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COI Expires 09/01/2017 i 1 ACORD • CERTIFICATE OF LIABILITY INSURANCE DATEI111AIDDITYTY) •.+/ 10/16/2016 THIS CERTIFICATE 1S 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the trots and conditions of the poky, certain poikies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s1. PRODUCER CONTACT Vick N CONTACT Van Wormer Brown & Brown Insurance - Clearwater PH O N E FAX 727 442 -7695 83 Park Place Blvd., Suite 101 a) ' Clearwater FL 33757 -2456 w anwormer@o bbpineltas.com INSURER(S) AFFORDING COVERAGE NAIL a INSURER A .Admiral Insurance Company 24856 INSURED IN sum s ;The Travelers Indemnity Company of 25666 l RER Kisinger Campo & Assoc. Corp. INSURER c : The Charter Oak Fire Insurance Comp 25615 Campo & Associates, PLLC, KCCS, Inc. INSURERD;Travelers Casualty and Surely Compa 19038 201 N. Franklin Street, Ste. 400 Tampa FL 33602 INSURER E t. INSURER F COVERAGES CERTIFICATE NUMBER: 397206912 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. 1rtBC POLICY EFP POLICY J; MS '. t_ LTR TYPE OF INSURANCE D 1 WVD POLICY NUMBER OIO YYYYI LMMA01TYYY1 LIMITS - C x ' COMMERCIAL GENERAL LIA8IUTY 630-825411604 9/1/2018 911/2017 EACH OCCURRENCE 51,000,000 1 CLAIMS-MADE U OCCUR PREMISES E a e) $300.000 X Con MED EXP (My one parson) 310,000 X xCU Liability PERSONAL & ADV INJURY S1,000.000 GENL AGGREGATE UMIT APPLIES PER GENERAI. AGGREGATE S2.000.000 POLICY I X 1 J n LOC PROOUCTS • COMP/OP AGG $2.000,000 OTHER S B AUTOMOBILE LIABILITY 8108254A804 9/112016 9/1/2017 COM � eNt�Ji war $1.000 X ANY AUTO BODILY INJURY gPer person) S — Z OYYHED — SG D BODILY INJURY (Per accident) S X AIRED AUTOS X AUTOS Per sElf I S S B X UMBRELIJ► LIAR X OCCUR CUP8254A604 9/112016 9/112017 EACH OCCURRENCE $4,000,000 EXCESS Lt (AS CLAIMS -MADE AGGREGATE $4,000.000 DEO Ix I RETENTION S10,000 I S D AND EMPLOYERS' LIABILITY Y J N UB2G811560 10/3/2016 10/312017 x 15 ATE U T1 xi gr" U.S.L.H. ANY PROPREeTORIPARTNERIEXECUTIVE ©N J A EL EACH ACCIDENT '' S500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE • EA EMPLOYEE 3500.000 II yes, desotbe under DESCRIPTION OF OPjrRATIONS below EL DISEASE • POLICY LIMIT , 3500.000 A Professional Liability E000002720503 11/2/2016 11/2/2017 Per Claim 5,000,000 Claims Made Aggregate 5,000,000 Deductible 250,000 DESCRIPTION Of OPERATIONS / LOCATIONS 1 VEHICLES IACORD tat, Additional Remarks Schedsde, may b. attached 1/ man spate Is required) Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability. Explosion, collapse and underground hazard included in CGL. . GARRISON BIGHT BRIDGE REPAIR DESIGN PROJECT. FPN 431918 -1. 60 -DAYS NOTICE OF CANCELLATION OR NON- RENEWAL PER FORM IL- T4050311. (KCA PROJECT #1201524.00) I 11 : oA rim L; ti a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE MONROE COUNTY - BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ATTN: JUDITH S. CLARKE, P.E., DIRECTOR OF ENG SVC ACCORDANCE WITH THE POLICY PROVISIONS. 1100 SIMONTON STREET, #218 KEY WEST FL 33040 AUTHOR,aO REPRESENTATIVE AMC. R. stalaip 1 EI 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD