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COI Expires 09/14/2014 ® DATE(MM/Do,YYYY,Ace CERTIFICATE OFLIBILITY INSURANCE4.,�,i 6/19/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE:CERTIFICATE HOLDER,THIS . CERTIFICATE DOES NOT AFFIRi1AATIVELY 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 it an ADDITIONAL INSURED,the.polity(ids)must be-endorsed. If SUBROGATION IS WAIVED,subjectto 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). CONTACT i PRODUCER. NAME:- Patricia Cholewa LL ! The James B.Oswald Company. • PHONE FAX,No1d216 839-2$15 1100 Superior Avenue,Suite 1500 MA�St,Eali 216 839-2i307 Cleveland OH 44114 ADDRESs:PCholewa• oswaldcompanies.com INSURER(S)AFFORDING COVERAGE __�.. I NAic a. _ I INSURER A:H.artfor C.ars.U.altylns.C.L _._...__.._._ �9424. INSURED MBIK2-1 INSURERS: ZCLSpe.cialiyJ>Zstdtanc,a.e.Q.._--- --�Z$85______..._, K2M Design INSURERC: 100,1 Whitehead St:,Suite 101 _ 1 INSURER.D , Key West FL 33040 7522 INSURER.E INSURER F.: COVERAGES 'CERTIFICATE NUMBER:1262239359 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. ADDS�S`URRI - POLICY EFF POLICY EXP INSR . TYPE OF INSURANCE . INSR WVD+ POLICY NUMBER IIMMIDDIYYYY1 (MMIDD/YYYY I LIMITS A GENERAL LIABILITY 'Y Y �45SBA107008" 9/14/2013. 9/14/2014 EACH OCCURRENCE- Si:000,000. DAMAGE TO RNTED X COMMERCIALGENERALLIABILITY I PREMISES(Ea occurrence) $1,000,000 JCLAIMS-MADE X I OCCUR. MED EXP lAnne person) S10,000 X AI Primary 8 PERSONAL&ADV INJURY $1,000_000. X Non-Contributory I GENERAL AGGREGATE $2,000,000 'GE N'L AGGREGATE MIT'APPLIESP.ER: i .PRODUCTS-COMP/OP AGO_ $2,000,000 POLICY X'. PED I(X 1 LOC. ' 'I . ! S- A AUTOMOBII E LIABILITY Y Y ! 0/14/2013 a/14/2014 COMBINED SINGLE LIMIT i 45SBA107008 -(Ea accident) S1 000 000 ANY AUTO I BODILY INJURY(Per person) S ALL OWNED' Tal'.SCHEDULED BODILYINJURY(Peracddonq $ _ C I NON-OWNED I 1 PROPERTY DAMAGE $ X HIRED AUTOS 1 X' 3 AUTOS I I(Per acc dent)__. i X Al Primary I I $ - i A X UMBRELLALIAB IX OCCUR' Y Y 45SRA107008 9/14/2013 9/14/2014- EACH OCCURRENCE- S1,000,000: EXCESS LIAB CLAIMS-MADE I AGGREGATE S1,000,000' ; DED I X RETENTION$10,000 I Excludes Professional 1 5 A WORKERS COMPENSATION y. 4 tt55BA107008' 9/14/2013' (i/14/2014 WC-STATU- {X `oTH- OH-STOP GAP ' AND EMPLOYERS'LIABILITY YIN I t ....TQ,R,Y;,L(MLT,SL__._.1_..Ef3__.�_ _............................. ANY PROPRIETOR/PARTNER/EXECUTIVE _ILL.EACH ACCIDENT S1,000,000' OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) i E.L.DISEASE-EA EMPLOYE!„.$1,000,000 If yes.describe under .. .... .._.'-. _._ DESCRIPTION OF OPERATIONS below ! E.L..DISEASE-POLICY LIMIT $1,000,000 B Professional Liability. N Y iDPR97165.62 6/12/2014 6/12/2015 Each Claim $3,000,000 Claims Made , Aggregate 53,000,000 Retro Date:9/1/2001 1 Pollution&Erivir. Liab.Included I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is-required)' Additional Insured and Waiver of Subrogation as designated above is provided when required of-the Named Insured by written contractor agreement. Project:Mk-13082 Marathon Sewer Connections Y PR I E Monroe County Board.-of County Commissioners is,an additional insured as noted above. �.G A. D WAIVER N/A_ E _ CERTIFICATE-HOLDER CANCELLATION V 1 A Wit ilU:1 .iUci OW •t a • fl3 V11 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 ACCORDANCE WITH THE POLICY PROVISIONS.• Attn:Ann M. Rigor 1100 Simonton Street Key Roo X?1g t mi 1— mnr blot AUTHORIZED REPRESENTATIVE• ,� K West FL 33040i► •`I Pi �J �,�'�.Cc+v1�- • t 080338 803 03111 . . . ©1988-2010 ACORD CORPORATION. All rights reserved. • ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD •