COI Expires 01/01/2019AC "R" CERTIFICATE OF LIABILITY INSURANCE D ATE
01 /02 /2016 D(YYYY)
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 endorsement(s).
PRODUCER CONTACT
MARSH USA INC. NAME:
501 MERRITT 7 PHONE Exit FAX Nod;
NORWALK, CT 06856 -6010 ADDRESS:
Attn Norwalk.certrequest @ marsh.com
INSURER(S) AFFORDING COVERAGE NAIC #
416752- ENVIS- GAWXM-18 -19 _ INSURER A: Allied World Assurance Company, Inc. 1949
INSURED Envision Pharmaceutical Holdings, LLC INSURER B : Travelers Pro perty Casualty Co. of America 25674 2181 East Aurora Road, Suite 201 INSURER C: WA NIA
Twinsburg OH 44087 IusuwcR n - Tha Tmvalarc Indemnity r.mmnanv 25658
COVERAGFS CFRTIFICATF NIIMRFR! NYC- 008864003 -20 REVISION NUMRFR_ 7
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
ADDL
SUER
POLICY NUMBER
MM D YYYY
MM/DD YYYY
OMITS
A
X
COMMERCIAL GENERAL LIABILITY
0309 -3594
0110112018
0110112019
EACH OCCURRENCE
$ 5,000,000
CLAIMS MADE I J OCCUR
D AGE To RENTED
RE
PMISES Ea occurrence)
$ 500,00
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 5,000,000
X POLICY PRO LOC
JECT
PRODUCTS - COMP /OP AGG
$ 5,000,000
OTHER:
$
B
AUTOMOBILEUASIUTY
TC2JCAP 8049X072 - 18
0110112018
01/0112019
COMBINED SINGLE LIMIT
Ea accident
$ 5.000.000
X
BODILY INJURY (Per person)
ANY AUTO
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
$
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per accident
ZED NON -OWNED
AUTOS ONLY AUTOS ONLY
$ _.
UMBRELLA LAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
EXCESS LIAB
CLAIMS -MADE
$
DIED I I RETENTION $
$
B
D
B
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY ' YIN
ANYPROPRIETOR /PARTNERlEXECUTIVE
OFFICER /MEMBER EXCLUDED? a
(Mandatory in NH)
NIA
TC2JUB- 7442L10A -18 (AOS)
TRKUB 7442L111 - 18 (AZ, MA)
OR TWXJUB 74421123 - 18 OH,
( )
0110112018
01/01/2018
01101/2019
0110112019
01/01/2019
X STATUTE � R H
--
E.L. EACH ACCIDENT
$ 2,000,000
E.L DISEASE - EA EMPLOYEE
$ 2,000,000
E L DISEASE - POLICY LIMIT
$ 2,000,000
If yes describe under
DESCRIPTION OF OPERATIONS below
'Excess WC
A
Healthcare Facilities
0309 -3594
01/01/2018
01/0112019
SEE ATTACHED
Medical Professional Liability
'(CLAIMS MADE)'
SEE ATTACHED
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
G- 147167 -B99 (12/06) Monroe County Board of County Commissioners is included as additional insured where required by written contract with respect to General Liability.
APP VE Y GEMENT
WAIVE /A � Y S _ (� P,
r`GDTICIf'ATC Uni r1FD CANrF=1 I ATIr1N IVI /IYI U — f�r11�p -L t'S
Monroe County Board of County
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Commissioners
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1100 Simonton St., Suite 2 -268.
ACCORDANCE WITH THE POLICY PROVISIONS.
Key West, FL 33040
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
, 1
Nancy Kalbfell k16
V 19t5t$ - ZUIb AcUKU l:uKrUKA 1 IUN. An rlgnis reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD