COI E&O Expires 01/31/2017 A ( ` D CERTIFICATE OF LIABILITY INSURANCE DATE(MMOD/YYYY)
11/17/2016
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 pollcy(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: Geri Navarro
AISI dba Pan American Insurance Agency, Inc. PHONE (925) 937 -1483 FAX
IA1C No. 1: (A/C, No):
1277 Treat Boulevard ADDRE gnavarro @ascensionins.com
Suite 400 ADpRESS'
INSURERS) AFFORDING COVERAGE NAIC N
Walnut Creek CA 94597 INSURERA:Great American E&S Insurance
INSURED
INSURER B :
Ascension Insurance Holdings, LLC INSURER C:
Ascension Benefits & Insurance Solutions INSURER D:
700 SE Central Parkway INSURERS:
Stuart FL 34994 INSURERF:
COVERAGES CERTIFICATE NUMBER:CL1612758012 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 POUCIES 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 SUER
LTR TYPE OF INSURANCE INVD yyvD POUCY NUMBER POLICY POUCY EXP
IMM/DO/YYT Y1 IMM(Dp1YYYY1 LIMITS
COMMERCIAL GENERAL UABIUTY
EACH OCCURRENCE $
CLAIMS -MADE I OCCUR DAMAGE TO RENTED —
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY _ $
GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $
POLICY PRO-
JECT LOC
PRODUCTS - COMP/OP AGG $
OTHER:
$
AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $
(Ea accident) _
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEOULED
AUTOS AUTOS BODILY INJURY (Per accident) $
—
HIRED AUTOS NON -OWNED PROPERTY DAMAGE
AUTOS (Per accident) $
$ —
UMBRELLA UAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE
AGGREGATE $
DED 1 RETENTION S $
WORKERS COMPENSATION STATUTE I ER
AND EMPLOYERS' UABIUTY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? I J N/ A EL EACH ACCIDENT $
(Mandatory In NH)
If yes, de scr i be unde E.L. DISEASE - EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $
A ERRORS & OMISSIONS TER3177425 1/31/2016 1/31/2017 Each Claim /Aggregate $15,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 1 more space Is required)
DEDUCTIBLE: $50,000 each occurrence /$100,000 aggregate / '/
Appr •' s :4 AGEMENT
WA IVER N/A st YES _
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Monroe County BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS.
Suite 2 -268
Key West, FL 33040 AUTHORIZED REPRESENTATIVE
Steve Martin /DP .a�--,•":
01988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)