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Certificates of Insurance --- WESTCON -04 LGLEASON ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) `----- 8/30/2016 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 CONTACT L ori B . Gleason NAME: Collinsworth, Alter, Lambert, LLC PHONE 561 776 -9001 FAX 561 427 -6730 23 Eganfuskee Street (A/C, No, at): ( ) lac, No): ( ) Suite 102 A oRESS: Igleason @callIc.com Jupiter, FL 33477 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Amerisure Insurance Co 19488 INSURED INSURER B : North River Insurance Company 21105 West Construction, Inc. INSURER c: Travelers Property & Casualty Co. of America 25674 318 S Dixie Highway Suite 4 -5 INSURER D : Lloyds London Ins. Co Lake Worth, FL 33460 INSURER E : 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP INSD MD POLICY NUMBER (MM /DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X C PP2085 7740301 01/01/2016 01/01/2017 DAMAGETORENruD 100,000 CLAIMS - MADE OCCUR PREMISES Ea occurrence $ X XCU & Contractual . • VE �t B -IN I• NAG M ,;� ED EXP (Any one person) $ 5,000 X Broad Form Prop. Dam BY r �` / y`I ! PERSONAL 8ADVINJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER ? GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- LOC DATE 1� a PRODUCTS - COMP /OP AGG $ 2,000,000 OTHER: WAIVER N/ • YES $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO CAl2999291901 01/01/2016 01/01/2017 BODILY INJURY (Per person) $ . ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY D X HIRED AUTOS X AAUTO-0WNED �0 (Per accident) D AMAGE $ V / / % le/t PIP Coverage $ 10,000 X UMBRELLA LIAB X OCCUR ,, EACH OCCURRENCE $ 1 0,000,000 B EXCESS LIAB CLAIMS - MADE 5811063597 ` " 01/01/2016 01/01/2017 AGGREGATE $ 20,000,000 DED X RETENTION $ 0 ^' $ WORKERS COMPENSATION 1 1 , • �, X PER OTH- AND EMPLOYERS' LIABILITY 777""" STATUTE ER YN A ANY PROPRIETOR/PARTNER/EXECUTIVE N N / A WC204157410 01/01/2016 01/01/2017 E.L. EACH ACCIDEN $ 1,000,000 OFFICER/MEMBER EXCLUDED'? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Rented /Leased Equip. QT6609215L272TIL16 01/01/2016 01/01/2017 Limit 200,000 D Builders Risk CSN0000497 09/12/2016 05/10/2017 Total Project Value 1,564,532 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is named as additional insured including products and completed operations for general liability per form CG7048, automobile liability, . and umbrella liability when required by written contract. General Liability and Auto Liability are primary and non contribute hen requi4gbygnitten contract. Waiver of subrogation applies to general liability, automobile liability, umbrella liability, and workers' compensatiorjhen requiia[by en contract. Umbrella extends over general liability, auto liability and employer's liability. Should any of the above described po es be cane ed, q jice will be delivered in accordance with the policy provisions. ©r ti"I C7 C Project #GAMD75 Florida Keys Marathon International Airport, Monroe County, New Storage Hangars �� j v ' I ■ SEE ATTACHED ACORD 101 �• CERTIFICATE HOLDER CANCELLATION r ' " 773 - x :I SHOULD ANY OF THE ABOVE DESCRIBED POSIES BE CAI(QILLEEFORE THE EXPIRATION DATE THEREOF, NOTI,a Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY P OVISIONS WILL B . - ED IN T 1100 Simonton Street ii C.J Suite 1 -213 Key West, FL 33040 AUTHORIZED REPRESENTATIVE • go; B.� © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: WESTCON -04 LGLEASON LOC #: 1 ACOR O¢ ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Collinsworth, Alter, Lambert, LLC West Construction, Inc. 318 S Dixie Highway POLICY NUMBER Suite 4 -5 SEE PAGE 1 Lake Worth, County 0 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations /LocationsNehicles: The Certificate Holder is expanded to read: The Monroe County Board of County Commissioners, its employees and officials and is also included as an Additional Insured and Loss Payee with respect to Builders Risk coverage. The perils of Flood and Windstorm are included under the Builders Risk coverage. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD