Certificates of InsuranceG0ab® CERTIFICATE QF LIABILITY INSURANCE
DA12/21/2010 Y)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsemen s .
PRODUCER Hull & Company, Inc.
Carillon Parkway, Suite 150
St. Petersburg FL 33716
NE T
_MM800
PHONE 30 852-9247 FAx
ac Ne ; 305 852-2734
E'M RIEs Sche ohnsonsinsure.COm
PRODUCERCUSTOMER 10 it 66406
INSURER(SP AFFORDING COVERAGE
NAIC N
INSURED Grader Mike LLC
2 Bay Dr
Key West FL 33040
INSURERA: Evanston Insurance Company
35378
INSURER B ;
INSURER C :
INSURERD:
INSURERS:
INSURER F ;
"UYL-KYL-"-N r_YFI I IFIr7nTw NI INlm3 sJ• nC-\llC1'\al t,atsr•r,-
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 BY 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.
ILTR
TYPE OF INSURANCE
INSR
VAID
POLICY NUMBER
MMlDDY EPP
MMNDIYrrY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X COMMERCIALGENERAL LIABILITY
CLAIMS -MADE a OCCUR
DAMAGE
REMISES T E.occurre cRENTED
$ 50,000
MEO EXP (Any one person)
$ 1,000
A
x
CLO90202493
08/23/10
08/23/11
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2.W0,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPlOPAGG
$ 1,000,000
POLICY PRO LOC
$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
PROPERTY DAMAGE
(Per acoldent)
$
HIRED AUTOS
$
NON -OWNED AUTOS
I
S
UMBRELLA LIAB
OCCUR
�-
EACH OCCURRENCE
$
EXCESS LIAe
CLAMS -MADE
AGGREGATE
$
DEDUCTIBLE
$
x
$
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y! N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑
NtA
-
VuC STATU- OTH-
L1M1T$ -
E.L EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
----
$
(Mandatory In NH)
ifyyea, describe under
-
E.L. DISEASE - POLICY LIMIT
-
$
OESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required)
Monroe County SOCC
Attn: Clark Briggs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1100 Simontom St, Rm, #216 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Key West, FL 33040 ACCORDANCE WITH THE POLICY PROVISIONS.
Is named as Additlonal Insured, AUTHORIZED REPRESENTATIVE ._ .._-11 - . /20 - .A
Surplus Lines Agent PA305417
198E-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
ACORDT. CERTIFICATE OF LIABILITY INSURANCE
12/'22/20 0
PRODUCER
Affiliated Agency Ops
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
16 South River Street
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Wilkes-Barre, PA 18702
Tel: (800) 673-2465 Fax: (570) 820-7968
INSURERS AFFORDING COVERAGE
NAIC #
?URED
Employee Leasing Solutions, Inc.
INSURER A: EastGUARD Insurance Company
14702
Phone: (941) 746-6567
INSURER B:
INSURER C:
1401 Manatee Ave W. Suite 600
Bradenton, FL 34205
INSURER D:
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.
INSR
WWI.
POLICY EFFECTIVE
POLICY EXPIRATION
TYPE F INSURANCE
POLICY NUMBER
DATE
GENERAL
_
LIABILFTY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES Ea occurence
$
CLAIMS MADE OCCUR
MED EXP (Any one arson
PERSONAL ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS _
PRO -
POLICY JECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
ANY AUTO
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
gWSS/UMBRELL&JJAPILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
�i
$
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
X TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1,000,000
A
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
EMWC 109947
01 /01 /2010
01 /01 /2011
E.L. DISEASE - EA EMPLOYEE
1 $ 1,000,000
H yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
Client ID: #4102002
* Valid in the State of Florida "
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS /+
COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF: EastGUARD Insurance Company
Grader Mike LLC carries an A.M. Best
Qualifiers Name: Travis L Livengood
Rating of A- (Excellent)
and a financial size Financial Strength
Aprox active employee count: 6 Category of VIII A- ESxc -Slant
Monroe County Board of County Commissioners
1100 Simonton Street
Key West, FI 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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
JOHNSON$ INS AGCY PRIMMMM
89015 OVERSEAS NN+N
TAVERNIER, FL 33070
305-852.9247
Policy number. 08212194-5
Underwritten by:
Progressive Express Ins Company
1 '1
OC'� I 3 — 0 December20, 2010
Page 1 of 2
Certificate of Insurance
cerdrkete HWde►
itwced
Agent
Additional Insured
.................................................
MIKE ANSON
.....,..............,,.....:..,............,.,.,........,,.....
10HNSONS INS AGCY
MONROE COUNTY BOCC
GRADE MIKE, LLC
89015 OVERSEAS HWY
1100 SJMONTON RM 216
2 BAY DRIVE
TAVERNIER, FL 33070
KEY WEST, F1' 33040
KEY WEST, FL 33040
This document certifies that insurance policies identified below have been issued by the designated insurer to the
insured named above for the petiod(s) indicated. This Certificate is issued for information purposes only, It confers no
rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies
listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations,
endorsements, and conditions of these policies.
Poiky Effective Date: Aug 13, 20T0 ......................Policy Expiration Date: Aug 23, 2011...................
0reunar" cnrN�gefsl Lhft
...
............................9......................._...........................................
Bod[ly Inlury/Property Damage $300,000 Combined Single limit
...................................................'�.......,:................,........ry............... :...............,,..............
Persona! Injury Protection $14,000 w 0 Ded Named Insured On
Description of LocationNehides/Special Items
Scheduled autos only
.....................................................................................................................................................
1997 KWT801XKDDUOX3VJ744725
1994 GMC C7H 1GDM7H1J7RJ504499
t999 NONE TRAilER4SODK4829X1000430
............
2000 EAGER BEAVER TRAILER i 12H5V30XYL053797
199
.....9 GM....,.........................0 F6B 1GDJ6C1C6XJ515212 ,...........,........................................,.,,,.................... ................ ..............................
Fire and Theft w/ CAC $1,000 Ded
:.........................
........
,..,.,.......,.,...............,.........,.......,.,,,...,......,.....
2D08 FORD F450 SUPER DUTY 1 FTXW43R58EC1i1279
Comprehensive $1,000 Ded
Collision $1,000 Ded
........................................................................................
2008 LOAD MAX TRAitER 5LSGF302781012532 ......""""""
.......................................................................................................................
1999 FORD F803FEWF801XXMA12977 """""""""""
..,.................................................,......,
2006 FAHTNT FLD 1 FYMALDE96DV80683 ..................................................
Comprehensive $1,000 Ded
Collision $1,000 Ded
............................................................................
Z011 FORD F450 SUPER DUTY 1 FTSW4DT18EA89838
Comprehensive $1,000 Ded
Collision $1,000 Ded
We will endeavor to provide 30 days notice of cancellation to the Certificate holder, but failure to do so shall impose no
obligation or liability of any find upon the insurer, its agents or representatives.
coop■■ed
Policy number. 08212194.5
Page 2 of 2
Certificate number
3541OA08194
Please be advised that addttIonal Insureds and loss payees wili be notified In the event of amid -term
cancellation.
Form 5241 (100)