HomeMy WebLinkAboutCertificates of Insurance �r1 CAPITOL OP ID: SC
ACORO. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDITYYY)
_ 411 ....../ .- 01109/2017 _
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 polities may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in Iieu of such endorsement(s).
PRODUCER CONTACT
Brown & Brown of FL Inc. NAME: Greg Jaap
3520 Thomasville Rd 1500 1 E, ,,t ; 850- 856 -3747 j A NO 850-656-4065
Tallahassee, FL 32309 E.MAIL
Greg Jaap .
INSURER(S) AFFORDING COVERAGE NAM 5
*sum A : Allied Ins Co of America 10127
INSURED Capitol Group, Inc. INSURERS.
325 W. College Ave 2nd Floor '
Tallahassee, FL 32301 INSURER C
INSURER D;
INSURER E :
INSURER F t
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES 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 �C C y LA AI IMS.
Wu TYPE TYPE Of INSURANCE MD iVNDt POUCY NUMBER im lYTO YY) a P ibeIYYYY) LIMITS
A X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE 5 1,000,000
.
CLAIMS-MADE X OCCUR X ACP3008055831 01/03/2017 01/0312018 O "` S ( E s IV caI s 300,000
MED EXP (My one person S 10,000
PERSONAL 8 ADV INJURY $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY E P IECT EI LOC PRODUCTS • COMP/OP AGG $ 2,000,000
—
OTHER: S
AUTOMOBILEUASIUTY '
(Ex N I SINGLEU MW $
ANY AUTO 4 • • LY INJURY (Per person) S
--
AUTOS OSCHEDULED �. e . I, Re( ' ` • (^a , . ! . . LY INJURY (Per suadent) NON-OWNED ALL OWNED —
�• HIRED AUTOS NON-OWNED �Y *� l � 'J �- ' J j • $
t - , w ,.,,.—• L $
UMBRELLA LIAa OCCUR DATE_ -..- I YES_— EACH OCCURRENCE S
—
EXCESS LIAS H CLAIMS•MADE WAIVER W AGGREGATE 5
DED 1 I RETENTIONS s
wORKIRS COMPENSATION
AND EMPLOYERS' many Y I N I STATUTE J ER
ANY PROPRIETOR/PARTNERJEXECUTNE E L EACH ACCIDENT $
OFFICERIMELeER EXCLUDED? LJ N 1 A
(Mandatory M NH) E.1. DISEASE • EA EMPLOYE S
' AROMA DESCRIP ION OF OPERATIONS below E.L DISEASE • POLICY LIMIT 'r S
DESCRIPTION OF OPERATIONS ! LOCATIONS I VEHICLES (ACORD 1St, Additional Remarks SOMdute, may fe attached If more sped Is required)
Monroe County Board of Commissioners is listed as Additional Insured on the
General Liability
CERTIFICATE HOLDER CANCELLATION
MONROEC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Monroe County Board of ACCORDANCE WITH THE POLICY PROVISIONS.
County Commissioners
1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West, FL 33040
1
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo ere registered marks of ACORD
NOTEPAD CAPITOL PAGE 2
INSURED NAME Capitol Group, Inc. OP ID: SC oa. 0110912017
ilia - additional insured if shown on this certificate, is added provided
this status is required by a written contract, that is executed prior to a
loss.