COI Expires 04/01/2019 ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
1/4/2019
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 CONTNAME ACT Taylor Tablett
Hylant-Cleveland PHONE FAX Not:216-447 4088
6000 Freedom Sq Dr, Ste 400 INC.No.Ext1:216 447-1050
Independence OH 44131 ADDRESS: taylor.tablett@hylant.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:Hartford Underwriters Ins Co 30104
INSURED K2MDESI-01 INSURER B:Hartford Casualty Insurance Co 29424
K2M Design, Inc.
3121 Bridge Avenue INSURERC:
Cleveland, OH 44113 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1963857699 REVISION NUMBER:
THIS IS TO CERTIFY T-IAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH 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 INSD,WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
B X COMMERCIAL GENERAL LIABILITY 45SBAAK3228SA 9/14/2018 4/1/2019 EACH OCCURRENCE $1000000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1000000
�'G` MED EXP(Any one person) $10000
P =VI . ENT
3 t� PERSONAL&ADV INJURY $1000000
GEN'L AGGREGATE LIMIT APPLIES PER: n • MwKll�► GENERAL AGGREGATE $2000000
POLICY PRO-
JECT LOC PRODUCTS-COMP/OP AGG $2000000
OTHER: $
A AUTOMOBILE LIABILITY 45UECBL6188SA 9/14/2018 4/1/2019 COMBINED SINGLE LIMIT $1000000
{Ea accident)
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY _ AUTOS ONLY (Per accident)
S
B X UMBRELLA LIAB X OCCUR 45SBAAK3228SA 9/14/2018 4/1/2019 EACH OCCURRENCE $5000000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5000000
DED X RETENTIONS 1nnnn $
g WORKERS COMPENSATION 45SBAAK3228SA 9/14/2018 4/1/2019 PER
AND EMPLOYERS'LIABILITY Y/N STATUTE ER OH Stop Gap
ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED?
(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
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Monroe County Board of County Commissioners("BOCC")is included as an additional insured where required by written contract.
This Agreement("Agreement")made and entered into this 21st day of January 2015,by and between Monroe County,a political subdivision of the State of
Florida,whose address is 1100 Simonton Street,Key West,Florida,33040,its successors and assigns,hereinafter referred to as"COUNTY,"through the
Monroe County Board of County Commissioners("BOCC"),and K2M Design.Inc.whose address is 1001 Whitehead Street.Key West.FL 33040
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
1100 Simonton Street AUTHORIZED REPRESENTATIVE
Key West FL 33040 `at/ JOG;.(:�,�i
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