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COI Expires 10/31/2017 } ACORCY CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YYYY) 1 4.—r. 01/31/2017 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 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 NAME; ____ -____ Applied Risk Services, Inc. PHONE rFAX 10825 Old Mill Rd (A/C, No, Ext): (877)234 - 4420 I(A/C,No): (877)234 -4421 Omaha, NE 68154 E -MAIL ADDRESS: PRODUCER (877)234 -4420 CUSTOMER ID# INSURER(S) AFFORDING COVERAGE - NAIC # INSURED INSURER A: Continental Indemnity Co. 28258 INSURER B: U.S. Water Services Corporation — — I 4939 Cross Bayou Blvd INSURER : NS C — New Port Richey, FL 34652 -3434 INSURER D: INSURER E: CTL 1273 1292223 —;. 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 C LAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DD/YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY !COMMERCIAL IABILITY r Il EACH OCCURRENCE $ - DAMAGE TO RENTED - CLAIMS GENERAL LI O CCUR L _ J L _ 1 [_ PREMISES (Ea occurrence) $ LMED EXPfly_one person) $ 7 I PERSONAL & ADV INJURY $ GENERAL AGGREGATE " $ GENII AGGREGATE LIMIT APPLIES PER: PRO- I 1 ! _PRODUCTS - COMP /OP AGG .___, - POLICY I JECT I LOC AUTOMOBILE LIABILITY - -- COMBINED SINGLE LIMIT ANY AUTO ' 1 1 _te accidentj $ ALL OWNED AUTOS : ! BODILY INJURY (per person) $ SCHEDULED AUTOS j 'I BODILY INJURY (Per accident) $ HIRED AUTOS ! ! PROPERTY DAMAGE Per accident $ !NON -OWNED AUTOS - -- -- - - - $ $ j UMBRELLA LIAB ' I OCCUR -.. EACH OCCURRENCE $ EXCESS LIAB I CLAIMS MADE �! I AGGREGATE $ DEDUCTIBLE J t RETENTION $ $ I ' WORKERS COMPENSATION . WC S TATU- _1 1OTH- AND EMPLOYERS' LIABILITY Y / N ! _ X 14RY LIMt7S !__ ER __ - _ ______ ___ _ . ANY PROPRIETOR/PARTNER/EXECUTIVE N A l L EACH ACCIDENT _ $1,000,000 A OFFICER/MEMBER EXCLUDED? N 7 3- 8 9 4 3 5 7- 0 1- 0 6 X110/31/2016 10/31/2017- -- (Mandatory in NH) 1 ` E.L. DISEASE - EA EMPLOYEE $ 1 , 0 0 0 , 0 0 0 If yes, describe under ! : - -- -- -- - -- - - -- - - -- - SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT f $ 1 , 0 0 0 , 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space Is required) 1 * PPR " / ED 0 # • AGM IRS ` b r Ir - ' I�rMUNI f WAI N/A ! Y cc 4t t , CERTIFICATE HOLDER CANCELLATION � ce _F .L MONROE COUNTY BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1111 12TH STREET BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED SUITE 408 IN ACCORDANCE WITH THE POLICY PROVISIONS. KEY WEST, FL 33040 G G; AUTHORIZED REPRESENTATIVE • - L 0 3 9 9 7 1 ACORD 25 (2009/09) ©1988 -2009 ORD CORPORATION. All rights reserved (