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COI Expires 05/12/2019 ACC7R o DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE E (MM/DDN 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 RBN Insurance Services PHONE FAX 303 E Wacker Dr Ste 650 (A/C. No. Ext): 312- 856 -9400 (Avc, No): 312 - 856 -9425 Chicago IL 60601 ADDRESS: Inortz @rbninsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hartford Fire Insurance Co. 19682 INSURED SAFELLC -01 INSURER B : Hartford Casualty Insurance Co 29424 M. T. Causley, LLC 97 NE 15th Street INSURERC: Navigators Insurance Company 42307 Homestead FL 33030 INSURER D : Twin City Fire Insurance Co. 29459 INSURER E : Great American E &S Ins. Co. 37532 INSURER F : _ COVERAGES CERTIFICATE NUMBER: 1702578246 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. I L T R TYPE OF INSURANCE INSD wvo POLICY EFF POLICY EXP POLICY NUMBER LIMITS (MM /DDrYYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY 83UENZV3951 10/3/2018 10/3/2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO POLICY X JECT LOC PRODUCTS - COMP /OP AGG $ 2,000,000 _ OTHER: $ B AUTOMOBILE LIABILITY 83UENPY9100 10/3/2018 10/3/2019 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED v NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) C U MBRELLA LIAB X OCCUR CH18EXC8856001V 10/3/2018 10/3/2019 EACH OCCURRENCE _ $10,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 _ DED X RETENTION $ n $ D WORKERS COMPENSATION 83WECE0623 5/12/2018 5/12/2019 PER PETUTE OTH AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A -- (Mandatory In NH) - -- - - - - E.L. DISEASE - - EA EMPLOYEE $ 1;000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Professional Liability TER2475972 10/3/2018 10/3/2019 Each Claim /Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Monroe County Board of County Commissioners is an Additional Insured as respects General Liability and Automobile Liability as required by a written contract. PPOED ;YRI^ 'y` ',T k r, II a I/ el I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissioners 1100 Simonton Street Key Wesp AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: SAFELLC -01 LNORTZ LOC #: 0 ACOROA ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED RBN Insurance Services M. T. Causle St LLC 97 NE 15th reet POLICY NUMBER Homestead,` FL 33030 SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance If required by a written contract, the following forms apply on a blanket basis. General Liability: Form HG0001 09 16 Additional Insureds; Primary and Non - contributory; Waiver of Transfer of Rights of Recovery Against Others to Us Auto Liability: HA9916 0312 Commercial Automobile Broad Form Endorsement includes Additional Insureds and Waiver of Subrogation Workers Compensation: WC 00 03 13 Waiver Of Our Right to Recover from Others ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD