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HomeMy WebLinkAboutCertificates of Insurance DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 09/16/2022 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 HOUSE NAME: Kelly White&Associates Insurance, LLC AICN No, Ext: 904-880-8881 A/c NO): 1622 Hickman Road E-MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32216 INSURER A: RLI Insurance Co AM Best A+XI 13056 INSURED INSURER B: Travelers Property&Casualty Company 36161 Coffin Marine Services, Inc INSURERC: P O Box 430538 INSURER D: Everest National Insurance Company 10120 INSURER E: Water Quality Insurance Syndicate Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF22091 61 4081 262 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE F_X1 OCCUR PREMISES(Ea occurrence) $ 50,000 X P&I including Jones Act MED EXP(Any oneperson) $ 5,000 A X Salvors Liability X X MRP0200000 09/23/2022 09/23/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PRO ❑ 1,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: Protection&Indemnity $ $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2022 08/17/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED IX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident )� �' Personal Injury $ 10,000 UMBRELLA LIAB OCCUR "' ' ,� ., �"""'"—"°""'"""" EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DA DED I I RETENTION$ W" ""'� $ WORKERS COMPENSATION WAW WkXyW., X STATUTE X EORTH Includes USL&H AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? ❑N NIA 9700000381-211 12/21/2021 12/21/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule $1,000,000 E Vessel Pollution 55-83732 09/23/2022 09/23/2023 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certificate holder is an additional insured as their interest may appear. Waiver of Subrogation on behalf of the certificate holder is applicable as required by contract for General Liability and Workers Compensation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Room 1-213 Key West FL 33040 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) ACORD® CERTIFICATE OF LIABILITY INSURANCE oa/os/2o22 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 HOUSE NAME: Kelly White&Associates Insurance, LLC A/CN No,Ext: 904-880-8881 FAX No: 1622 Hickman Road E-MAIL ADDRESS: kelly@kwhiteinsurance.com kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32216 INSURERA: RLI Insurance Co AM Best A+XI 13056 INSURED INSURER B: Travelers Property&Casualty Company 36161 Coffin Marine Services, Inc INSURERC: P O Box 430538 INSURER D: Everest National Insurance Company 10120 INSURERE: Water Quality Insurance Syndicate Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF22080814262883 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X �/ DAMAGE TO RENTED 50 DOQ CLAIMS-MADE OCCUR PREMISES Ea occurrence $ X P&I including Jones Act MED EXP(Any oneperson) $ 5,000 A X Salvors Liability X X MRP0200000 09/23/2021 09/23/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO 1,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: Protection&I nde m nity $ $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OW AUTNEDONLY AUTOS SCHEDULED BA4902R108 08/17/2022 08/17/2023 BODILY INJURY(Per accident) $ X HIRED OS �/AUTOS ONLY /� AUTOS ONLY I'SK , (Per a c dentNON-OWNED PROPERTY DAMAGE $ Personal Injury $ 10,000 UMBRELLA LIAB OCCUR - Po ,, �^� EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE D�A1P� ,,, 8. 8, 2 Qom -, __tea, AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WAMP m"�' X STATUTE X ER Includes USL&H AND EMPLOYERS'LIABILITY Y/N D OFFICER/MEMBER/EXCLUDE/D?ANY PROPRIETORPARTNEREXECUTIVE� N/A 9700000381-211 12/21/2021 12/21/2022 E.L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule $1,000,000 E Vessel Pollution 55-83732 09/23/2021 09/23/2022 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insured with respects General Liability as per form (Blanket Additional Insured/Waiver of Subrogation)OMGL 624(11/07) and Auto Liability,with respects to insureds operations as required by written contract. Protection & Indemnity is proof of Jones Act coverage required by law. USL&H coverage is provided under Workers Compensation policy. 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. Marine Resources Office AUTHORIZED REPRESENTATIVE 2798 Overseas Highway Ste.420 Marathon FL 33050 �h ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: MRP0200000 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED(S) & WAIVER OF SUBROGATION (BLANKET) It is agreed that this Policy will include, as an Additional Insured, any person or organization, but only to the extent that you are obligated by a "written contract" to include them as Additional Insured(s) and only with respect to work and/or operations performed by you or on your behalf. The inclusion of an Additional Insured does not in any way extend the type of coverage afforded by the Policy, nor does it increase the limits of liability under the Policy. It is further agreed that we waive any right of recovery we may have against any person or organization because of payments we make for"bodily injury"or"property damage" arising out of"your work"with that person or organization, but only to the extent that you are obligated by a "written contract" to provide such waiver of rights of recovery and only with respect to "your work"or to your premises or the premises you use. OMGL 624 (11/07) Page 1 of 1 INSURED DATE ACCORD® CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 05/24/2022 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 endorsements . PRODUCER CONTACT HOUSE NAME: Kelly White&Associates Insurance, LLC a/CNNo Ext: 904-880-8881 A/c No: 1622 Hickman Road E-MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32216 INSURERA: RLI Insurance Co AM Best A+XI 13056 INSURED INSURERB: Travelers Property&Casualty Company 36161 Coffin Marine Services, Inc INSURERC: P O Box 430538 INSURER D: Everest National Insurance Company 10120 INSURERE: Water Quality Insurance Syndicate Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF22052408342288 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ X P&I including Jones Act MED EXP(Any oneperson) $ 5,000 A X Salvors Liability X X MRP0200000 09/23/2021 09/23/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: APPROVED BY RISK MANAGEMENT GENERAL AGGREGATE $ 2,000,000 PRO- POLICY ❑LOC BY , / $ 1,000,000PX OTHER DATE � Protection&I nde m nity $ $1,000,00 0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 WAVER MA YES Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2021 08/17/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED N NON-OWNED PROPERTYDAMAGE $ AUTOS ONLYAUTOS ONLY Per accident Personal Injury $ 10,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ CORKERS COMPENSATION X STATUTE X FOR H Includes USL&H AND EMPLOYERS'LIABILITY Y/N ANY D OFFICER/MEMBER/EXCLUDE/D?ECUTIVE� N/A 9700000381-211 12/21/2021 12/21/2022 E.L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule $1,000,000 E Vessel Pollution 55-83732 09/23/2021 09/23/2022 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insured with respects General Liability as per form (Blanket Additional Insured/Waiver of Subrogation)OMGL 624(11/07) and Auto Liability,with respects to insureds operations as required by written contract. Protection & Indemnity is proof of Jones Act coverage required by law. USL&H coverage is provided under Workers Compensation policy. 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. Marine Resources Office AUTHORIZED REPRESENTATIVE 2798 Overseas Highway Ste.420 Marathon FL 33050s �- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: MRP0200000 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED(S) & WAIVER OF SUBROGATION (BLANKET) It is agreed that this Policy will include, as an Additional Insured, any person or organization, but only to the extent that you are obligated by a "written contract" to include them as Additional Insured(s) and only with respect to work and/or operations performed by you or on your behalf. The inclusion of an Additional Insured does not in any way extend the type of coverage afforded by the Policy, nor does it increase the limits of liability under the Policy. It is further agreed that we waive any right of recovery we may have against any person or organization because of payments we make for"bodily injury"or"property damage" arising out of"your work"with that person or organization, but only to the extent that you are obligated by a "written contract" to provide such waiver of rights of recovery and only with respect to "your work"or to your premises or the premises you use. OMGL 624 (11/07) Page 1 of 1 INSURED DATE ACCORD® CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 05/24/2022 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 endorsements . PRODUCER CONTACT HOUSE NAME: Kelly White&Associates Insurance, LLC a/CNNo Ext: 904-880-8881 A/c No: 1622 Hickman Road E-MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32216 INSURERA: RLI Insurance Co AM Best A+XI 13056 INSURED INSURERB: Travelers Property&Casualty Company 36161 Coffin Marine Services, Inc INSURERC: P O Box 430538 INSURER D: Everest National Insurance Company 10120 INSURERE: Water Quality Insurance Syndicate Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF22052408342288 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ X P&I including Jones Act MED EXP(Any oneperson) $ 5,000 A X Salvors Liability X X MRP0200000 09/23/2021 09/23/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: APPROVED BY RISK MANAGEMENT GENERAL AGGREGATE $ 2,000,000 PRO- POLICY ❑LOC BY , / $ 1,000,000PX OTHER DATE � Protection&I nde m nity $ $1,000,00 0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 WAVER MA YES Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2021 08/17/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED N NON-OWNED