Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Certificates of Insurance
a— a ACORO" CERTIFICATE OF LIABILITY INSURANCE 11/1/201510/14/2014 ATE(MM/DD/YYYY) r 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 ADDITIONA , the policy(ies) must 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). 414 PRODUCER Lockton Com anies 444 W. 47th Street, Suite 900 Kansas Cityy MO 64112 1906 Finance Dept• (816) 960-9000 WNIACT NAME: -PHONt FAX A/C No Ext : A/C No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Company 16535 INSURED PARSONS BRINCKERHOFF, INC. 1328100 ONE PENN PLAZA NEW YORK NY 10119 INSURER B : INSURER C : INSURER D INSURER INSURER F rnvener_ee DADDIDI17 PC0T1CIr`ATC UIIIu1QCD• 110c0110 DCt/ICinAI AIIII1IIRCD• yyyy'v'vy 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 TR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP M D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE XXXXXXX CLAIMS -MADE ❑ OCCUR NOT APPLICABLE DAMAGE TO RENTED PREMISES Ea occurrence XXXX��X MED EXP An one person)XHXXXXXX PERSONAL & ADV INJURY $ XXX� GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ XXXXXXX POLICY JE� LOC PRODUCTS - COMP/OP AGG $ XXXXXXX $ OTHER AUTOMOBILE LIABILITY ANY AUTO NOT APPLICABLE Ea a..,dentSINGLE LIMIT $ XXX0C= BODILY INJURY (Per person) $ XXYY�= AUTOWNED AUTOS BODILY INJURY (Per accident $ XXXXXXX PROPERTY DAMAGE Per accident $ XXXXXXX NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ X)CXXXXX EXCESS LIAB CLAIMS -MAD NOT APPLICABLE AGGREGATE $ XXXXJy-x DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORMARTNER/EXECU I IVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A NOT APPLICABLE PER OTH- STATUTE E.L. EACH ACCIDENT $ XXXXXXX E.L. DISEASE - EA EMPLOYEE XX XXXXX If y DESCRIPTION OF OPERATIONS We E.L. DISEASE - POLICY LIMIT S XXXXXXX A PROFESSIONAL LIABILITY N N E00587103612 11/1/2014 11/1/2015 $ 1,000,000 PER CLAIM $2,000,000 AGGREGATE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) (PB #173965) CEI SERVICES FOR THE NO NAME KEY BRIDGE REPAIR PROJECT. FPN.(S) 430121-1 & 430121-2. YPPRO I AGEMENT WAIVER N/A Y _ CERTIFICATE HOLDER CANCELLATION See Attachment d 13 niNI103 3 8HOW 1SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �6 �� E D REPRESENTATIVE 12959129 to'; MONROE COUNTY ENGINEERING ATTN: CLARK BRIGGS, SENIOR PROJECT MANP@9003� 80.E 131IJ 1100 SIMONTON STREET, ROOM 216 KEY WEST FL 33040 ACORD 25 (20141011 ©1 8-2014 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Professional Liability Notification to Others of Cancellation Electronic Schedule Named Insured and Mailing Address: Producer: Parsons Brinckerhoff, Inc. Lockton Companies, LLC. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Architects and Engineers Professional Liability Insurance Policy In consideration of the premium already charged, we agree with you, subject to all terms, exclusions, and conditions of the policy that: A. If we cancel this policy by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation: Received 1. To the name and address corresponding to each person or organization shown in provided to us by the first "Named Insured". Such schedule: a. Must be initially provided to us within 15 days: (1) After the beginning of the policy period shown in the Declarations; or (2) After this endorsement has been added to the policy; b. Must contain the names and addresses of only the persons or organizations requiring notification that this Policy has been cancelled: c. Must be in an electronic format that is acceptable to us; and d. Must be accurate. tkZ9cl-2uN 14 Finance Dept Such Schedule must be updated and provided to us, by the first "Named Insured", during the policy period. Such updated Schedule must comply with paragraphs b., c., and d. above. 2. At least thirty (30) days prior to the effective date of the cancellation, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule provided to us. B. Our notification, as described in Paragraph A. of this endorsement, will be based on the most recent Schedule provided to us by the first "Named Insured" as of the date the notice of cancellation is mailed. C. Proof of mailing will be sufficient proof that we have complied with Paragraph A. of this endorsement. D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the Schedule provide to us as described in Paragraphs A. of this endorsement. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Policy No: E005871036-11 Eff Date: 11 /1 /2013 Exp Date: 11 /1 /2014 Miscellaneous Attachment: M471607 Certificate ID : 12959129 PARSBRI-01 HEVANS ACORO DATE (MMIDDmm) CERTIFICATE OF LIABILITY INSURANCE 10/1/2015 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 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 "'"E:''"' JILT Service Team NAM JLT Specialty Insurance Services Inc. PHONE FAX (A/C,No._E?J:(713 ) 325-7615 (A/C,No1: Q13) 7$970415 '5847 San Felipe St. !Suite 2800 —_ _ ADDRESS: Wsppbcertmquest@jltus.com Houston, TX 77057 - - - - - INSURER(S) AFFORDING COVERAGE NAIC N INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B: Liberty Insurance Corporation 42404 PARSONS BRINCKERHOFF, INC. INSURERC: 4139 Oregon Pike INSURER D : Ephrata, PA 17522 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS -MADE X OCCUR X X GLO9835819-02 04/01/2015 04/01/2016 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,00 X Contractual Liab MED EXP (Any one person) S 6,00 PERSONAL & ADV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 5,000,00 POLICY X JECT X LOC PRODUCTS - COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 2,000,00 _ B X ANY AUTO X X AS7-621-094060-035 10/01/2015 11/01/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS , AUTOSAUTOS NON -OWNED D B I IujA'NA y MENT PROPERTY DAMAGE - $ _ HIRED APPROV UTOS(Per accident) _ _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE DATE AGGREGATE $ NIA YES_ _ DED RETENTION $ WAIVER $ WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY YIN B ANY PROPRIETOR/PARTNEWEXECUTIVE X WA7-62D-094060-15 10/01/2015 11/01/2016 E.L. EACH ACCIDENT $ 2,000,00 ❑. NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE. - -- - $ 2,000,00 -- If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,00 O T1 C3 Z rn DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIRTY (30) DAYS NOTICE CANCELLATION O 1 #173965) CEI SERVICES FOR THE NO NAME KEY BRIDGE REPAIR PROJECT. FPN.(S) 430121-1 & 430121-2. MONROE 0- � COUNTY BOCC IS AN ADDITIONAL INSURED AS RESPECTS GENERAL AND AUTO LIABILITY, AS REQUIRED BY xFC -T) WRITTEN CONTRACT. !C_ 3 €� r— CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOCC ATTN: CLARK BRIGGS, SENIOR PROJECT MANAGER 1100 SIMONTON STREET, ROOM 216 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 REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORDn. CERTIFICATE OF LIABILITY INSURANCE 10/1/2015 DATE(MM/DD/YYYY) 9/18/2014 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 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 Lockton Companies 444 W. 47th Street, Suite 900 Kansas Cityy MO 64112-1906 (816) 960-9000 coRrAUr ac No Ext : (FAX No E-MAIL Ur N INSURER A : Llbe Mc"e-TOrp oration 42404 INSURED PARSONS BRINCKERHOFF, INC. 1319027 ONE PENN PLAZA NEW YORK NY 10119 INSURER B : INSURER C : INSURER INSURER E: INSURER F: COVERAGES PARBR02 CERTIFICATE NUMBER: 12959124 REVISION NUMBER: XXXXXXX 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 NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY Y N TB7-621-094060-024 10/1/2014 10/1/2015 EACH OCCURRENCE 2,000,000 CLAIMS -MADE � OCCUR DAMAGEERENTED o� ence 300000 X MED EXP (Any oneperson) 5,000 CONTRACTUAL LIAR PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PE0 LOC GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP/OP AGG $ 5,000,000 $ OTHER A AUTOMOBILE LIABILITY Y N AS7-621-094060-034 10/1/2014 10/1/2015 COtaBINED SINGLE LIMIT $ 2,000, 000 X ANY AUTO BODILY INJURY (Per person) $ XXXY,�VM X AUTOWNED SCHEDULED BODILY INJURY (Per accident $ )XXXX�� NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ XXJx $ XXXy-xxX UMBRELLA LIAB OCCUR EACH OCCURRENCE $ XXX��JCXX EXCESS LIAB CLAIMS -MADE NOT APPLICABLE AGGREGATE $ XXXXXXX DED RETENTION $ $ A AANY WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROPRIETOR/PARTNER/EXECUTIVE Y❑ OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A N WA7-62D-094060-014 (AOS) WC7-621-094060-044(WI) 10/1/2014 10/1/2014 10/1/2015 10/1/2015 PER OTH- X STATUTE EAC H CH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT is 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) (P13 #173965) CEI SERVICES FOR THE NO NAME KEY BRIDGE REPAIR PROJECT. FPN.(S) 43012 1 -1 & 430121-2. MONROE COUNTY BOCC IS AN ADDITIONAL. INSURED AS RESPECTS GENERAL AND AUTO LIABILITY, AS REQUIRED BY WRITTEN CONTRACT. BY PR Y AGEMENT WAN N/ 4 E CERTIFICATE HOLDER CANCELLATION See Attachments v �� � ai3�'N"' 12959124 fi 26 N� �,- 330 W ATOTN NROE LARK BRIGGSCOUNTY GSEN OR P 03111 1100 SIMONTON STREET, ROOM �I KEY WEST FL 33040 f 4-lklt711!Fill 11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0)1 8-2014 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Policy No. AS7-621-094060-034 Issued by: LIBERTY INSURANCE CORPORATION Endorsement Effective Date: 10/01 /2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - NOTICE OF CANCELLATION ENDORSEMENT & NON -RENEWAL This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. We will not cancel or non -renew this policy or make a "material change" to the insurance afforded by this policy until written notice of cancellation, non -renewal or "material change" has been mailed or delivered to those listed in the schedule below at least; a) 10 days before the effective date of cancellation, if we cancel for non-payment of premium; or b) 30 days before the effective date of the cancellation, non -renewal or "material change" if we cancel, non -renew or make a "material change" to the insurance afforded by this policy for any other reason. For the purpose of this endorsement, "material change" is defined as a reduction in Limits of Insurance. Name: As per schedule on file with broker TO Q`G pePt. Miscellaneous Attachment: M467199 Certificate ID : 12959124 Policy Number: TB7-621-094060-024 Issued By: Liberty Insurance Corporation THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - NOTICE OF CANCELLATION & NON -RENEWAL ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART We will not cancel or non -renew this policy or make a "material change" to the insurance afforded by this policy until written notice of cancellation, non -renewal or "material change" has been mailed or delivered to those listed in the schedule below at least: 1. 10 days before the effective date of cancellation, if we cancel for non-payment of premium; or 2. 30 days before the effective date of the cancellation, non -renewal or "material change" if we cancel, non -renew or make a "material change" to the insurance afforded by this policy for any other reason. For the purpose of this endorsement, "material change" is defined as a reduction in Limits of Insurance. Name: as per schedule on file with broker Address: as per schedule on file with broker Miscellaneous Attachment: M467221 Certificate ID : 12959124 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - NOTICE OF CANCELLATION AND NON -RENEWAL ENDORSEMENT This endorsement modifies insurance provided under the following: WORKERS COMPENSATION We will not cancel or non -renew this policy or make a "material change" to the insurance afforded by this policy until written notice of cancellation, non -renewal or "material change" has been mailed or delivered to those listed in the schedule below at least: 1. 10 days before the effective date of cancellation, if we cancel for non-payment of premium; or 2. 30 days before the effective date of the cancellation, non -renewal or "material change" if we cancel, non -renew or make a "material change" to the insurance afforded by this policy for any other reason. For the purpose of this endorsement, "material change" is defined as a reduction in Limits of Insurance. Name As per schedule on file with broker. Address As per schedule on file with broker This endorsement is executed by the Liberty Insurance Corporation. Effective: 10/01 /2014 Expiration: 10/1 /2015 For Attachment to Policy No: WA7-62D-094060-014 WC7-621-094060-044 Issued to: PARSONS BRINCKERHOFF, INC. ONE PENN PLAZA NEW YORK, NY 10119 Miscellaneous Attachment: M467762 Certificate ID : 12959124 DATE(MMIDD/YYYY) A� ® CERTIFICATE OF LIABILITY INSURANCE 4/9/15 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 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 NeME`CT Jennifer Sprinkle PHONE — 713-325-7593 FAx JLT Specialty Insurance Services Inc. tAW N4..E[iJ - INC. Mgt, E-MAIL 5847 San Felipe Street, Suite 2750 AoDREss: wspobcertreauestia'�iltus.com _ Houston, TX 77057 _ _ INSURER(S)AFFORDING COVERAGE ---.— _-..__—_.. INSURERA:Liberty Insurance Corporation _ 42404 INSURED INSURER a _Zurich American_ Insurance Company--- 16535 ---- PARSONS BRINCKERHOFF, INC. INSURER C:_________—______________.--____—------------- --- 4139 Oregon Pike INSURERD_[_ _. Ephrata, PA 17522 INSURERE:_ . _--__-- __- _------- --._ eo.nernu ununcD• COVERAGES GtK I IrII:A I C InumDcrc: LISTED BELOW HAVE BEEN - - - ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONS AND .ADDL SUER' -... • POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER '.GLO 9835819-02 MMID M 4/1/2015 4/1/2016 EACH OCCURRENCE $2,000,000 B X COMMERCIAL GENERAL LIABILITY _--, —_— DAMAGE TO RENTED 000,000 CLAIMS -MADE XOCCUR ''.. ''. PREMISES (Ea .occurrence) ._. , -.. 5,000 EXP (Any one person) $ X Contractual Liability PERSONAL 8 ADV INJURY $ 2,000, 000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER - _. $ 5,000,000.. PRO- '... X POLICY_-, JECT LOC PRODUCTS - COMP /OP AGG ----- --- S — ---, _ .OTHER. AS7621094060024 IN SIN L LIMIT$2,000,000 10/1/2014 10/1/2015 iEa_ademl_-__ A AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ X ANY AUTO _ — ALL OWNED 'SCHEDULED BODILY INJURY (Per accident) - . 'AUTOS AUTOS '.. NON -OWNED '', PROPERTY DAMAGE (Per acadeng ' HIRED AUTOS AUTOS ',- $ - UMBRELLA LIAB OCCUR EACH OCCURRENCE ._ .._. EXCESS LIAS .._..- CLAIMSMADE''., AGGREGATE _. $ DIED RETENTION $ WORKERSCOMPENSATION WA762DO94060014 (Aos) pER OTH- 10/1/2014 10/1/2015 k STATUTE _ ER AND EMPLOYERS LIABILITY YIN. WC7621094060044 (wi) 10/1/2014 10/1/2015 1,000 000 EL. EACH ACCIDENT $ ANY PROPRIETOR+PARTNER/EXECUTIVE A OFFICERMIEMBER EXCLUDED DIN/A L — -- E.L. DISEASE - E_A EMPLOYEE $ 1 ,OOO OOO ---- - (Mandatory in NH) tt yes, desc ,be under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT ^$ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) certificate replaces any previously issued certificate(s). 4APPROV ISThis R N/A (PB #173965) FOR ADDITIONAL INFORMATION SEE PAGE 2 MONROE COUNTY ATTN: CLARK BRIGGS, SENIOR PROJECT MANAGER 1100 SIMONTON STREET, ROOM 216 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 REPRESENTATyVE - j 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ACORDs provided by Forms Boss. www.FormsBoss.com: (c) Impressive Publishing 800-208-1977