COI Expires 12/13/2018ACOR 76
�- CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
11/28/2017
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 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:
PHONE
No Ext : FAX
A/C AIC No):
KOuwenhoven &Associates
ADDRESS:
365 Wekiva Spring Road, Suite 251
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Markel Insurance Company
38970
Longwood FL 32779
INSURED
INSURER B
INSURER C :
Pallo, Marks, Hernandez, Gechijian & DeMay, P.A.
INSURER D :
3701 Catalfumo Way South
INSURER E :
INSURER F :
Palm Beach Gardens FL 33410
COVFROGSFS CFRTIFICOTF NIIMRFR• RFVISIr]N NIIMRFR-
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.
LTR
TYPE OF INSURANCE
INSD
NND
POLICY NUMBER
POLICY EFF
MMIDD
POLICY EXP
MM/DD
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE 0 OCCUR
'
7AMAUE TO RENTED
PREM SES fEa occurrence
$
MED EXP (Any oneperson)
$
PERSONAL & ADV INJURY
S
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRO ❑ LOC
POLICY JECT
PRODUCTS -COMPlOPAGG
$
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
HIREDAUTOS NON -OWNED
AUTOS
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAR
DED RETENTION$
$
KERS COMPENSATION
AND EMPLOYERS'LIABILITY y/ N
PEROTH-
STATUTE ERANY
PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑N
NIA
E.L. EACH ACCIDENT
$
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYE
S
Ifyyes, describe underIWOR
OC-&6P.IPTION OF-0PFRAT!0NL"P.hw '—
_
— _ — _
_ _ _
_ _ __
_E-I-.DISEASE - POLICY.LIMIT
$__
A.
PL- Professional Liability _F
I
TLA30.5895
_
12/13/201F�2J`13/2018
$3,000,000 - Each Claim
$3,000,000 -Annual Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached K more space is quire
RETRO DATE: 6/1/1997
APP V Y AC7EMENT
��
WAIVE /A YES_
� C�2- (�
Monroe County Board of County Commissioners
1111 12th Street
Suite 408
Key West FL 33040
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
Ell
ll-1-JOO�GV IY NI+VRY LrVRr VRMIIVI\. MII IIIJIIW IG.IGYCY.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD