Loading...
COI Expires 09/01/2018ACOR 7 @ A� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 110/30/2017 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 PHONE 727-450-7018 F^X 727-450-7083 E-MAIL ,vvanwormer@bbpinellas.com INSURERS AFFORDING COVERAGE NAIC # 1NSURERA:Admlral Insurance Company 24856 INSURED INSURER B:TheTravelers .lndemnit Company of America 25666 Kisinger Campo & Assoc. Corp. INSURER C :The Charter Oak Fire Insurance Company 25615 Campo & Associates, PLLC, KCCS, Inc. 201 N. Franklin Street, Ste. 400 INSURERD:Travelers Casualty and Surety Company 19038 Tampa FL 33602 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 617073408 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. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY 630-8254A604 9/1/2017 9/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $300,000 X MED FRCP (Any one person) $10,000 Contractual X XCU Liability PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY FX—] jEOOT- LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 8108254A604 9/1/2017 9/1/2018 COMBINEDSINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY N AUTOS ONLY X PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB X OCCUR CUP7J748484 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 / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N / A UB2G641560 10/3/2017 10/3/2018 - -X- PER _ -X OTH- STATUTE ER U:S:L.H. - - - E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 A Professional Liability E000002720504 11/2/2017 11/2/2018 Per Claim 5,000,000 Claims Made 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. . ON-RENEWAL GARRISON BIGHT BRIDGE REPAIR DESIGN PROJECT. FPN 431918-1. 60-DAYS NOTICE OF CW/AYES PERFORM IL-T4050311. (KCA PROJECT #1201524.00) BAYEMENT WA_ CERTIFICATE HOLDER CANCELLATION MONROE COUNTY - BOCC ATTN: JUDITH S. CLARKE, P.E., DIRECTOR OF ENG SVC 1100 SIMONTON STREET, #216 KEY WEST FL 33040 LG' 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 4,M. R.v ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD