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Certificate of Insurance A 1/4 CO � 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. S 2 015 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 NSURED, th ic dorsed. If S IBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorseme t. A stateme t es not miff" rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ' NAME: PHONE FAX Applied Risk Services, Inc. DFC 1 f/C,1fyd): (877)) 34 -4420 (A/C,No): (877)234 -4421 10825 Old Mill Rd E - MAIL Omaha, NE 68154 ADDRESS: PRODUCER (877) 2 34 014°N1113"12431"71 D # SURER(S) 4FFORDING COVERAGE NAIC N INSURED ININV ' a' ' A: Continental Indemnity Co. 28258 INSURER B: U.S. Water Services Corporation INSURER C: 4939 Cross Bayou Blvd New Port Richey, FL 34652 -3434 INSURER D: INSURER E: CTL 1273 1105461 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER I (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS — PREMISES (Ea occurrence) $ MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENtAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY PROJECT LOC ` AUTOMOBILE LIABILITY II • i, • COMBINED SINGLE LIMIT $ ANY AUTO I APPR• ! _ E L I1 • GEMEN" (Ea accident) $ ALL OWNED AUTOS r�11�� U (4.(4/11 BODILY INJURY (Per person) $ • SCHEDULED AUTOS WAIV ` • E / • L Q /4 /J BODILY INJURY (Per accident) $ HIRED AUTOS l �' 1 l/ PROPERTY DAMAGE $ _ er accident NON -OWNED AUTOS $ _UMBRELLA LIAB _ OCCUR EACH OCCURRENCE _$ EXCESS LIAB CLAIMS - MADE I I AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/ N X TORY LIMITS ER ANY PROPRIETOR /PARTNER/ E.L. EACH ACCIDENT $ 1,000,000 A EXCLUDED ?OFFICER /MEMBER IN I N/A I 1 7 3- 8 9 4 3 5 7- 01- 04 10/31/2015 10/31/2016 (M In NH) E.L. DISEASE -EA EMPLOYEE $ 1, 0 0 0 , 0 0 0 SPECIAL PROVISIONS v ROVIS ONS below 7 + h(i o.� 3U� W ' I • � 13 • W1: , El. DISEASE-POLICY Limn $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) 10 Day notice of cancellation for non- DaymetAt'of Fyr} ipm, /41 d�y��yor� e, of cancellation for all other reasons UU 11 �a �.JJ..77((��I L CERTIFICATE HOLDER ( CANCELLATION 1ZZ County BOCC Lid l038 80j 0 I� ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 1100 Simonton Street THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE /) do'`. C VL 039971 ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ©19 8 -2009 ACORD CORPORATION. All rights reserved.