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Item D43 CPHEN-1OP ID: KM DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/07/2015 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificate holder in lieu of such endorsement(s). CONTACT Kristin McIntosh PRODUCER NAME: JCJ Insurance Agency FAX PHONE 321-445-1117321-445-1076 2208 Hillcrest Street (A/C, No): (A/C, No, Ext): Orlando, FL 32803 E-MAIL certs@jcj-insurance.com ADDRESS: Mark E. Jackson INSURER(S) AFFORDING COVERAGENAIC # Continental Casualty Company20443 INSURER A : CPH, Inc. Valley Forge Insurance Company20508 INSURED INSURER B : CPH Engineers, Inc. Transportation Insurance20494 INSURER C : 500 West Fulton Street RLI Insurance Company13056 Sanford, FL 32771 INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: 8,-7-783')68-*=8,%88,)430-'-)73*-2796%2')0-78)(&)03;,%:)&))2-779)(838,)-2796)(2%1)(%&3:)*368,)430-'=4)6-3( -2(-'%8)(238;-8,78%2(-2+%2=6)59-6)1)288)6136'32(-8-323*%2='3286%'83638,)6(3'91)28;-8,6)74)'883;,-',8,-7 ')68-*-'%8)1%=&)-779)(361%=4)68%-28,)-2796%2')%**36()(&=8,)430-'-)7()7'6-&)(,)6)-2-779&.)'883%008,)8)617 )<'097-327%2('32(-8-3273*79',430-'-)70-1-877,3;21%=,%:)&))26)(9')(&=4%-('0%-17 ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD AX 1,000,000 COMMERCIAL GENERAL LIABILITY )%',3''966)2') (%1%+)836)28)( X X C509961819904/01/201504/01/2016 300,000 '0%-171%()3''96 46)1-7)7 )ESGGYVVIRGI X Contractual Liab 5,000 1)()<4 %R]SRITIVWSR X XCU 1,000,000 4)6732%0 2,000,000 +)20%++6)+%8)0-1-8%440-)74)6+)2)6%0%++6)+%8) X 463 2,000,000 430-'=03'463(9'87'31434%++ .)'8 Emp Ben.1,000,000 38,)6 '31&-2)(7-2+0)0-1-8 1,000,000 AUTOMOBILE LIABILITY )EEGGMHIRX BX X C509961820404/01/201504/01/2016 &3(-0=-2.96= 4IVTIVWSR %2=%983 %003;2)(7',)(90)( &3(-0=-2.96= 4IVEGGMHIRX %9837%9837 XX 2323;2)( 4634)68=(%1%+) ,-6)(%9837 4IVEGGMHIRX %9837 X X 5,000,000 UMBRELLA LIAB )%',3''966)2') 3''96 C C509961821804/01/201504/01/2016 5,000,000 EXCESS LIAB '0%-171%()%++6)+%8) 10000 X ()(6)8)28-32 4)638, WORKERS COMPENSATION X 78%898))6 AND EMPLOYERS' LIABILITY Y / N D PSW000290701/01/201501/01/2016 1,000,000 %2=46346-)8364%682)6)<)'98-:) )0)%',%''-()28 Y N / A 3**-')61)1&)6)<'09()(# 1,000,000 (Mandatory in NH) )0(-7)%7))%)1403=)) -J]IWHIWGVMFIYRHIV 1,000,000 )0(-7)%7)430-'=0-1-8 ()7'6-48-323*34)6%8-327FIPS[ D Professional LiabRDP001893904/01/201504/01/2016 Per Claim2,000,000 Claims-Made Form Aggregate2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Monroe County is inlcuded as additional insured as respects to General & Auto Liability when required by written contract. 60 Day Notice of Cancellation, except for 10 days for non-payment. CERTIFICATE HOLDERCANCELLATION MONR110 SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN Monroe County ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street Key West, FL 33040 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD