIONAL INSURED:
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
PB #173668
This endorsement is part of your policy and takes effects on the effective date of your policy, unless another effective
date is shown below.
ENDT. NO.
POLICY NO.
Complete Only When This Endorsement is Not Prepared
with the POlicv Or is Not to be Effective with the Policv
ISSUED TO: EFFECTIVE
PB AMERICAS, INC. DATE OF THIS
ONE PENN PLAZA ENDORSEMENT
NEWYORK,NY 10119 11/1/06
Must Be Completed
1
BUA 2077469066
--""...",.."...."
f)'tJ/LU () ~
Counter Signature
Authorized Representative
AP2009US 02-06
Page 1 of 1
KTljmsfAdditionallnsured As Required by Wrillen Contractdoc