COI Expires 05/22/2018UtK 11HUATE OF LIABILITY INSURANCE DATE(MWDD/YYYY)
11/30/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAE HOLDER.
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY T T THIS
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT
CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUR
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ER(S), AUTHORIZED
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 certain
policy, 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
THOMAS LEDWIDGE INSURANCE AGENCY
CONTACT
NAME PHONE Thomas Le
1
Stafefatrt. 6177 MIAMI LAKES DRIVE E
LAIC, 305 - 822 -2424 FAX
Extl _ �IAIC No):�
E-MAIL
�- MIAMI LAKES, FL 33014
.
ADDRESS. _ @_t___d geagency.com
INSURERS) AFFORDING COVERAGE
NAIC S
$
INSURED OAC ACTION COTRUCTION _ CORP
- NS
INS URER A State Farm Mutual Aut Insurance Company
-- --
25178
(10260)
11980 SW 144 Ct. Suite 101
INSURER B
- - - --
INSURERC:
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED �/ SCHEDULED
AUTOS ^ AUTOS
-- HIRED AUTOS NON -OWNED
AUTOS
MIAMI FL 33186 -6266
N
447 7958- E22 -59F
689 4492 - E22 -59F
927 4908 - E22 -59D
9454338- E22 -59C
INSURER D : _
BODILY INJURY (Per person)
I NSURER E:
BODILY INJURY (Per accident)
COVERAGE CERTIFICATE nttuumr =a•
INSURER
F
$ 1, 000 , 000
THIS r 11C`IVIV Vi Ll V1131twil:
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 R EDUCE D BY PAID CLAIMS.
INSR ADDL SUER ----- - - - - -- pOLICV EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER MMI Y
IC EFF P01JC` YYYY LIMITS
COMMERCIALGENERALLIABILITV
1 I EACH OCCURRENCE $
CIAfMS -MADE OCCUR D MMAGE TO RENT -
r I I PREMISES Ea occurrence S
DESCRIPTION OF OPERATIONS i LOCATIONS / VEHICLES (ACORD 1111, Additional Remarks Schedule, may be attached it more space is required)
2008 CHEVROLET C1500 VIN: 2GCEC13J281158461 2017 Infiniti QX60 MDX VIN: 5NIDLOMN9HC543707
2017 Cadillac XT5 VIN: 1 GYKNBRSXHZ132209 2011 FORD F250 SD PICKUP VIN: 1 FT7W2BT1BE652505
CGC License #061561 A n
CERTIFICATE HOLDER CANCELLATION
Monroe County Board of County Commissioners
1100 Simonton Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Key West, FL 33040 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORI;F�Q REPRESENTATIVE —
c r vin vt T1A
ACORD 25 (2014101) The ACORD name and logo are registered mo 19 8-2014 D AC ORD CORPORATION. fights reserved.
7001486132849.9 02 - 0 4-2014
MED EXP (Any one person)
$
1
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY 0 PRO-
JECT LOC
DTHER:
PERSONAL 8 A. INJURY
--
$
G ENERAL AGGREGATE
--
$
PRODUCTS •COMPlOPAGG
$
COMBINED SINGLE LIMIT
Ea accident
-
$
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED �/ SCHEDULED
AUTOS ^ AUTOS
-- HIRED AUTOS NON -OWNED
AUTOS
Y
N
447 7958- E22 -59F
689 4492 - E22 -59F
927 4908 - E22 -59D
9454338- E22 -59C
11/22/2017 05122/201$
11/22/2017 05/22/2018
11122/2017 05/22/2018
11/22/2017 05/22/2018
BODILY INJURY (Per person)
5 1,00.000
BODILY INJURY (Per accident)
$ 1,000,000
PROPERTY DAMAGE
P eraccden0 ____
$ 1, 000 , 000
$
UMBRELLA LIAB 1
!OCCUR
EXCESS LIAB
� I CLAIMS•MADE
EA CH OCCURRENCE
g
-- --
DED NTION $ RETE
AGGREGATE
S
—
--
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YINI
ANY PROPRIETORIPARTNER'FXECUTIVE ❑i
R'
OFFICEMEMBER EXCLUDED?
(Mandatory in NH)
I! es, desaibe under
DESCRIPTION OF OPERATIONS below
NlA I
I
PER OTH-
STATUTE - ER
E.L. EACH ACCIDENT !
E.L. DISEAS - EA EMPLO
_
$
- .
E.L. DISEASE POLICY LlbllT
--
S
_
DESCRIPTION OF OPERATIONS i LOCATIONS / VEHICLES (ACORD 1111, Additional Remarks Schedule, may be attached it more space is required)
2008 CHEVROLET C1500 VIN: 2GCEC13J281158461 2017 Infiniti QX60 MDX VIN: 5NIDLOMN9HC543707
2017 Cadillac XT5 VIN: 1 GYKNBRSXHZ132209 2011 FORD F250 SD PICKUP VIN: 1 FT7W2BT1BE652505
CGC License #061561 A n
CERTIFICATE HOLDER CANCELLATION
Monroe County Board of County Commissioners
1100 Simonton Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Key West, FL 33040 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORI;F�Q REPRESENTATIVE —
c r vin vt T1A
ACORD 25 (2014101) The ACORD name and logo are registered mo 19 8-2014 D AC ORD CORPORATION. fights reserved.
7001486132849.9 02 - 0 4-2014