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Certificate of Insurance
AUG 2 8 2015 ACOZs CERTIFICATE OF LIABILITY INSURANCE finance Dept DATE(MMIDDIYYYY) `� r 7/15/2015 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 terns 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 CONTNAME: Leighton Campbell 1st Allegiant Insurance, LLC {arcNE Exq (954)378-3235 jAIX No) (954)323 547'. 2450 Hollywood Blvd. EMAIL ADDRESS g g lei hton@lstalle iant.com # 303B INSURER(S) AFFORDING COVERAGE NAIC e Hollywood FL 33020 INSURERA:Ohio Security Insurance Co 24082 INSURED INSURERB:Esse% Insurance Company 39020 HB Hoffman LLC INSURER C: 1340 Stirling Rd Ste 3B INSURERD: INSURER E : LDania Beach FL 33004 1INSURER F: COVERAGES CFRTIFIrATF NI IMRFR-CL1571500340 ocvlclnkl klnlur0co. 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 TH;S 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 INSR ADOL SUER LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MMIDDIYYYY MMIDDlYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 X BKS55938464 1/26/2015 1/26/2016 VIED EXP (Any one personl S 15,000 PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LM,T APPL�FS PER GENERAL AGGREGATE S 2,000,000 X POLICY PRO- JECT LOC PRODUCTS COMPIOPAGG S 2,000,000 OTHER Employee Benef is $ AUTOMOBILE LIABILITY EOMBBINEEDt> SINGLE LIMIT g 1,000,000 A X ANY AUTO BODILY INJURY (Per person) S ALL OWNEDSCHEDULED AUTOS AUTOS X BAS55938464 3/18/2015 3/18/2016 BODILY INJURY (Per accident) $ NON OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE $ (Per accident) PIP -Basic $ 10,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE S 5,000,000 B EXCESSUAB CLAIMS -MADE AGGREGATE $ 5,000,000 DEO RETENTION X MAPXS00004199 1/26/2015 1/26/2C16 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' UABILITY Y / N STATUTE ER ANY PflOPR ETORtPARTNERIEXE . - VE E L EACH ACCIDENT $ OFFICERIMEMBER EXCL OF D7 N I A (Mandatory In NH) If E-L. DISEASE - EA!fWPLOYEE S tv es, describe under DESCRIPTION OF OPERATIONS below SO E.L DISEASE - POUDY LIMIT $ ` +3 C- f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUonal Remarks Schedule, may be attached if more space Is required) Certificate holder is an additional insured for general liability, auto liability andAireess liabiff y (umbrella) when required by written contract. C, rtI V ElvtfNi DATF WANrR N/A p 7Z _ r, t+CK I IrIL.A I c MVLUr-K GANGCLLA I IUN The Monroe County Board of County Commiss 1100 Simonton St Key West, FL 33040 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 I.,eighton Campbell/LC © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 ['n1401I TO: MONROE COUNTY BOARD OF COUNTY Cerdled: 7101 0412 3440 22855322 OWNER: COMMISIONERS CONSTRUCTION ADMICAPITAL IMPRV WO# 2168562 SW WHITEHHEAD ST BATCH-.,M141D-HBH47 DATE:12M6115 KEY WEST FL 33040-6581 T:JM R:KD S:KD The undersigned hereby Informs you that he or she has furnished or is furnishing services or materials as foliOW8: Lebo armor BuUdktp M@%WIals. MECHANICAL - CHILLER REPLACEMENT For improvement of the real property described as: S063S OVERSEAS HWY, MARATHON PORTION OF PUBLIC LAND IN MONROE COUNTY FLORIDA Under an order given by: MONROE COUNTY MEDICAL EXAMINER'S OFFICE CHILLER REPLACEMENT (ton k*W avail" 800.432-1959) 1537 Florida law prescribes the serving of this Notice and restricts your right to make payments under your contract in accordance with Section 713.06 Florida Statutes. Pursuant to Florida Statute 713.16(1) please furnish a copy of your direct contract with the contractor. Responsibility for copy costs is acknowledged. Request for Sworn Statement of Account must be addressed to: a HOFFMAN LlC 1325 SE 1TTH ST FORT LAM,I?ERD/+LE F4 3181707 If a payment bond exists for this project, t s notice seal' serve as the preliminary notice of intention to make claim against any such bond(s). Request for a copy of the bond(s) is hereby made, with acknowledgment of responsibility for copy costs. Failure to furnish the requested copy may have adverse consequences as described in Florida Statutes. IMPORTANT INFORMATION FOR YOUR PROTECTION Under Florida's laws, those who work on your property or provide materials and are not paid have a right to enforce their claim for payment against your property. This claim is known as a construction lien. If your contractor fails to pay subcontractors or material suppliers or neglects to make other legally required payments, the people who are owed money may look to your property for payment, EVEN IF YOU HAVE PAID YOUR CONTRACTOR IN FULL. PROTECT YOURSELF —RECOGNIZE that this Notice to Owner may result in a lien against your property unless all those supplying a Notice to Owner have been paid. The urKWsiyred will look to conhaciors bond for proucllon of the work. --LEARN more about the Construction Lien Law, Chapter 713, Part I, Florida Statutes, and the meaning of this notice by contacting an attorney or the Florida Department of Business and Professional Regulation. Lienor: He Hwum PHONE 7M I= SE 17TH ST FORT LAUDERDALE FL 33316-IM By:jatt:�:A 2. Kenneth R DeAngells, Agent '� 1 �1NilOJ IS11 Wd ZZ330SIOl fCMNEM Cwdfbd: 70110412 3440 2265 5322 MONROE COUNTY BOARD OF COUNTY COMMISIONERS CONSTRUCTION AOMICAPITAL IMPRV 500 WHiTEHEAD ST MONROE COUNTY (905)292-4429 ATTN JOHNNIE YONGM 1100 SIMONTON ST 2-218 KEY WEST FL 3304"10 To assemble manually, fold A to A then fold B to B