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Certificates of InsuranceCOASGUN -02 MNORTON A` OR DA DATE JMMIIDD R CERTIFICATE OF LIABILITY INSURANCE 8/20/20 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 Towne Insurance Agency, LLC TJG 301 Bendix Road Suite 300 Virginia Beach, VA 23452 INSURED P. ",°"� (757) 468 -6100 1 ", No (757) 468 -9917 CMl• - INSURER(S) AFFORDING COVERAGE nAi INSURERA •XL Specialty Insurance Comp INSURERB - Harleysville Insur Company 23582 Coastal GuniteConst. Co. INSURER C: Arch Insurance Company : Ld ATTN: Shelly Blake INSURER D: Signal Administration P.O. Box 977 Cambridge, MD 21613 -0788 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: •noon ABOVE FOR TWIP Pni Ir.Y PFRInn THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LS A IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH TYPE OF INSURANCE X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 11 OCCUR OF PERTAIN, POLICIES. INSURANCE U LISTED BtLUW HAVt ottlV TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN REDUCED POLICY NUMBER UM00028978MA14A Ioou Cu !;_I CONTRACT THE POLICIES BY POLICY EFF MM/DD/YYYY 04/1612014 i n� uvov OR OTHER DESCRIBED PAID CLAIMS. POLICY EXP MM/DD/YYYY 04116/2015 «v ,. ,•,�.+ ��� • • • •_ . __._ . _. .. _ - DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ 1 PREMISES Ea occurrence $ 50'00 MED EXP (Any one person) $ 5 PERSONAL & ADV INJURY $ 1+000 GENERAL AGGREGATE $ 2,000+00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PRO El LOC JECT PRODUCTS - COMP /OP AGG 1,000,00 $ B AUTOMOBILE X OTHER: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS 8N995 BA 8 0411612014 04/16/2015 OMBINED SINGLE LIMIT Ea accdent $ 1'000'00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA UAB EXCESS X OCCUR CLAIMS -MADE UM00025117MA14A 04/16/2014 04/16/2015 EACH OCCURRENCE $ 5,000 AGGREGATE $ 5 + 000 ' 00 X STATUTE EER $ N / A WC19859800 21500 UM00028978MA14A 10/01/2013 10/01/2013 04/16/2014 10/01/2014 10/01/2014 04/16/2015 DIED X RETENTION $ 25,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below USLIIrH/ JONES ACT Equipment Floater C D A EL EACH EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1+000+00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 LIMIT 10,000,00 RENTED ITEMS 200,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: No Name Key Bridge Repair Project Monroe County Board of County Commissioners, its employees and officials are included as additional insured with respect to general liability, auto liability and excess liability where it is required by written contract. Waiver of Subrogation in favor of Monroe County Board of County Commissioners with respect to General Liability and Workers Compensation where it is required by written contract. 30 day Notice of Cancellation has been requested and will be forwarded upon receipt. A�PRO GEMENT B WAIVER N/ YES IUR Monroe County BOCC 1100 Simonton Street, Room 2 -213 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE nn.. wr•non rrf%00n0ATInN All rinhts reserved ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD / 1 ACORO" AGENCY CUSTOMER ID: COASGUN -02 MNORTON LOC #: 1 ADDITIONAL REMARKS SCHEDULE Paae 1 of 1 AGENCY NAMED INSURED Towne Insurance Agency, LLC TJG Coastal Gunite Const. Co. POLICY NUMBER ATTN: Shelly Blake P.O. Box 977 SEE PAGE 1 Cambridge, MD 21613 -0788 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 W ZUU0 AGVRU UORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COASGUN -02 KPOWIS ACORO CERTIFICATE OF LIA BILI TY I N S U R ANCE 71-0; 23/2015 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 REPRESEN OR P AND T HE CERTIFICA H 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 NAME: Mary A. Norton Towne Insurance Agency, LLC TJG PHONE 468 -6100 F aC No ; 757 468 - 9917 301 Bendix Road Suite 300 VC No El ( 757) Virginia Beach, VA 23452 E-MAIL mnorton@towneinsurance.com INSURE S) AFFORDING COVERAGE NAIC # INSURER A:XL Specialty Insurance Company 37885 INSURED INSURER Harleysville Insurance Company 23582 Coastal Gunite Const. Co. INSURER C: Arch Insurance Company 11150 ATTN: Shelly Blake INSURER D: Signal Administration P.O. Box 977 Cambridge, MD 21613 -0788 INSURER E: INSURER F rre DCVISInki NI IMRGR- 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. SHOULD ANY OF THE ABOVE DESCRIBED BE CANCELLED BEFORE INN POLICY EFF POLICY E7(P LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDOII A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1+000,00 CLAIMS -MADE X OCCUR UM00028978MA15A 0411612015 0411612016 PREMISES Ea occurrence $ 50,00 X Sudden S Accidental MED EXP (Any one person) $ 5,00 X Pollution PERSONAL BADVINJURY $ 1,000,00 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2.000,00 PRO- LOC PRODUCTS - COMPIOPAGG $ POLICY 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED EaaccidentSINGLELIMIT $ 1,000,00 BODILY INJURY (Per person) $ B X ANY AUTO BA00000098123S 04116/2015 0411612016 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED PROPERTY DAMAGE Peraccldent $ HIRED AUTOS AUTOS $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5.000,00 A EXCESS LIAR CLAIMS -MADE UM00025117MA15A 04/16/2015 041161`2016 DED X RETENTION$ 25,000 $ WORKERS COMPENSATION STATUTE ER (. AND EMPLOYERS' LIABILITY ANYPROPRIETOR /PARTNER/EXECUTIVE YIN iZAWC19900900 10/01/2015 10/01/2016 E.L. EACH ACCIDENT $ 1.000,00 E.L. DISEASE - EA EMPLOYEO $ 1 + 000 + 00 OFFICER/MEMBER EXCLUDED? F—] (Mandatory in NH) NIA E.L. DISEASE - POLICY LIMIT 1 $ 1,000 If yes, describe under DESCRIPTION OF OPERATIONS below D USLBH & Jones Act 21500 10/01/2015 10/01/2016 LIMIT 10,000,00 A Equipment Floater UM00028978MA15A 04116/2015 I 04/16/2016 RENTED ITEMS 200,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: No Name Key Bridge Repair Project Monroe County Board of County Commissioners, its employees and officials are included as additional insured with respect to general liability, auto liability and excess liability where it is required by written contract. Waiver of Subrogation in favor of Monroe County Board of County Commissioners with respect to General Liability and Workers Compensation where it is required by written contract. 30 day Notice of Cancellation has been r sted and will be forwarded upon receipt. PPR G MEM v,• I V - I;loo-LU 14 JAI�Ur[U l.Vr[r AVIV. rrr rryrrw rcac+vc�. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 4LICIES SHOULD ANY OF THE ABOVE DESCRIBED BE CANCELLED BEFORE 9� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN O/ n ACCORDANCE WITH THE POLICY PROVISIONS. 1J610 l 1 ((x�,,11 00 Rcl AUTHORIZED REPRESENTATIVE Monroe County BOCC 1100 Simonton Street, Room 2-21'3 Key West FL 33040 (� J V - I;loo-LU 14 JAI�Ur[U l.Vr[r AVIV. rrr rryrrw rcac+vc�. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORO AGENCY CUSTOMER ID: COASGUN -02 LOC #: ADDITIONAL REMARKS SCHEDULE KPOWIS Page 1 of 1 AGENCY NAMED INSURED Towne Insurance Agency, LLC TJG Coastal Gunite Const. Co. ATTN: Shelly Blake P.O. BOX 977 POLICY NUMBER SEE PAGE 1 Cambridge, MD 21613 -0788 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Remarks: Additional Coverage's Hull & P &I XL America Insurance, Inc. UM00028978MA15A 04/16/2015 -016 r+i,UMLJ ,u, kzuDawl I © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COASGUN -02 KPOWIS ,4co CERTIFICATE OF LIABILITY INSURANCE DA 10 /23/2 2312 /Y 105 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS "'ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. 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 Towne Insurance Agency, LLC TJG 301 Bendix Road Suite 300 Vir inia Beach, VA 23452 g NAME: CT Mary A. Norton PHONE FAX ac No Ext : (757) 468 -6100 ac No) (757) 468 -9917 E-MAIL ADDRESS: mnorton@towneinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:XL Specialty Insurance Company 37885 $ 1,000,00 INSURED INSURER B: Harleysville Insurance Company 23582 Coastal Gunite Const. Co. INSURERC:Arch Insurance Company 11150 ATTN: Shelly Blake P.O. Box 977 INSURER D: Signal Administration INSURER E Cambridge, MD 21613 -0788 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. I LTR TYPE OF INSURANCE 1 ' slol (1J6 / Monroe County BOCC �6 6f0 1100 Simonton Street, Room 2 -2A 0 .3 7f Key Wes FL 33040 JMM POLICY NUMBER MM /DD MMIIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE � OCCUR IUM00028978MA15A 04116/2015 04/1612016 PREMISES Ea occurrence $ 50,00 X i Sudden & Accidental MED EXP (Any one person) $ 5,00 X� Pollution PERSONAL & ADV INJURY $ 1,000,00 L AGGREGATE LIMIT APPLIES PER: POLICY [ JECT LOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP /OP AGG $ 1,000,00 $ .. OTHER: AUTOMOBILE LIABILITY ANY AUTO iBA00000098123S 04/16/2015 0411612016 ( Ea aBaUeMSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ i` ALL OWNED SCHEDULED AUTO BODILY INJURY (Per accident) $ X X NON -OWNED HIREDAUTOS AUTOS :� Per accident DAMAGE $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAR CLAIMS -MADE UM00025117MA15A 0411612015 04/16 12016 I DED I X I RETENTION $ 25,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N iANYPROPRIETOR /PARTNER /EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ '(Mandatory in NH) N/A !ZAWC19900900 10/01/2015 /2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 D IUSL&H & Jones Act 21500 10/01/2015 10101/2016 LIMIT 10,000,00 A Equipment Floater UM00028978MA15A 0411612015 04/1612016 RENTED ITEMS 200,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: No Name Key Bridge Repair Project Monroe County Board of County Commissioners, its employees and officials are included as additional insured with respect to general liability, auto liability and excess liability where it is required by written contract. Waiver of Subrogation in favor of Monroe County Board of County Commissioners with respect to General Liability and Workers Compensation where it is required by written contract. 30 day Notice of Cancellation has been and will be forwarded upon receipt. ;pted PPR G MEW CERTIFICATE HOLDER , � '1li .30:Jun.. CANCELLATION WAIVER N /A� YES 7.? 40LICIES 9 ©/ SHOULD ANY OF THE ABOVE DESCRIBED BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Z ACCORDANCE WITH THE POLICY PROVISIONS. 1 ' slol (1J6 / Monroe County BOCC �6 6f0 1100 Simonton Street, Room 2 -2A 0 .3 7f Key Wes FL 33040 AUTHORIZED REPRESENTATIVE y� , n �- 9LU✓ I WVY` ©1988 -2014 ACORD CORPORATION. All rights res rved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: COASGUN -02 KPOWIS LOC #: 1 AC40R LY ADDITIONAL REMARKS SCHEDULE Page AGENCY Towne Insurance Agency, LLC TJG NAMED INSURED Coastal Gunite Const. Co. ATTN: Shelly Blake P.O. Box 977 POLICY NUMBER SEE PAGE 1 Cambridge, MD 21613 -0788 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Remarks: Additional Coverage's Hull & P &I XL America Insurance, Inc. UM00028978MA15A 04/16/2015 -016 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. of 1, The ACORD name and logo are registered marks of ACORD