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HomeMy WebLinkAboutCertificates of Insurance CPHINCO-01 KMCINTOSH �►co�ro,,, CERTIFICATE OF LIABILITY INSURANCE DAT6/2/2 D/YYYY) 022 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 NAME: JCJ Insurance Agency, LLC PHONE 2208 Hillcrest Street (A/C,No,Ext): (321)445-1117 (A/c,No):(321)445-1076 Orlando,FL 32803 ADDRESS:certs@jcj-insurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Contractors Bondin &Insurance Co. RLI 37206 INSURED INSURER B:RLI Insurance Company 13056 CPH Consulting, LLC DBA CPH,LLC INSURER 7 500 West Fulton Street INSURER D: Sanford,FL 32771 INSURER E 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CKB0200150 4/1/2022 4/1/2023 DAMAGE TO RENTED 300,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT1:1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO X PSA0003057 4/1/2022 4/1/2023 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE X CKB0200157 4/1/2022 4/1/2023 AGGREGATE $ 5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N PSW0002907 1/1/2022 1/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000'OOO If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Professional Liab RDP0046508 4/1/2022 4/1/2023 Per Claim 5,000,000 B RDP0046508 4/1/2022 4/1/2023 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insureds with regards to General,Auto and Umbrella Liability when required by written contract. Sly— CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ty ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1026 Key West,FL 33041 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) / ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CPHINCO-01 KMCINTOSH �►co�ro,,, CERTIFICATE OF LIABILITY INSURANCE DAT6/2/2 D/YYYY) 022 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 NAME: JCJ Insurance Agency, LLC PHONE 2208 Hillcrest Street (A/C,No,Ext): (321)445-1117 (A/c,No):(321)445-1076 Orlando,FL 32803 ADDRESS:certs@jcj-insurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Contractors Bondin &Insurance Co. RLI 37206 INSURED INSURER B:RLI Insurance Company 13056 CPH Consulting, LLC DBA CPH,LLC INSURER 7 500 West Fulton Street INSURER D: Sanford,FL 32771 INSURER E 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CKB0200150 4/1/2022 4/1/2023 DAMAGE TO RENTED 300,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT1:1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO X PSA0003057 4/1/2022 4/1/2023 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE X CKB0200157 4/1/2022 4/1/2023 AGGREGATE $ 5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N PSW0002907 1/1/2022 1/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000'OOO If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Professional Liab RDP0046508 4/1/2022 4/1/2023 Per Claim 5,000,000 B RDP0046508 4/1/2022 4/1/2023 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insureds with regards to General,Auto and Umbrella Liability when required by written contract. Sly— CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ty ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1026 Key West,FL 33041 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) / ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CPHINCO-01 L.HAMPTON CERTIFICATE OF LIABILITY INSURANCE CSAT4/6/2 DtYYYY) 021 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 endorsements . PRODUCER CONTACT PP JCJ Insurance Agency,LLC HHOONN - FAX } 2208 Hillcrest Street Arc,No,ExtI 321)4451117 IA1C,NoI: 321 445-1076 Orlando,FL 32803 E-MAI ADDRSS'. INSURER(S)AFFORDING COVERAGE NAIC q INSURER A,RLI Insurance Company 13056 INSURED INSURER B: CPH,Inc ',,INSURER-C - 500 West Fulton Street INSURER D Sanford,FL 32771 INSURER_E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LINED 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"r0 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, F HE 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 ADDL SUBR POLICY .L , a.a... . Err POLICY EXP TYPE OF INSURANCE POLICY NUMBER LIMITS . w.a ..w. w.a.., .LMt�pY� ,-. ALtDYYY}".." w.a. ----w---- w-a..."w.a..."w.a..."w.a �..,._..., A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAINIS-MADE X OCCUR PS84563547 411/2021 4/112022 PRaMISESc�I2omufr) 300,000 - _ X � � PREMISES(Ea 5 _ HIED EXP(Any one person) $ 5,000 Approved i5 n gement PERSONAL&ADV INJURY S 1,000,600 GENT,AGGREGATE LIMIT APPLIES PER ��r � � �-GENERA AGGREGATE S 2,000,000 POLICY X JE+ 7` LUC, PRODUCTS Cf3P.PIOP AGG $ --.2,000,000 OTHER 7-1-2021 Emp Ben. S 1,000,000 •� � .A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT " - -1,000,000' 11N�;1crlcl�rrs} X ANY A TO X PSA0003057 41112021 4/1/2022 BODILY INJURY tPwr pefson) ,$ 01AINfa7 SCHEDULr AUTOS ONLY AUTOS BODILY INJURY I'Pw'ac=dent), s. I4II'"1Y NON WNED PROPERTY DAMAGE AU S ONLY AU I()S ONLY (Pei accidentl A X UMBRELLA LIAR X OCCUR EAt"Y1 OCCURRENCE 5,000,000 EXCESS LIAR CLAIMS-MADE' PSA0004525 4/1/2021 4/112022 AGGREGATE � 5,000,000 OFD X 1 RE FNTION$ 10,000' A WORKERS COMPENSATION X PER i OTH- AND EMPLOYERS`LIABILITY YIN -_ STATUTE ER --- ANY PRCJP,I'OFTOR)PARTNFFt1Ex�IyUTI,aE PSW0002907 11112021 1/112022 1,000,000` C Un"ER+Y��fiK E74CWDED'r N N 1 A ! EACH Af I HIVT {M dattary«n IN 1,000,000 EL DISEASE LA1-INIPLOYEE If yes describe under raEc R€PTiON CF,a�ETlas� r #e 1,000,000 �I���q�� _.._.._... A Professional Liab RDP0042906 411/2021 4/112022 Per Claim 5,000,000 A RDP0042906 411/2021 411/2022 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,ma be attached if more space is required) Monroe County SOCC is an Additional insureds with regards to General&Auto Liability when required by written contract. mCERTIFICATE HOLDER.................................................................................................................................... CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County BOCC Insurance Compliance THE EXPIRATION DATE THEREOF`, NOTICE WILL BE DELIVERED IN ty p ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 100085-FX Duluth,GA 30096 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) f CU". 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From: Certs(iiJej-insurance.com To: monroecountyfl nioitroecotiiityflr,4,),Ebix.coni CC: phunt(-Weplicorp.com Subject: RE: Monroe County Florida Certificate of Insurance Req Date: 4/6/2021 5:27:49 AM Attachment(s): Good morning, Attached is the requested COI and endorsements. Thanks, Lauren Hampton JCJ Insurance Agency DESIGNED TO INSURE SUCCESS Direct: (321)280-99291 2208 Hillcrest Street I Orlando, Florida 32803 >C From:Customer Service <monroecountyfl@ebix.corn> Sent: Monday, April 5, 20214:34 PM To:Certs<Certs@jcj-insurance.com> Subject: Monroe County Florida Certificate of Insurance Req The attached notice is being sent to you on behalf of Monroe County Florida by Fbix RCS. Monroe County Florida has engaged with Ebix to manage insurance compliance verification on its behalf. You must be properly insured while doing business with Monroe County Florida and comply with insurance requirements, As of the date of this notice we have not received proper evidence of insurance coverage. Please review the attached notice as it includes the information needed -", CPHEN-1 OP ID: KM '4coiRo. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �•� 02/24/2020 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 321-445-1117 CONTACT Kristin McIntosh JCJ Insurance Agency PHONE FAx 2208 Hillcrest Street (A/C,No,Ext): 321�45-1117 (A/C,No):321-445-1076 Orlando,FL 32803 E-MAIL certs@jcj-insurance.com Mark E.Jackson ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Continental Casualty Company 20443 INSURED INSURER B:Valley Forge Insurance Company 20508 CPH,Inc Transportation Insurance 20494 500 West Fulton Street INSURERC: P Sanford,FL 32771 INSURER D:RLI Insurance Company13056 INSURER E: 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 DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MWDD/YYYY MWDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Xrl OCCUR C5099618199 04/01/2020 04/01/2021 DAMAGE TO RENTED 300,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY� jECT1:1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Emp Ben. $ 1,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO X C5099618204 04/01/2020 04/01/2021 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 LAB LB CLAIMS-MADE X C5099618218 04/01/2020 04/01/2021 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N PSW0002907 01/01/2020 01/01/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE [N] N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Professional Liab RDP0031831 04/01/2020 04/01/2021 Per Claim 5,000,000 Claims-Made Form Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insureds with regards to General,Auto I, and Umbrella Liability when required by written contract. a 4/16/20202 CERTIFICATE HOLDER CANCELLATION MONR102 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe Count Board of Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y y ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners PO Box 1026 Key West, FL 33041 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .........--1 CPHEN-1 OP ID:KM .4,C®R®' CERTIFICATE OF LIABILITY INSURANCE DATE(MMfODTYYYY) iii.