COI Expires 02/08/2017 __.-..0.0mill DIONENT OP ID: KL1
/►coEZO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
( ..... 02/16/2016
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
Phone: 305 - 238 -1000 NAME
Morris 8. Reynolds Inc. Fax; 305-255-9643 PHONE FAx
1 South Dixie Highway LAIC, Ng, Eel, ( !. No)
Miami, FL 33176 E -MAIL
Robert D. Reynolds ADDRESS
INSURERIS) AFFORDING COVERAGE NAIG a
INSURER A United States Fire Insurance 21113
INSURED Dion Fuels LLC INSURER B Bridgefield Employers Ins. Co. 10701
Mr. Steven Uphoff INSURER Endurance Reinsurance 11551
Post Office Box 1209
Key West, FL 33041 INSURER 0 •
INSURER E •
INSURER F __-
COVERAGES CERTIFICATE NUMBER: 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
tNSk TYPE OF INSURANCE ADDS SUER POLICY EFF POLICY EXP LIMOS _
LTR W POLICY NUMBER
SR WVD (MM/OD IY
/YYYYI (MMIDDYYY)
GENERAL LIABILITY E/ CH OCCURRENCE 5 1,000,00
A X COMMERCIAL GENERAL LIABILITY 5068840536 02/08/2016 02/08/2017 r S / E a o 'ED 5 100,001
)'REMISES {Ea ctr.
CLAIMS -MAO€ X OCCUR MED ExP (Any one peraalli 5 5.001
PERSONAL 5 ADV INJURY 5 1 ,000,00
GENERAL AGGREGATE $ 2,000,001
GEN'L AGGRE(,,AlE I non APPOES PER PRODUCTS . COAlPAOP AGO 5 2,000,00
PRO-
E m B e n. s 1
.
POLICY
• L _�. __._._. p
AUTOMOBILE LIABILITY - - - -- EO *cadent) SINGLE LIMIT 5 1,000,001
A ANY AUTO 5068840536 02/08/2016 02/08/2017 ea0$LY IN JURY' leer person) 5
X ALL TO O WNED SCHEDULED
AUTOS Ii�.JUII r IN: URY !Per ecddenq 5
AU
r:ON- O`Nrl€L? F'k )PERTY DAMAGE
X HIRED AUTOS X AUTOS tt er acddent) ..
$
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 10,000,001
A EXCESS WAD __CLAIMS_MADE 5238037188 02/08/2016 02/08/2017 AGGREGATE $ 10,000,00*
_ _
DEC) X RETENTION$ . 0 s
WORKERS COMPENSATION 'NC STATU- OTF,-
AND EMPLOYERS' LIABILITY X 10RY UM*T6 ER
B AN+ PROPRIETOR /PARTNERJEXECUTIVE YT N 83040822 02/08/2016 02/08/2017 L FACH ACCIDENT $ 500,001
OFFICFRfMEMBER EXCLUDED' C .., N 1 A
(Mandatory M NH) E l DISEASE - EA EMPLOYES 5 500,00f
( ;n 56 descr undo,
RIPTiON OF OPERATIONS Geion E L DISEASE - POLICY LIMIT 500,00
C Excess Liability EXC30000056100 02/08/2016 02/08/2017 Excess Li 5,000,001
DI_ SCRIPTION OF OPERATIONS ! LOCATIONS 7 VEHICLES (Attach ACORD 101 Aodit)onal Remarks Schedule. it more space is regtered)
Petroleum Distributor - State of Florida
Monroe County Board of County Commissioners are Additional Insured
on Liability Policies as their interest may appear with respect to contract
for fuel delivery services ,
APP ' O\ m "*• ANAGEMENT
�1 �v _ oils:, (e7eic_
D•' d's (..
WA R N /A r S Cc LC,
CERTIFICATE HOLDER 1 CANCELLATION (4� Te
V 1, ,-. iRRI 1UJ 3U�1MOW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
. i) '2413 'W11 •�1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County BOCC
Risk Managnlent
1100 Simonton Street AUTHORIZED REPRESENTATIVE
Key West, FL 33� : Ina 6Z 833 9101 �`�,� a
j '((}} ( (���� f + 1988 -2010 ACORO CORPORATION. All rights reserved.
ACORD 25 (2010/05) i ! �1 f1CYl�RO t1�r� land logo are registered marks of ACORD
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