PROPERTYDAMAGE $ AUTOS ONLYAUTOS ONLY Per accident Personal Injury $ 10,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ CORKERS COMPENSATION X STATUTE X FOR H Includes USL&H AND EMPLOYERS'LIABILITY Y/N ANY D OFFICER/MEMBER/EXCLUDE/D?ECUTIVE� N/A 9700000381-211 12/21/2021 12/21/2022 E.L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule $1,000,000 E Vessel Pollution 55-83732 09/23/2021 09/23/2022 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insured with respects General Liability as per form (Blanket Additional Insured/Waiver of Subrogation)OMGL 624(11/07) and Auto Liability,with respects to insureds operations as required by written contract. Protection & Indemnity is proof of Jones Act coverage required by law. USL&H coverage is provided under Workers Compensation policy. 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. Marine Resources Office AUTHORIZED REPRESENTATIVE 2798 Overseas Highway Ste.420 Marathon FL 33050s �- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: MRP0200000 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED(S) & WAIVER OF SUBROGATION (BLANKET) It is agreed that this Policy will include, as an Additional Insured, any person or organization, but only to the extent that you are obligated by a "written contract" to include them as Additional Insured(s) and only with respect to work and/or operations performed by you or on your behalf. The inclusion of an Additional Insured does not in any way extend the type of coverage afforded by the Policy, nor does it increase the limits of liability under the Policy. It is further agreed that we waive any right of recovery we may have against any person or organization because of payments we make for"bodily injury"or"property damage" arising out of"your work"with that person or organization, but only to the extent that you are obligated by a "written contract" to provide such waiver of rights of recovery and only with respect to "your work"or to your premises or the premises you use. OMGL 624 (11/07) Page 1 of 1 INSURED ACn DATE 1/7/2021W) `/ CERTIFICATE OF LIABILITY INSURANCE gq,p7,2gp, 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 HOUSE FAX No' Kelly White&Associates Insurance,LLG PHONE 904-880-8881 FAX P.O.Box 350909 ADDRESS: kelly@kwhiteinsurance.com INSURERS)AFFORDING COVERAGE ANC it Jacksonville FL 32235 INSURER A: RLI Insurance Co AM Best A+XI 13056 INSURED INSURER R: Travelers Property 8 Casualty Company Coffin Marine Services,Inc INSURER C: PO Box 430538 INSURER D: Everest National Insurance Company INSURER E: Great American Insurance Company 16691 Big Pine Key FL 33043 INSURER F- COVERAGES CERTIFICATE NUMBER: COFF21042709051004 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 T RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IY EAR ADDLINSD WBR POLIPOLICY NUMBER IMMIDCY EFF DIYYYYI IMMIODIYYYYI LIMIT LTR TYPE OF GENERAL LIABILITY INSD WVD 1,000.000 X COMMERCIAL GENERAL EACH OCCU RRENCE DREMSES RENTED 50.000 CLAIMS.MADE nOLCVR PREMISES( occurren'el occvrtenr'el X P&I Including Jones Act MED EXP I.Any one person) 5,000 A X Salvors Liability X MRP0200000 09/23/2020 09/23/2021 PERSONAL P.AOV INJURY 1,000.000 G�EML AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE 2,000,000 n I POLICY ❑;Co- I LOC Approved Risk/ Manaement PRODUCTS-COMPIOP AGO 1,000,000 OTHER. °l2L � Pretection&Indemnity S1,000,000 „ -"BiLE LA22IDTY- COMBINED SINGLE LIMIT 1,000000 (Ea accident) X ANY AUTO 4-28-2021 BODILY INJURY(Per person) B OWNED SCHEDULED X BA4902R108 08/17/2020 08/17/2021 BooILY INJURY(Per accident) AUTOS ONLY _AUTOS "HIRED NNONOWNEDPROPERTY DAMAGE XAUTOS ONLY XAUTOS ONLY er acOdenu Personal Injury 10,000 UMBRELLA LAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTIONS y WORKERS COMPENSATION X PERTUTE X [p H :P ' {ILI}lyA 4$K&H' AND EMPLOYERS'UABILITY YIN EL EACH ACCIDENT S 1,000.000 D OOFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE NIA 9700000381-201 12/21/2020 12/21/2021 1,000,000 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below E.L.DII yes.cleambe underISEASE•POLICY LIMIT S 1,000,WO Per cc Schedule $1.000,000 E Vessel Pollution 0MH1440763 09/23/2020 09/23/2021 DESCRIPTOR OF OPERATIONS I LOCATIONS I VEHICLES (ACORD I DI,Additional Remarks Schedule,may W at-Wawa H mon apace Is nqul,ed) Certificate Holder is listed as Additional Insured as required per written contract. CFRTIFICATE HOLDER CANCELI ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVERED IN Monroe County BOCG ACCORDANCE WITH THE POLICY PROVISIONS. 2798 Overseas Highway AUTHORIZED REPRESENTATIVE Ste 420 Marathon FL 33050 (.---j I,a,+l x\ :ham I O 1988-2015 ACORD CORPORATION. All Tights reserved. ACORD 25 I2016/03) The ACORD name and logo are registered marks of ACORD A RD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12/16/2019 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 'HOUSE NAME: , Kelly White&Associates Insurance,LLC PAHicNN.Fxtl. 904-880-8881 FAX Nol: P.O.Box 350909 E-MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE -NAIC# Jacksonville FL 32235 INSURER A: RLI Insurance Co AM Best A+Xl INSURED INSURER B: Travelers Property&Casualty Company Coffin Marine Services,Inc INSURER C: P 0 Box 430538 INSURER D Everest National Insurance Company INSURER E: Great American Insurance Group Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF19121611274900 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY! (MMIDDIYYYY! X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(a occurrence) $ 50,000 X Protection&Indemn/Jones Act MED EXP(Any one person) $ 5,000 A X Salvors Liability x x MRP0200000 09/23/2019 09/23/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECOT- LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 YEa accident) , , X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2019 08/17/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AHUTOIREDS ONLY AUT X NONOS-OWNONLY ED PROPERTY DAMAGE (Per accident) $ . MEN Personal Injury $ 10,000 UMBRELLA LIAB _OCCUR BY { EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE DATE LI AGGREGATE $ WAIVER IA „-- DED RETENTION$ $ WORKERS COMPENSATION X STATUTE X FOR H Includes USL&H AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBEREXCLUDED? N N/A 964639-01 12/21/2019 12/21/2020 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule E Vessel Pollution OMH1440763 09/23/2019 09/23/2020 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insured with respects General Liability as per form(Blanket Additional Insured/Waiver of Subrogation)OMGL 624(11/07) and Auto Liability,as required by written contract.Protection&Indemnity is proof of Jones Act coverage required by law.USL&H coverage is provided under Worker's Compensation policy. • 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. Marine Resources Office AUTHORIZED REPRESENTATIVE 2798 Overseas Highway Ste.420 Marathon FL 33050 C / � : 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: MRP0200000 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED(S) & WAIVER OF SUBROGATION (BLANKET) It is agreed that this Policy will include, as an Additional Insured, any person or organization, but only to the extent that you are obligated by a "written contract" to include them as Additional Insured(s) and only with respect to work and/or operations performed by you or on your behalf. The inclusion of an Additional Insured does not in any way extend the type of coverage afforded by the Policy, nor does it increase the limits of liability under the Policy. It is further agreed that we waive any right of recovery we may have against any person or organization because of payments we make for"bodily injury"or"property damage" arising out of"your work"with that person or organization, but only to the extent that you are obligated by a "written contract"to provide such waiver of rights of recovery and only with respect to"your work"or to your premises or the premises you use. OMGL 624 (11/07) Page 1 of 1 INSURED l A�L1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/28/2019 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 HOUSE NAME: . Kelly White&Associates Insurance,LLC PHONE FAX 904-880-8881 FA No): P.O.Box 350909 E-MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# , Jacksonville FL 32235 INSURER A: RLI Insurance Co AM Best A+XI INSURED INSURER B: Travelers Property.&Casualty Company Coffin Marine Services,Inc INSURER C: P 0 Box 430538 INSURER D: Amtrust North America INSURER E: Great American Insurance Group Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF19082813261963 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 ADDLSUBR POLICY EFF POLICY EXP L TYPE OF INSURANCE TRINSD wVD POLICY NUMBER (MMIDD/YYYY) IMM/DD/YYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TCLAIMS-MADE X OCCUR PREMISESO(Ea occu ence) $RETED 50,000 X Protection&Indemn/Jones Act MED FRCP(Any one person) $ 5,000 A X Salvors Liability MRP0200000 09/23/2019 09/23/2020 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PEA LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2019 08/17/2020 BODILY INJURY(Per accident) $ ALTOS ONLY AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) , r1Pf R `` { 's1T Personal Injury $ 10,000 IV UMBRELLA LIAB _OCCUR BYT EACH OCCURRENCE $ , EXCESS LIAB CLAIMS-MADE WAIVER N/A s L Ci AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE X ER H Includes USL&H AND EMPLOYERS'LIABILITY D OFFICER/MEMBOEREXCLUDED ECUTIVE YNN N/A WWC3393036 12/21/2018 12/21/2019 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule E Vessel Pollution OMH1440763 09/23/2019 09/23/2020 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insured as respects General Liability as per form(Blanket Additional Assured/Waiver of Subrogation)OMGL 624(11/07) and Auto Liability.Protection&Indemnity is proof of Jones Act coverage required by law.USL&H coverage is provided under Worker's Compensation policy. 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. Marine Resources Office AUTHORIZED REPRESENTATIVE 2798 Overseas Highway Ste.420 Marathon FL 33050 . :-\. I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACO DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/17/2018 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 HOUSE NAME: Kelly White&Associates Insurance,LLC PHOA/C NE FXt) 904-880-8881 FAX No): P.O.Box 350909 "AIL s: kelly@kwhiteinsurance.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32235 INSURER A: RLI Insurance Co AM Best A+XI INSURED ,, INSURER B: Travelers Property&Casualty Company Coffin Marine Services,Inc INSURER C: P 0 Box 430538 INSURER D: Amtrust North America INSURER E: Great American Insurance Group Big Pine Key FL 33043 INSURER F: • COVERAGES CERTIFICATE NUMBER: COFF18121716123702 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 LTR TYPE OF INSURANCE IANSDQL_SWVI] POLICY NUMBER (MM/DDY/YYYY) (EFF MMIDDY�) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE REED CLAIMS-MADE X OCCUR PRFM SESO(Fa occur ence) $ 50,000 X Protection&Indemn/Jones Act MED EXP(Any one person) $ 5,000 A X Salvors Liability MRP0200000 09/23/2018 09/23/2019 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO 1,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: • $ AUTOMOBILE LIABILITY COMBINEaccideDnt)SINGLE LIMIT $ 1,000,000 (Ea X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2018 08/17/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A P e- /€ ® ENT Personal Injury $ 10,000 • UMBRELLA LIAB _OCCUR �� EACH OCCURRENCE $ • EXCESS LIAB CLAIMS-MADE WAI ER A --^ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PERTUTE X O H Includes USL&H AND EMPLOYERS'LIABILITY D OFFICER/MEMBER ER EXCLUDED?ANY ECUTIVE YNN N/A WWC3393036 12/21/2018 12/21/2019 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ Per co Schedule E Vessel Pollution OMH1440763 09/23/2018 09/23/2019 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate Holder is an Additional Insured as respects General Liability as per form(Blanket Additional Assured/Waiver of Subrogation)OMGL 624(11/07) and Auto Liability.Protection&Indemnity is proof of Jones Act coverage required by law.USL&H coverage is provided under Worker's Compensation policy. 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. Marine Resources Office 2798 Overseas Highway Ste.420 AUTHORIZED REPRESENTATIVE Marathon FL 33050 • I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD J T ® DATE (MMIDD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 09/24/2018 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 HOUSE NAME: Kelly White & Associates Insurance, LLC PH iO N N Fxt), 904 -880 -8881 1 FAX Not: P.O. Box 350909 E - MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # Jacksonville FL 32235 INSURER A: RLI Insurance Co AM Best A+ XI INSURED INSURER B : Travelers Property & Casualty Company Coffin Marine Services, Inc INSURER C : P 0 Box 430538 INSURER D : Amtrust North America INSURER E : Great American Insurance Group Big Pine Key FL 33043 INSURER F : COVERAGES CERTIFICATE NUMBER: COFF18092409323222 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 POLICY EFF POLICY EXP LIMITS LTR IN TY Sn wvn POLICY NUMBER (MM /DDTYYYY) (MMIDDYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO I CLAIMS -MADE I X OCCUR PREMISES (Ea occurrence) $ 50 X Protection & Indemn /Jones Act MED EXP (Any one person) $ 5,000 A X Salvors Liability MRP0200000 09/23/2018 09/23/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT I LOC PRODUCTS- COMP /OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY CEa OMaBcidenINED t) SINGLE LIMIT $ 1,000,000 { X ANY AUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2018 08/17/2019 BODILYINJURY(Peraccident) $ AUTOS ONLY AUTOS X HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Personal Injury $ 10,000 UMBRELLA LIAB _ OCCUR PP 0 Et.: y A 1G EMh i% EACH OCCURRENCE . $ EXCESS LIAB r. �` `+ • C LAIMS -MADE Nit III 4. AGGREGATE $ • DED RETENTION $ ° $ WORKERS COMPENSATION X STATUTE X OR H Includes USL &H AND EMPLOYERS' LIABILITY D PROPRIETOR/PARTNER/EXECUTIVE I OFFICER/MEMBER ER EXCLUDED Y N I N NIA WWC3316881 12/21/2017 12/21/2018 E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Per co Schedule E Vessel Pollution OMH1440763 09/23/2018 09/23/2019 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) • Certificate Holder is an Additional Insured as respects General Liability as per form (Blanket Additional Assured/Waiver of Subrogation) OMGL 624 (11/07) and Auto Liability. Protection & Indemnity is proof of Jones Act coverage required by law. USL & H coverage is provided under Worker's Compensation policy. • 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. Marine Resources Office AUTHORIZED REPRESENTATIVE 2798 Overseas Highway Ste. 420 Marathon FL 33050 app. . \ ..,c4 I ' © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 ( 1g/03) The ACORD name and logo are registered marks of ACORD GL;