Certificate of InsuranceEACCO-1 OP ID: CF
CERTIFICATE OF LIABILITY INSURANCE
DATE04M/DDIY YY)
14114
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 305-446-2271
Kahn -Carlin & Company, Inc. 305-448-3127
3350 S. Dixie Highway
Miami, FL 33133-9984
Roy V Fabry
NAM"EpCOT T
PHONE 305-446-2271 (FAX
No : 305-448-3127
E-MAIL
ADDR processing@kahn-carlin.com
INSURERS AFFORDING COVERAGE
NAIC N
INSURERA:FCCI Insurance Company
10178
INSURED EAC Consulting Inc.
INSURER a: National Trust Insurance Co
20141
815 NW 57th Avenue #402
Miami, FL 33126
INSURER C: Fireman's Fund Insurance Co.
20141
INSURER D:Ironshore Specialty Ins Co
25445
INSURER E:
rnWCcer_cc CER'r !LATE H IIIMRFR• REVISION NUMBER:
vTHIS 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.
TYPEOFINSURANCE
ADDLSUB
p LICYN M R
POLICYEFF
POLICYEXP
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00C.
PREMIDAMAGSES EE TO a occurrence
$ 300,00
rA
X COMMERCIAL GENERAL LIABILITY
X
CPP00110494
04/22114
04/22M5
MED EXP (Any one person)
$ 10,00
CLAIMS -MADE OCCUR
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00,
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ INCLUDE
$
POLICY X PRO- LOC
AUTOMOBILE LIABILITY
Ea accident COMBINED SINGLE LIMIT
$ 1,000,00
BODILY INJURY (Per person)
$
B
X ANY AUTO
X
CA00157204
04/22/14
04/22/15
BODILY INJURY (Per accident)
$
ALL OW NED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X AUTOS
PROPERTY DAMAGE
Per accident
$
UMBRELLALIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,00
X
AGGREGATE
$ 5,000,00
C
EXCESS LIAB
CLAIMS -MADE
X
UMB0016564301
04/22/14
04/22/15
DED X RETENTION 10,000
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTNE YIN
001WC12A59714
04/22/14
04/22115
X WC STATU- OTH-
T RY 1 ER
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE -EA EMPLOYE
$ 1,000,00
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
N / A
E.L. DISEASE -POLICY LIMB
$ 1,000,00
If yes, describe under
DES RIPTION OF OPERATIONS below
D
Professional Liab.
000970202
04/22/14
04122/15
Per Claim 2,000,00
Deductible-$50,000
RETRO DATE- 916/94
Aggregate 5,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
PROJECT: Professional Engineering Services - EAC Project #13036.SD01-00
The certificate holder is additional insured as respects General Liability &
Auto Liability. V i
BP v < ENT
DA -
-_
WAIV /A E
MONRO-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Monroe County ACCORDANCE WITH THE POLICY PROVISIONS.
Engineering Services
Room #216 AUTHORIZED REPRESENTATIVE
Simonton Street Key —�
Key West, FL 33040
V'IV55-'eU1U AL.VKu %.VRrVR/il lure. All r19111S reuerveu.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD