Loading...
COI Expires 03/06/2020 A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDN ) 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 NAME:CONTACT Certificate Department Five County Insurance Agency Inc PHONE FAX 14120 Metropolis Ave (A/C,No,Extl:239-939-1400 (NC,No):239-939-3813 Fort Myers FL 33912 E-MAILDSS: certs@fivecountyinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:American Builders Insurance 11240 INSURED DECCO-1 INSURER B:National Builders Insurance 16632 DEC Contracting Group Inc 1560 Matthew Dr Unit B INSURER C:Old Dominion Insurance 40231 Fort Myers FL 33907 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:154371360 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. I S LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) (MMIDD/YYYY) B X COMMERCIALGENERALLIABILITY ' Y PKG016751707 3/6/2019 3/6/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR 1� DAMAGE TO RENTED X Aj r,t,�_ AIM .MENfi PREMISES(Ea occurrence) $100,000 r_D MED EXP(Any one person) $5,000 _ "' -"-PERSONAL&ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: 5-1 ,, __ PANERALAGGREGATE $2,000,000 X PRO- LttA'i ,,, l =::i .. POLICY JECT LOC � - PRODUCTS-COMP/OP AGG $2,000,000 OTHER: WAI WA'.{(\ Y $ C AUTOMOBILE LIABILITY Y B1P0157N 5/8/2019 5/8/2020 COMBINED SINGLE LIMIT $1,000,000 1 (Ea accident) X ANY AUTO ( BODILY INJURY(Per person) $ W ONED SCHEDULEDUlt. I BODILY INJURY(Per accident)' $ AUTOS ONLY AUTOS 94' HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY el/` / (Per accident) � L W� $ A X UMBRELLA LIAB X OCCUR UMB018902304 3/6/2019 3/6/2020 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION 5 4.4.:."ee $ A WORKERS COMPENSATION WCV016799205 3/6/2019 3/6/2020 X I PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER _ ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1$1,000,000 OFFICER/MEMBER EXCLUDED? NIA (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) Re: Key West International Airport Noise Insulation Program,Construction of KWBTS Building B Floors 3-6 The Monroe County Board of County Commissioners;Key West By the Sea Association Inc their employees and officials are included as additional insureds with respects to General Liability and Auto Liability. Thirty days Notice of Cancellation applies;10 days for non-payment of premium per Florida Statute. 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 AUTHORIZED REPRESENTATIVE KEY WEST FL 33040 "1--t- .r4/7-4-AN-.. I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD