COI Expires 02/17/2018ACC>RE
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDNYYY)
11/03/17
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
NAME:
PHCNt o Ext : (305) 501-2801 FAX No, (305) 553-9010
Hemisphere Insurance Group
E-MAILADDRESSO hemisphereinsgrp@aol.com
12350 SW 132 CT #107
INSURERS AFFORDING COVERAGE
NAIC #
Miami, FL 33186
INSURER A: ATLANTIC CASUALTY INS COMP
Phone (305) 501-2801 Fax (305) 553-9010
INSURED
INSURER B : PROGRESSIVE INSURANCE
INSURER C
Conch Wastewater, Inc.
INSURER D
89 INDUSTRIAL RD
INSURER E :
BIG PINE KEY, FL 33043
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.
ILTR
TYPE OF INSURANCE
ADDLSUBR
NSR
WVD
POLICY NUMBER
MMILDDY/YEYri
MMIDD//YYYY
LIMITS
A
GENERAL LIABILITY
❑d COMMERCIAL GENERAL LIABILITY
❑ ❑ CLAIMS -MADE❑ OCCUR
❑
L144000691-7
04/18/2017
04/18/2018
EACH OCCURRENCE
$ 1,000,000.00
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100.000.00
MED EXP (Any one person
$ 5,000.00
PERSONAL & ADV INJURY
$ 1,000,000.00
❑
GENERAL AGGREGATE
$ 2,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER:
❑ POLICY ❑ PRO ❑ LOC
PRODUCTS - COMP/OPAGG
$ 1,000,000.00
$
B
AUTOMOBILE LIABILITY
❑ ANY AUTO
❑ ALL AUTOS OWNED ❑ AUTOS SCHEDULED
❑HIRED AUTOS NON -OWNED
❑ AUTOS
❑ ❑
02876247
02/17/2017
02/17/2018
COMBINED SINGLE LIMIT
Ea accident)$
1,000,000.00
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
❑ UMBRELLA LIAB ❑ OCCUR
❑ EXCESS LIAB ❑ CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
❑ DED ❑ RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
if yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
❑ T/ RY LAMU- ❑ OTRH-
ITS
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS AS ADDITIONAL INSURED.
`PPRO ED erg_atc
WAV A fJ�!GEMENT
_ cc: -F e
_ a
CERTIFICATE HOLDER CANCELLATION '
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
9400 OVERSEAS HWY
SUITE 200
MARATHON, FL 33050
ACORD 25 (2010105) QF
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
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