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COI Expires 03/01/2019 44384 DATE (MMfDD/YYYY) A�� °O CERTIFICATE OF LIABILITY INSURANCE E (MMI 018 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 NAME: CONTACT Francys Tolon Commercial Lines - (305) 443 -4886 PHONE FAX 1A/C. No. Ext): 786.785.1126 I (ac, No): 7862649232 USI Insurance Services National, Inc. ADDRESS: francys.tolon @usi.com 2601 South Bayshore Drive, Suite 1600 INSURER(S) AFFORDING COVERAGE NAIC # Coconut Grove, FL 33133 INSURERA: Old Republic Insurance Company 24147 INSURED INSURER B: American Guarantee and Liability Insurance Com 26247 Weekley Asphalt Paving, Inc. INSURER C: AGCS Marine Insurance Company 22837 20701 Stirling Road INSURER D: INSURER E : Pembroke Pines FL 33332 INSURER F: , COVERAGES CERTIFICATE NUMBER: 13299344 REVISION NUMBER: See below 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 POLICY EFF POLICY EXP -LIMITS LTR INSD WVD POLICY NUMBER (MM /DD/YYYYI (MMIDD!YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 A X MWZY 312q6 03 e 0 0.,�Bry CLAIMS -MADE I OCCUR P O ' to , ` NACit ED = RISK ^-' •' DAMAGE TO RENTED 500;000 _ I_ X J A 1� f PREMISES (Ea occurrence) $ �Y / r MED EXP (My one person) $ 10,000 �� PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: DAT - -- . . /' GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC WAIVER NI - - - YES-- PRODUCTS - COMP /OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X MWTB 312425 03/01/2018 03/01/2019 COMaccideBINED nt) SINGLE LIMIT S . - 1,000,000 CO X ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS ONLY _ AUTOS _ HIRED NON -OWNED PROPERTY DAMAGE s AUTOS ONLY _ AUTOS ONLY (Per accident) $ B j( UMBRELLA LIAB X OCCUR AUC593410904 03/01/2018 03/01/2019 EACH OCCURRENCE _ S 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED RETENTION S $ WORKERS COMPENSATION PER OTH- A 03/01/2018 03/01/2019 X AND EMPLOYERS' LIABILITY Y / N MWC 312427 00 I STATUTE I I ER ANYPROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? Y N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Leased & Rented Equipment - MXI93071287 03/01/2018 03/01/2019 L &R Equipment $200,000 Deductible $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Key Largo II Roadway & Drainage Improvement Project South Florida Water Management District, Florida Department of Transportation, Monroe County, Property Owners for Lot 1: Raymond Hinds /Sadie or current owner, Property Owners for Lot 10: John Parry or current owner, Property Owners for Lot 14: Jason and Monique Luna•or current owner, Property Owners for Lot 15: Ingrid White or current owner are listed as additional insureds on General Liability Policy and Automobile Liability Policy. CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1100 Simonton Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE 1 The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) (This ce,Gficate replaces cer6r 4116# 13048181 issued on 5125/2018) G■ :,14/1/444/144•LI . Key Largo II Roadway and Drainage Improvement Project Bidder's Insurance Statement The Insurance requirements are set forth in Section 00900 of the project manual as follows: Insurance Requirement Limits Worker's Compensation Statutory Limits Employer's Liability WC3 $ 1,000,000 /$1,000,000 /$1,000,000 General Liability GL4 $5,000,000 Combined Single Limit GLXCU *Required Endorsement Underground, Explosion and Collapse (XCU) Vehicle Liability VL3 $500,000 per person; $1,000,000 per occurrence (Owned, hired and $100,000 Property Damage Non- owned Vehicles) or $1,000,000 Combined Limit r - The Coo t aactor must include the South Florida •Water Management District, Florida Departmentof l- Transportation,:Monroe County property owners of 'lots 1 10, 44 and 15 as,ad`ditiorial in §ured. on General Liabiiityfolicy I understand the insurance that will be mandatory if awarded the contract and will comply in full with all these requirements. All insurers shall have an A.M. Best rating of VI or better and shall be licensed to do business in the state of Florida. WEEKLEY ASPHALT PAVING, INC. 5/10/18 Name of Business Signature Daniel D. Wee. , President Date 12/8/17 BID PROPOSAL 00110- 11