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COI Expires 06/12/2019 � ® DATE (MMIDD/YYYY) A CC CERTIFICATE OF LIABILITY INSURANCE 6/5/2018 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 NAME: S erena Turchik The James B. Oswald Company PHONE FAX 1100 Superior Avenue, Suite 1500 lac. No. Ertl: 216 (A/C, No): Cleveland OH 44114 AD STurchik @oswaldcompanies.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: XL Specialty Insurance Co. 37885 INSURED MBIK2 - INSURER B : K2M Design 1150 Virginia St INSURERC: Key West FL 33040 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 614400043 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 TYPE OF INSURANCE ADDL SUBR 1 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) IMM /DDIYYYY1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ DAMAGE TO RENTED CLAIMS - MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL. AGGREGATE $ POLICY PRO JECT LOC PRODUCTS - COMP /OP AGG $ OTHER $ AUTOMOBILE LIABILITY ^ ��� ' COMBINED SINGLE LIMIT $ A�pfj�OVE , gY qIS (Ea accident) ANY AUTO j, BODILY INJURY (Per person) S OWNED SCHEDULED .' BODILY INJURY (Per accident) S AUTOS ONLY AUTOS HIRED NON -OWNED L - PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY DA (Per accident) WAWA UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANYPROPRI ETOR /PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? N (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S A Professional Liability N Y DPR9926712 6/12/2018 6/12/2019 Each Claim $3,000,000 Claims Made Aggregate $3,000,000 Retro Date: 9/1/2001 Pollution 8, Envir. Liab. Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Waiver of Subrogation as designated above is provided when required of the Named Insured by written contract or agreement. Project:Key West Customs Terminal Phase II — 15103 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ann Riger 1100 Simonton Street, Room 2 -216 AUTHORIZED REPRESENTATIVE Key West FL 33040 aSt:mck ■wlk © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Bureau of Workers' 30 W. Spring St. Ohio Compensation Columbus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. This certificate is only valid if premiums and assessments, including installments, are paid by the applicable due date. To verify coverage, visit www.bwc.ohio.gov, or call 1- 800 - 644 -6292. This certificate must be conspicuously posted. Policy number and employer Period Specified Below 01493325 07/01/2017 to 07/01/2018 K2M DESIGN INC 9435 WATERSTONE BLVD. SUITE 250 , • , CINCINNATI, OH 45249 p,. • www.bwc.ohio.gov • l,Z;s Issued by WC Administrator /CEO You can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation Required Posting Effective Oct. 13, 2004, Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work - related injury. The burden of proof is on the employee to prove the presence of alcohol or a controlled substance was not the proximate cause of the work - related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. Bureau 'of Workers' Ohio Compensation You must post this language with the Certificate of Ohio Workers' Compensation. DP -29 BWC -1629 (Rev. July 1, 2015)