COI Expires 05/01/2019CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD1YYYY)
I 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 ri h'ts to the certificate holder in lieu of such endorsemelnt s).
PRODUCER CONTACT
NAt,1 Pe rteo Insurance R.gency,..Inc,
;
Pettineo HONE FAX Insurance Agency, Inc. lnc. 954- 4'93 - 9424 (AM , 954A93 -83 8
E -MAIL
2430 E Commercial Boulevard 4DDRE
Fort Lauderdale, FL 33308 INSUREN AFFORDING COVERAGE
INSURFRA. The Burlington Insurance Co.
INSURED INSURER B . Hudson Excess In urallCe Co. 11 Triple M Roofing Corp. IN$URCRC Merkel I
914 NW 19th Avenue INSURER 0; Travelers 27998
rnVFPAnf r`.'.FPTIFIrATF NIIMRr —R- R9=VI61nM MtsMal =w•
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.
A660 50dril' LTR ( TYPE OF INSURANCE INSD Wyp I POLICY NUMBER ;A CY EF Y MM 4t Y_'E_' i LIMITS
z COMMERCIAL GENERAL LIABILITY
( �, � EACH OCCURRENCE ( $ 1 ,000,000
f
t CLAIMS -MADE X . OCCUR
E ° OAMA6e: TO 0_4TtL3 • . ..
` PEiLS La e�.'r. rw r ec6 E $ 100, 000
_ d `E. _ .. .... . _. .....
f c PRE
5
A ! Y
Y 289BW44707 5!)l�,(11 5119 PERSONALa NJURV $ 1,Op
�-y 0 000
' ENT ALnCi REGALE LIMITAPPLIES PER.
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PRO- �
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APP, ' � ,�'` �� � S �'a GENERAL AGGREGATE I 2,000,000 -,
PC."Licy �,, JECT I LOC�
(
.I 1 OS1.9Ef1:....
y •' •,,.,„_. PRODUCTS • COMP/01 AGG $ _ 1
-.
$
AUTOMOBILE LIABILITY
•
„� °' °^ LIF. #4F
- - - COMBINED SINGLE
J i ($ 1,000 r QOO
ANY AUTO (
_ r,
WAIV 9 -' A.. YFB. i BODILY INJURY (Per person) $
,,..
OWNED j SCHEDULED
D AUTOS ONLY AUTOS Y
" BODILY INJURY (Per accidanl
Y BA- 3J367451- 18 -SEL 5/112018 511/2019 # )
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTYgyAMACE
PIP $
UMBRELLA LIAR OCCUR
_,
" 10,000
( EACH OCCURRENCE N
B -x
EXCESS LIAB ( CLAIMS.MA Y
Y HXS100037902 5/1/2018
y 5/1/2019 AGGREGATE $ 5,000,000
OED RETEN
_
_
$
WORKERS COMPENSATION "
I AND EMPLOYERS' LIABILITY YIN
+
' PER U1H• #� _
STt1, v:rE
, ANY I ROIIR Y014Jf�AIeTfJH: ,EXECUTIVE
" ICETi.FI�eIO SEE EXCL.§, Ot )'? N I A
(51 T
I
i
E L EACH ACCIDENT $
e - .
(A0n4;tory In NH)
E.L. DISEASE EA EMPLOYEE $
I If yes describe under
D
DESCRIPTION . OF OPERATIONS below
_
-
,7 - --
E.L DISEASE - POLICY LIMIT j $
Equipment: I $318,502
C
11-1 511!2018
5/112019 Job Site: $193,000
INLAND MARINE
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ,
Monroe County Board of County Commissioners
is listed as an additional insured. A E Y ISK M, N,� EMENT
BY £. -..
_
DATE
WAIVER WA YE6 _
aw
Monroe County Board of County
Commissioners
500 Whitehead Street
Key West, FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPAIR
5 ACORD CORPORATION All rlahts rPSarved
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD