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COI Expires 11/02/2017, ® A CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/2/2017 v 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 endorsements . PRODUCER Bowen, Miclette & Britt of Florida, LLC 1020 N. Orlando Avenue Suite #200A Maitland FL 32751 CONTACT NAME: Angie Desormeaux PHONE Fxt407-647-1616 FAX c N : 407-628-1635 E-MAIL Certificates@bmbinc.com MESS, INSURERS AFFORDING COVERAGE NAIC # _ INSURERA:Amerisure Insurance Company I19488 INSURED PEDROFALCO Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C Big Pine Key FL 33043-4516 INSURER B :Amerisure Mutual Insurance Com an 23396 INSURER C : INSURER D INSURER E INSURER F COVERAGES GtFiIIrIGAIt Num01=11: www. 1 —•--•---_--- INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYYENERAL LIMITS LIABILITY Y Y GL2092941 11/2/2016 11/2/2017 EACH OCCURRENCEq 1,000,000 DAMAGE TO RENTEDDE PREMISES Ea occurrence100,000 "��j I X OCCUR MED EXP (Any one person5,000 PERSONAL & ADV INJUR1,000,000GEN'L AGGREGATE2,000,000 AGGREGATE LIMIT AP�PL�IES PER:GENERAL PELT '�� LOC � PRODUCTS - COMP/OP AGG $$2,000,000 POLICY A OTHER: AUTOMOBILE LIABILITY Y Y CA2092939 11/2/2016 11/2/20171,000,000 IN I LIMIT$ Ea accident) BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS NON -OWNED UTOS PROPERTY DAMAGE Per accident $ HIRED AUTOS AUTOS $ B X UMBRELLA LIAB I OCCUR Y CU2092942 11/2/2016 11/2/2017 EACH OCCURRENCE $4,000,000 AGGREGATE $ EXCESS LIAB CLAIMS -MADE $ A DED RETENTION $ WORKERS COMPENSATION Y WC2094526 11/2/2016 11/2/2017 X PER OTH- STATUTE � ER E.L. EACH ACCIDENT $500,000 AND EMPLOYERS' LIABILITY Y� ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $500,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) E.L. DISEASE - POLICY LIMIT $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below Y K Nt i I APP V W Ad DATE VC W R N/A YE DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing: certificates@bmbinc.com When required by written contract, those parties listed in said contract, including the Certificate Holder, are added as an Additional Insureds with respect to the General Liability, Auto Liability and Umbrella Liability as afforded by the policy and/or endorsements. See Attached... a.. Monroe County Board of County Commissioners 1100 Simonton Street Suite 2-213 Key West FL 33040 C C.' 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 �/ •1A1'9ATIA\I A11 ­e-A ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PEDROFALCO AC RO EP 1161913; ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Bowen, Miclette & Britt of Florida, LLC NAMEDINSURED Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C Big Pine Key FL 33043-4516 POLICY NUMBER CARRIER 7r!EF_ FECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE When required by written contract, a Waiver of Subrogation, with respect to the General Liability, Auto Liability and Worker's Compensation is granted to those parties listed in said contract, including the Certificate Holder. The General Liability and Umbrella Liability, certified herein are primary and non-contributory to other insurance available, but only to the extent required by written contract. Project Reference: Big Pine Park, Shade Structure Retrofitting/New Bocce Courts ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD