COI Expires 08/01/2019 AC ,a, DATE(MMIDDIYYYY)
�� CERTIFICATE OF LIABILITY INSURANCE DATE
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 INSURERS), 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
NAME:
Stateretfil ILEANA CABRERA-RODRIGUEZ INS AGCY INC ( mr PHONE EXt1, 305-529-9966 • Fq •x No): 305-529-2856
(% ILEANA CABRERA RODRIGUEZ,AGENT EMAIL
ADDRESS:
1925 PONCE DE LEON BLVD INSURER(S)AFFORDING COVERAGE NAIL S
CORAL GABLES FL 33134 INSURER A State Farm Mutual Automobile Insurance Company 25178
INSURED INSURER B:
INSURER C: _
ABC CONSTRUCTION INSURER D: _
7215 NW 7TH ST INSURERS:
MIAMI FL 33126 , INSURERF:
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 MAD WVD POLICY NUMBER IMM(Dp(YYYTI JCY EFF PMMIDDIYYYTI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE 0 OCCUR DAMAGE TO
Eaoccu RENTED
$
MED EXP(Any one person) $
•
• PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY n PRJECOT —LOC PRODUCTS-COMP/OP AGG $ '
•
OTHER: $
AUTOMOBILE LIABILITY 939-7970-BO1 02/01/2019 08/01/2019 COMaacciBINdEenDt!SINGLE LIMIT $ •
(E
ANY AUTO BODILY INJURY(Per person). $ 1,000,000
A T (Pm'OWNED 4 SCHEDULED BODILY INJURY(P accident) $ 1,000,000
AUTOS ONLY G� AUTOS \.
XHIRED NON-OWNED PROPERTY DAMAGE $ 1,000,000
AUTOS ONLY AUTOS ONLY (Per accident
UMBRELLALIAB
OCCUR EACH OCCURRENCE •• $
EXCESS LAB CLAIMS-MADE AGGREGATE • • $
DED RETENTION$ _ $
WORKERS COMPENSATION •
AND EMPLOYERS'LIABILITY YIN PER ERA ,
ANY PROPRIETORIPARTNERIEXECUTIVE ❑ N!A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory to NH) E.L.DISEASE-EA EMPLOYEE$ •
If yes.describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Key West International Airport 04/16 APPR V R S{ I ENT
Monroe County BY
Strengthen/Rehabilitate Commercial Apron DATE •
Project No.GAKAP145 WAIVER N
' Certificate Holder is also Add)Insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County Bocc .
AUTHORIZED-REF ESENTATNE
1100 Simonton St / •
Key West FL 33050 •
I -
01988-2015A ' RD CO RATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
1001486 132849.12 03.16.2016
AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM!DI)IYYYY)
`----- 01/21/2019
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 iti lieu of such endorse(nent(s). .
PRODUCER CONTACT
NAME:
StateRarrn ILEANA CABRERA-RODRIGUEZ INS AGCY INC HONE E, 305-529-9966 Da No), 305-529-2856
ILEANA CABRERA-RODRIGUEZ,AGENT E-MAIL
al 0 ADDRESS:
1925 PONCE DE LEON BLVD • •
INSURER(S)AFFORDING COVERAGE NAIL C
CORAL GABLES FL 33134 INSURER A:State Farm Mutual Automobile Insurance Company . 25178
INSURED INSURERS: _
INSURER C:
ABC CONSTRUCTION INSURER D:
7215 NW 7TH ST INSURER E:
MIAMI FL 33126 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 • TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP • •
INSD WVD POLICY NUMBER • (MMIDDIYYYYI IMM100IYYYY) . . UNITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE nOCCUR PREMISES(Ea occurrence) $
MED EXP(Any one person) $
PERSONAL BADV INJURY • $ •
GENII.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
CT
POLICY JE LOC PRODUCTS-COMP/OP AGG $
OTHER: $ •
AUTOMOBILE LIABILITY • 063 7061-B01 02/01/2019 08/01/2019 (Ea ewrdeD SINGLE LIMIT $ 1,000,000
ANY AUTO C65 3744-B01 02/01/2019 08/01/2019 BODILY INJURY'(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident $
A AUTOS ONLY AUTOS )
HIRED NON-OWNED 025 6901-B01 .02/01/2019 08/01/2019 PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident) • • $
_ • . .. $ —
UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
•
EXCESS LIAB CLAIMS-MADE AGGREGATE • $ . .
DEC ,RETENTION$ $ .•
WORKERS COMPENSATION PER OTH=
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? 1-7NIA E.L.EACH ACCIDENT $
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ •
If yes,describe under
DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $
I
'DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Ir more space is required) i
Key West International Airport 04/16
Monroe County
Strengthen/Rehabilitate Commercial Apron BY P •VEe BY MENT
Project No.GAKAP145 DAT" 6:);I Lip'm.
WAIVER N Y S_
Certificate Holder Is also Add!Insured
•
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 Bocc
1100 Simonton St Awry') IZET RZEP ESENTATNE
f
Key West FL 33050 t e---,
01988-2015 AD CORPORATION. All rights reserved. •
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
1001486 132849.12 03-16-2016 •