Loading...
COI Expires 01/01/2020 f `! A ® CERTIFICATE OF LIABILITY INSURANCE DATE (MWD19 D/YYYY) 1/3/20 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 Wallace Welch&Willingham, Inc. PHONE Certificates FAX 300 1st Ave.So., 5th Floor (NC,No,Ext): 727-522-7777 (A/c,No):727-521-2902 Saint Petersburg FL 33701 ADDRESS: certificates@w3ins.com INSURER(S)AFFORDING COVERAGE NAIC# , INSURERA:Zurich American Ins.Co. 16535 INSURED BILTCON-01 INSURERS:American Guarantee&Liability Ins.Co. 26247 Biltmore Construction Co., Inc. 1055 Ponce de Leon Blvd. INSURERC:Indian Harbor Insurance Co. 36940 Belleair FL 33756 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:111484235 REVISION NUMB R: 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 SUER POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GL0008451104 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000 X Contractual Liab APP RIONO t t ENT MED EXP(Any one person) $15,000 BY .110 X XCU DATE _ _/''—! PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: WAIVER r GENERAL AGGREGATE $2,000,000 POLICY X 128T LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAP008451204 1/1/2019 1/1/2020 C(EaOMBINEDaccident)SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ - $ B X UMBRELLA LIAB X OCCUR AUC578165505 1/1/2019 1/1/2020 EACH OCCURRENCE $20,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2.0,000,000 DED X RETENTION$ $ g WORKERS COMPENSATION WC008451404 1/1/2019 1/1/2020 X AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N 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 C Professional/Pollution Liability PEC004885102 1/1/2019 1/1/2020 Per Claim 2,000,000 Aggregate 2,000,000 Deductible 50,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) `BCC Project#988;fuel•Island Relocation Project 30000MMagnoliaStreet Key Largo FI 33037 Monroe County Board of County Commissioners its employees and officials,Project Owner and Others as required by written contract are additional insured on a primary and non-contributory basis with respect to General Liability subject to terms,conditions,and exclusions of the policy. Monroe County Board of County Commissioners its employees and officials,Project Owner and Others as required by written contract are additional insured on a primary basis with respect to Auto Liability subject to the terms and conditions and exclusions of the policy. See Attached... 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 its ACCORDANCE WITH THE POLICY PROVISIONS. employees and officials - - 500 Whitehead Street AUTHORIZED REPRESENTATIVE Key West FL 33040-0000 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: BILTCON-01 LOC#: A ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Wallace Welch&Willingham,Inc. Biltmore Construction Co.,Inc. 1055 Ponce de Leon Blvd. POLICY NUMBER Belleair FL 33756 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Monroe County Board of County Commissioners its employees and officials,Project Owner and Others as required by written contract are additional insured on the Excess Liability Policy(vs Excess Policy)subject to terms, conditions and exclusions of the policy. A Waiver of Subrogation in favor of Monroe County Board of County Commissioners its employees and officials,Project Owner and Others as required by written contract applies to General Liability,Auto,Umbrella and Workers Compensation if required by written contract. 30 day written notice of cancellation non-renewal,or material change reducing coverage will be given to Certificate Holder by the carrier except for nonpayment of premium which will be ten days. • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD