COI Expires 12/13/2019 AC®® DATE(MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/10/2018
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 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
NAME:
Kouwenhoven&Associates (A/CNNo,Ext): FAX
No):
E-MAIL
365 Wekiva Spring Road,Suite 251 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
Longwood FL 32779 INSURER A: Markel Insurance Company 38970
INSURED INSURER B:
Pallo,Marks,Hernandez,Gechijian&DeMay,P.A. INSURER C:
3701 Catalfumo Way South INSURER D:
INSURER E:
Palm Beach Gardens FL 33410 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.
INSRLT TYPE OF INSURANCE AUULSUBR POLICY EFF POLICY EXP W /Y LIMITS
INSD VD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RETED
$
CLAIMS-MADE OCCUR PREMISESO(a occurrence) $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _
POLICY n P - I^I LOC PRODUCTS-COMP/OP AGG $
JECROT 11
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
_ ANY AUTO _
BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS _ AUTOS
NON-OWNED PROPERTY DAMAGE
_ HIRED AUTOS _ AUTOS (Per accident)
$
UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER 0TH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A PL-Professional Liability $3,000,000-Each Claim
LA307086 12/13/2018 12/13/2019
$3,000,000-Annual Aggregate
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Deductible:$5,000-Annual Aggregate
Retroactive Date:6/1/1997 BY AP
ED RI 1 T
DAT
WAIVER
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. P
1111 12th Street — li)36r
AUTHORIZED REPRES TATIVE
Suite 408
Key West FL 33040 P ,
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