Certificates of Insurance
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ACORD@ CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
~ 6/5/2009
PRODUCER (727)391-9791 FAX: (727)393-5623 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Stahl & Associates Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
110 Carillon Parkway AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Petersburg FL 33716 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Amerisure Insurance Co
Smith Industries, Inc. INSURERB:Amerisure Mutual Ins Co
DBA Smith Fence Company INSURERC:Great American Ins Co
4699 110th Ave N INSURER D:
Clearwa1:1er FL 33762 INSURER E:
COVERAGES
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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~: ~~~~ TYPE OF INSURANCE POLICY NUMBER C2f~~~~r66~1 b~~\frM~~b~WY~ LIMITS
GENERAL LIABILITY ~2CCURRENCE $ 1,000,000
-
X DAMAGE TO RENTED 100,000
COMMERCIAL GENERAL LIABILITY PREMISES lEa occurrence) $
A I CLAIMS MADE ~ OCCUR GL2062042 6/1/2009 6/1/2010 MED EXP (Anyone person) $ 10,000
X Blkt Waiver of Subro CG 70 49 applies PERSONAL & ADV INJURY $ 1,000,000
-
X Blkt Add Insureds CG 70 48 (inc. CG 20 10) ~~~GGREGATE $ 2,000,000
t-------
GEN'L AGGREGATE LIMIT APnS PER: Primary by Written Contr. PRODUCTS - COMP/OP AGG $ 2,000,000
n POLICY !Xl ~~8,: LOC 60 Day Notice to Cancel*
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
t------- $ 1,000,000
X ANY AUTO (Ea accident)
r-----
A ALL OWNED AUTOS ~062045 6/1/2009 6/1/2010 BODILY INJURY
f---- $
SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
60 Dav Notice to Cancel* (\ (Per accident)
GARAGE LIABILITY Yl~ ~tf AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS / UMBRELLA LIABILITY V/ l (. , EACH OCCURRENCE $ 5,000,000
~ OCCUR D CLAIMS MADE 'f AGGREGATE $ 5,000,000
Products CO Agg $ 5,000,000
B =1 DEDUCTIBLE CU2062043 6/1/2009 6/1/2010 BI By Disease Aqq $ 5 000 000
RETENTION $ None $
WORKERS COMPENSATION IlXgJT~J,~~ I IOJ~-
AND EMPLOYERS' LIABILITY Y1N
ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $
~~~~,~tS~~b8~~?~NS below E.L. DISEASE - POLICY LIMIT $
C OTHERExcess Umbrella SBE033274300 6/1/2009 6/1/2010 Limi t $5,000,000
(Over $5Mil Primary) General Aggregate $5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Project: Plantation Key and Marathon Jails. Monroe and Monroe County Board of county Commissioners are named as
additional insured as respects to the General and Automobile Liability policies. *10 Day Notice of Cancellation For
Non-Payment of Premium*
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Monroe County Board of County DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
Commissioners NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Bob Stone
10600 Aviation Blvd IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Marathon, FL 33050 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~~ ~
Kelly Petzold/BARNES p~~
ACORD 25 (2009/01)
INS025 (200901)
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Policy Number: r0830-30352
Date Entered: 10/10/2008
CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
6/ 5/2009
PRODUCER WorkComp Partners THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
215 East Main Street ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Bartow, FL 33830 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone: (863) 533-4178
Fax: (863) 534-3562 INSURERS AFFORDING COVERAGE NAIC#
INSURED Smi th Industries, Inc. dba Smith Fence INSURER A: Bridgefield Employers Insurance Compa n.y
Company and Smith Fence and INSURER B:
Raymond P. Smi th INSURER C:
4699 110th Avenue North INSURER D:
Clearwater, FL 33762
I INSURER E:
COVERAGES
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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~:: ~~~ POLICY NUMBER POLICY EFFECTIVE ~~~lfY EXPIRATION LIMITS
TYPE OF
GENERAL LIABILITY EACH OCCURRENCE $
I---- ~~:~~J?E~~~~ence)
COMMERCIAL GENERAL LIABILITY $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PlOP AGG $
I POLICY n ~~p.,: n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS ,~ ~7 BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS W BODILY INJURY
- $
NON-OWNED AUTOS "01' (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY '{ AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION XI WC STATU- IXIOTH-
AND EMPLOYERS' LIABILITY TORY LIMITS ER
Y/N $1,000,000
A ANY PROPRIETOR/PARTNER/EXECUTIVE 0 0830-30352 10/10/2008 10/10/2009 E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000
~~~~I~tS~~~~1~1o~s below E.L. DISEASE - POLICY LIMIT $1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Project: Plantation Key & Marathon Jails
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE enger
Robin Stenger
ACORD 25 (2009/01) @ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing 800-208-1977
MOnroe County Board of Commissioners
10600 Aviation Blvd.
Marathon, FL 33050