----- 11/26/2019 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 POUCIES 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 pollcy(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 321-445-1117 NA) ACT Kristin McIntosh JCJ Insurance Agency PHONE 321-445-1117 I FAX 321-445-1076 2208 Hillcrest Street (AJc,No,Esy: WC.Ho): Orlando,FL 32803 ittt6.certs@Jcj-Insurance.com Mark E.Jackson INSURERISI AFFORDING COVERAGE RAID 4 _ INSURERA:Continental Casualty Company 20443 itipc INSURER B:Valley Forge Insurance Company 20508 anrd5tpulton Street INSURER c:Transportation Insurance 20494 FL 32771 INSURER D:RLI Insurance Company 13056 INSURER E: 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 ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP J TRJIIWQ p@ fMM1DOTYYYY1 1MM1DDtYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH p�OCCURRENCE S 1,000,000 CLAIMS-MADE El OCCUR X C5099618199 04/01/2019 04/01/2020 OAA(AGETORWyrrn„re) S 300,000 ma EXP fAnvone personl S 5,000 - PERSONAL 6 ADV INJURY S 1,000,000 SFNL AGG LIMIT AP S PER GENERAL AGGREGATE $ 2,000,000 POLICY j LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: Emp Ben. S 1,000,000 B AUTOMOBILE LIABILITY , _LCOOMBiINED SINGLE LIMIT S 1,060,000 X ANY AUTO EO X C5099618204 04/01/2019 04/01/2020 BODILY INJURY Mot pors0nl S - AAA�U���T��OppS ONLY A�UUpTT�OSS1y'1� BODILYB INJURYpA (Perp Acdden) $ , .-_. AUTOS ONLY , AUTOSONLY fper9a YII GE $ $ C X UMBRELLALIAB X OCCUR5,000,000 _ EACH OCCURRENCE S EXCESSLIAB CLAIMs•MADE X C5099618218 04/01/2019 04101/2020 AGGREGATE $ 5,000,000 DED X I RETENTIONS 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS LIABILITY ,.X r STA O TIRF FRS ANY PROPRIETOR/PARTNER/EXECUTIVE P5W0002907 01/01/2020 01/01/2021 1,000,000 FlCCE�E E�TgO�Rq PARTNEExCLUD/E N NIA S.L.EACH ACCIDENT S antlaWrylnNH) EL.DISEASE-EAEMPLOYEE$ 1,000,000 ryes describe under 1,000,000 ESCRIPTION OF OPERATIONS below D PI'llEL.DISEASE-POLICY LIMIT ; Professional Llab RDP0031831 04101/2019 04/01/2020 Per Claim 5,000,000 Claims-Made Form Aggregate 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more space Is'squired) Certificate Holder is an Additional Insureds wi ,...• j trt , 'NT and Umbrella Liability when required by writtens ontract yi��!'w v WAIVER N-I s11►�' 4�'. v CERTIFICATE HOLDER CANCELLATION MONR1 02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe CountyBoard of CountyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners PO Box 1026 Key West,FL 33041 AUTHORIZED REPRESENTATIVE illatie ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �-.1140 CPHEN-1 OP ID: KM ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03/01/2019 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 321-445-1117 CONTACT Kristin McIntosh JCJ Insurance A enc NAME: 2208 Hillcrest Street y ONE (A/C,N ,Eat):321-445-1117 FAX No):321-445-1076 Orlando,FL 32803 E-MAIL certs@jcj-insurance.com Mark E.Jackson ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Casualty Company 20443 CINSUREDc. INSURER B:Valley Forge Insurance Company 20508 PH In 5001)I/est Fulton Street INSURERC:Transportation Insurance 20494 Sanford,FL 32771 INSURER D: an RLI Insurance Company 13056 INSURER E: 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD .IMMIDDIYYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR C5099618199 04/01/2019 04/01/2020 DAMAGE TO RENTED 300 000 X PREMISES(Ea occurrence) S MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: i Emp Ben. s 1,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X C5099618204 04/01/2019 04/01/2020 BODILY INJURY(Per person) S OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) S _ AUTOS ONLY _ NON-OWNEDUUT NY PROPERTY accidentDAMAGE S S C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 EXCESSLIAB CLAIMS-MADE X C5099618218 04/01/2019 04/01/2020 AGGREGATE S 5,000,000 DED X RETENTIONS 10,000 $ D WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY _ STATUTE EERH Y/N PSW0002907 01/01/2019 01/01/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S D Professional Liab RDP0031831 04/01/2019 04/01/2020 Per Claim 5,000,000 Claims-Made Form Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is an Additional Insureds with regards to General,AA Y 't MANAGEMENT and Umbrella Liability when required by written contract. i�Y BY DATE - WAIVi W/i YES_ CERTIFICATE HOLDER CANCELLATION MONR102 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe CountyBoard of CountyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners PO Box 1026 Key West,FL 33041 AUTHORIZED REPRESENTATIVE a lil Z____ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD