COI Expires 11/02/2017---, ®
aCC)R o CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
8/29/2017
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 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
Brown & Brown Insurance - Clearwater
83 Park Place Blvd., Suite 101
Clearwater FL 33757-2456
NT
NAMEACT Vicky Van Wormer
PNONE 727-450-7018 FAX 727-450-7083
E-MAIL
, vvanwormer@bbpinellas.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Admiral Insurance Company
24856
INSURED
INSURER B :The Travelers Indemnity Company of America
25666
INSURER C :The Charter Oak Fire Insurance Company
25615
Kisinger Campo & Assoc. Corp.
Campo & Associates, PLLC, KCCS, Inc.
201 N. Franklin Street, Ste. 400
INSURER D :Travelers Casualty and Surety Company
19038
Tampa FL 33602
INSURER E :
INSURER F :
^ nvicit`ATC ki"umco 139SWARRSH RPVISIrIN NIIMRER,
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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
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DDNYYY
LIMITS
C
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X❑ OCCUR
630-8254A604
9/1/2017
9/1/2018
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$300,000
X
MED EXP (Any one person)
$10,000
Contractual
X
XCU Liability
PERSONAL&ADVINJURY
$1,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000,000
GEN'L
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY [X] PRO- LOC
OTHER:
$
B
AUTOMOBILE LIABILITY
8108254A604
9/1/2017
9/1/2018
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY X AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
B
X
UMBRELLA LIAB
X
OCCUR
CUP8254A604
9/1/2017
9/1/2018
EACH OCCURRENCE
$4,000,000
AGGREGATE
$4,000,000
EXCESS LIAB
CLAIMS -MADE
DED X RETENTION $10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNER/EXECUTIVE ❑
DED? OFFICER/MEMBER EXCLU
(Mandatory In NH)
N / A
UB2G641560
10/3/2017
10/3/2018
H
X STATUTE X ER
U.S.L.H.
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYE
1500,000
E.L. DISEASE - POLICY LIMIT
$500,000
M yes, describe under
DESCRIPTION OF OPERATIONS below
A
Professional Liability
Claims Made
E000002720503
11/2/2016
11/2/2017
Per Claim 5,000,000
Aggregate 5,000,000
Deductible 250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability. Explosion, collapse and
underground hazard included in CGL.
GARRISON BIGHT BRIDGE REPAIR DESIGN PROJECT. FPN 431918-1. 60-DAY&NICE ELLATION OR NON -RENEWAL
PERFORM IL-T4050311. (KCA PROJECT #1201524.00)A
DEMENT
W
GtK 11t IL:A I t MULUtK lil11\6rGGGI91 IVI�
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MONROE COUNTY - BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN: JUDITH S. CLARKE, P.E., DIRECTOR OF ENG SVC ACCORDANCE WITH THE POLICY PROVISIONS.
1100 SIMONTON STREET, #216
KEY WEST FL 33040
AUTHORIZED REPRESENTATIVE
CG 'lM.annn / R.
tJ Iy81f-ZUIO AI,UKU t.UKYUKFII lUM- AN ngnis rCserveu.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD