Certificate of Insurance
A
MACTINC1
ACORDTM CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
1/21/2010
PRODUCER Commercial Lines ... (770) 850-0050 THIS CERnFICATE IS ISSUED AS A MATTER OF INFORMAnON
ONLY AND CONFERS NO RIGHTS UPON THE CERnFICATE
Wells Fargo Insurance Services USA, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4401 Northside Parkway, Suite 400
Atlanta, GA 30327 INSURERS AFFORDING COVERAGE NAIC ,
INSURED MACTEC Engineering and Consulting. Inc. & MACTEC, Inc. INSURER A: Zurich American Insurance Co 16535
5845 N.W. 158th Street INSURER B: Lloyd's, London
INSURER C:
INSURER D:
Miami Lakes, FL 33014 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.
INSRI: TYPE OF INSURANCE POUCYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR
A GENERAL LIABIUTY GL0225862812 09/01/09 09/01/10 EACH OCCURRENCE $ 1,000.000
~
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1,000.000
~ ~ CLAIMS MADE ~ OCCUR
MED EXP (Any one perIOn) $ 5.000
f-
PERSONAL & ADV INJURY $ 1.000,000
-
GENERAl AGGREGATE $ 2,000.000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP~PAGG $ 2.000.000
Xl POLICY n ~~ n LOC
A ~TOMOBILE LIABILITY BAP225862912 09/01/09 09/01/10 COMBINED SINGLE LIMIT S 1,000,000
X ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS .1\1\. ~ -~ BODILY INJURY
- $
X NON-OWNED AUTOS . i ~ . (Per accident)
-
~ \ J1 .. ~ PROPERTY DAMAGE $
- -..... ....-........ ".~...-, (Per accident)
GARAGE LIABILITY "'-J I \ 'o"'-:f - AUTO ONLY - EA ACCIDENT $
q ANY AUTO . . ._~......., .....~..flO'+. ..... -.._.........~ .
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSJUMBRELLA LIABILITY , EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
==i DEDUCTIBlE $
RETENTION $ $
A WORKERS COMPENSAnON AND WC225863012 (AOS) 09/01/09 09/01/10 X I ~~ s~~~: I IO~
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE WC283354012 (WI&MI) 09/01/09 09/01/10 E.L. EACH ACCIDENT S 1,000,000
OFFICER/MEMBER EXCLUDED? WC943289901 (Guam) 09/01/09 09/01/10 E.L. DISEASE - EA EMPlOYEE S 1.000,000
~~~~I:'~~~~~1~~s below E.L. DISEASE - POLICY LIMIT $ 1,000.000
OTHER
B Professional QF054509 09/01/09 09/01/10 $1.000,000 Each Claim
Liability $2,000,000 Aggregate
DESCRIPTION OF OPERAnONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE:Geiger Creek Bridge Repair CEI As respects general and automobile liability coverages, certificate holder is included as an additional insured, when
required by contract, but only for work performed by or on behalf of MACTEC Engineering & Consulting, Inc.
CERTIFICATE HOLDER
CANCELLAnON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATI! THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
Monroe County Board of Commissioners NOTICE TO THE CERnFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO so SHALL
Attn: Judith Clarke IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1100 Simonton St., Room 216 REPRESENTATIVES.
Key West, FL 33040 AUTHORIZED REPRESENTATIVE 9(~
ACORD 25 (2001/08) 1 of 2 1142345
(This certificate replaces certificate# 1080461 issued on 12/28/2009)
@ ACORD CORPORAnON 1988