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HomeMy WebLinkAboutCOI Expires 08/17/2017/ l ® ,acoRo CERTIFICATE OF LIABILITY INSURANCE/2017 =E1IDDIYY`rY) 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER CONTACT HOUSE NAME: PHONE 904-880-8881 1C No Kelly White & Associates Insurance, LLC E-MAIL ADDRESS: y@ kell kwhiteinsurance.com P.O. Box 350909 INSURERS AFFORDING COVERAGE NAIC # INSURERA: RLI Insurance Co AM Best A+XI Jacksonville FL 32235 INSURED INSURER B : Travelers Property & Casualty Company Coffin Marine Services, Inc INSURER C : INSURER D : Amtrust North America PO BOX 430538 INSURER E : Great American Insurance Group INSURER F : Big Pine Key FL 33043-0538 COVERAGES CERTIFICATE NUMBER: COFF17110316154289 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDNM POLICY EXP MMIDDIYYYY LIMITS rA X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RTED PREMISES (Ea occurrrence $ 50,000 X MED EXP An one person)$ 5,000 Protection & Indemn/Jones Act X Salvors Liability PER SONAL&ADVINJURY $ 1,000,000 MRP0200000 09/23/2017 09/23/2018 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO JECT❑LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS BA4902R108 08/17/2017 08/17/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED E NON -OWNED AUTOS ONLYAUTOS ONLY Personal Injury $ 10,000 UMBRELLA LIAR EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN nN OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N/A WWC3246363 12/21/2016 12/21/2017 X STATUTE X EORH IncludesUSL&H E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Per co Schedule E Vessel Pollution OMH1440763 09/23/2017 09/23/2018 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is an additional insured as their interest may appear. APP VE I 5�NAGEMIENT Y WAIVE /A YES_. cc: •� IG Monroe County Board of County Commissioners 2798 Overseas Highway Marathon C"; j'� FL 33050 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Ac o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �■ 12/07/2016 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 HOUSE NAME: Kelly White & Associates Insurance, LLC (NCNN E . Fxt): 904- 880 -8881 I F AX, Not: P.O. Box 350909 ADDRESS: kelly @kwhiteinsurance.com rs - 11 INSURER(S) AFFORDING COVERAG ["- NAIC # Jacksonville FL 32235 INSURER A : RLI Insurance Co AM Best A+ XI Z C7 r Travelers Property & Casualty Cont IN SURER B : T l P P Y Y INSURED C - Coffin Marine Services, Inc r1 :, INSURER C : - 1 . l• P.O. Box 430538 INSURER D : A m t rus t N A mer i ca U C: INSURER E : Great American Insurance Group Big Pine Key FL 33043 .INSURER F : ^ , COVERAGES CERTIFICATE NUMBER: COFF16120712021004 REVISION NUMBER: 4...... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECfTO WHICH 11 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDNYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS - MADE 1 X1 OCCUR PREMISES (Ea occur ence) $ 50 • X Protection & Indemn /Jones Act MED EXP (Any one person) $ 5,000 A X Salvors Liability MRP0200000 09/23/2016 09/23/2017 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I ECT 1 I LOC PRODUCTS - COMP /OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED BA4902R108 08/17/2016 08/17/2017 BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE $ AUTOS (Per accident) Personal Injury $ 10,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE _ $ DED 1 RETENTION $ $ WORKERS COMPENSATION X PER TUTE I " /� I ER OTH- Includes USL &H AND EMPLOYERS' LIABILITY /� I STA D OFFICER/MEMBER EXCLUDED? XECUTIVE ( N N ( N /A WWC3246363 12/21/2016 12/21/2017 E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) I l E.L. DISEASE - EA EMPLOYEE $ 1 ������� If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ E Vessel Pollution OMH1440763 09/23/2016 09/23/2017 Per co Schedule $1,000,000/ $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Hi / t7 - ` G MENT Certificate holder is an additional insured as their interest may appear. : ,* �► w ■ •• � D - - 1r!"�'v t WA R /A�,,[, c j ( I t'r h d (1..P,o CERTIFICATE HOLDER CANCELLATION C. C ; F WU:Lb -KR_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE 2798 Overseas Highwa Marathon FL 33050, \ \ �ti�. 1 © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACCORD 00 DATE (MMIDD/YYYY) L� CERTIFICATE OF LIABILITY INSURANCE 10 /10/2016 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 HOUSE NAME: Kelly White & Associates Insurance, LLC (A/C. Fxtl 904- 880 -8881 F No): P.O. Box 350909 E - MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # Jacksonville FL 32235 INSURER A : RLI Insurance Co AM Best A+ XI INSURED INSURER B : Travelers Property & Casualty Company Coffin Marine Services, Inc INSURER C : P.O. Box 430538 INSURER D : Amtrust North America INSURER E : Great American Insurance Group Big Pine Key FL 33043 INSURER F : COVERAGES CERTIFICATE NUMBER: COFF16101011220379 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED 50,000 PREMISES (Ea occurrence) $ X Protection & Indemn /Jones Act MED EXP (Any one person) $ 5,000 A X Salvors Liability MRPO200000 09/23/2016 09/23/2017 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO I00 JECT LOC PRODUCTS - COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SIDE LIMIT �1, o (Ea accident) X ANY AUTO BODILY INJURY' reerson) C r B ALL OWNED SCHEDULED BA4902R108 08/17/2016 08/17/2017 BODILY INJURY ident) $ s AUTOS AUTOS r7 X HIRED AUTOS X NON -OWNED PROPERTY DAM G . $ ','S) _AUTOS (Per accident) Personal Injurq . $ 1.01,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE' � $ EXCESS LIAB ..e- (,f1 - -, CLAIMS -MADE AGGREGATE $ DED RETENTION$ �/,�..� $ 1 I . - WORKERS COMPENSATION XJSTATUTE 1 X16RTH- Incluf7e5 USL &H '. AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $ 1,000,000 Ii OFFICER/MEMBER EXCLUDED? N N / A W WC3119140 12/21/2015 12/21/2016 (Mandatory in NH) E .L. DISEASE - EA EMPLOYEE $ 1 ,000, If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ E Vessel Pollution OMH1440763 09/23/2016 09/23/2017 Per co Schedule $1,000,000/ $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) '.. Certificate Holder is an Additional Insured as respects General Liability as per form (Blanket Additional Assured/Waiver of Subrogation) OMGL 624 (11/07) and Auto Liability. Protection & Indemnity is proof of Jones Act coverage required by law. USL & H coverage is provided under orker's Compensation policy. ' . APPR• E R ' N ( A a ■ ' _. ► I , / (e 4, IL v C t 1 —�- CERTIFICATE HOLDER CANCELLATION WAIVER N/A EG Y S_ 1 614A C ( . . `� ° "'` c. Q SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL ED BEF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 2798 Overseas Highway Ste. 420 AUTHORIZED REPRESENTATIVE Marathon FL 33050 /— ` � � : ' \ © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD