COI Expires 03/01/2015Ae° r CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
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(S), AUTHORIZED REPRESENTATIVE
OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsement(s).
PRODUCER
Applied Risk Services, Inc.
10825 Old Mill Rd
Omaha, NE 68154
(877)234-4420
CONTACT
NAME:
PHONE
(MC, No, Ext): 214-4420
FAX
(A/C, No): _
E -MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #
INSURERS) AFFORDING COVERAGE
NAIC #
INSURED
Sea Tech of the Florida Keys IHc.
dba Sea Tech of the Florida Keys I=.
PO BOX 420529
Sugarloaf Key, FL 33042 -0529
CTL 1273 843402
INSURER A: nontinantail TnAAmnity en-
29258
INSURER B:
INSURER C:
$
INSURER D:
$
INSURER E:
$
INSURER F:
$
Tc .......- 0G11MI"w NI lmmFw.
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 REDUCE BY PAID C LAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YY
POLICY EXP
MM/DD/YYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS
MADE OCCUR
❑
-
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES (Ea occurrenm)
$
MED EXP ( Any one person)
$
PERSONAL & ADV INJURY
$
_
GEN'LAGGREGATE LIMIT APPLIES PER* :
POLICY PROJECT LOC
GENERAL AGGREGATE
$
PRODUCTS - COMP /OPAGG
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
❑
1:1
'
q DA �'
N/ YE
GEMENT
COMBINED SINGLE LIMIT
(Ea aciident)
$
BODILY INJURY Per erson
$
BODILY INJURY Per accident
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLALIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
L
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/
EXECUTIVE OFF
EXCLUDED? ICER/MEMBER
(Mandatory in NH)
If yes, describe under
SPECIAL PROVISIONS below
N/A
❑
L 6-885792-01 -01
3/01/2014
3/01/2015
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
$3.1000#000
E.L. DISEASE - POLICY LIMIT
1 $1 1 000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, If more space is required)
Mixunoe QOlIIlty BOaICl Of QOlIIlty �t[R�SS1Ctl]er8
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
1100 SiMOMM St
THE POLICY PROVISIONS.
RB,Y West, FL 33040
AUTHORIZED REPRESENTATIVE
Attn: Project bmnager
- L 0 3 9 9 7 1
ACORD 25 (2009/09) I ne Acvnu name anu logo are reglelereu mama ul n..wnu -1 - 1—....--- ....,,�.....,, ,. ..,o.........