COI Expires 07/08/2019 A`ORD® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY)
08/17/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,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 pollcy(les)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 pC/AOM TACT Mary Smith
Stahl&Associates Insurance Inc. PHONE (813)818-5300 FA% (813)818-5398
u{IVtCC a.Es* I LAIC.No).
3939 Tampa Road a o RSS: mary.smithttstahlinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC
Oldsmar FL 34877 INSURER A, Wilshire Insurance Company 13234
INSURED INSURER a: Owners Insurance Co 32700
Razorback LLC INSURER C: Nestahester Surplus Lines Ins Co 10172
278 Knoltwaod Road INSURER 0:
INSURER E:
Tarpon Springs FL 34688 INSURER F:
COVERAGES CERTIFICATE NUMBER: 18.19000PU19.20AUTO 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.
LTR TYPE OF INSURANCE I MD POLICY NUMBER (MMIDDmYY) IM =1 UNITS
X COMMERCIAL GENERAL LIABILITY 1,000,000
EACH OCCURRENCE S
CLAIM&MADE X OCCUR �AA7ACtETORENIED 100,000
.PFIEMI E'SIEeocci mail S _
MED EXP(Any one oaraon) s 5,000
A L800070382 07/08/2018 07/08/2019 PERSONAL&ADVINJURY s 1.000,000
GENLAGGREGATE LIMIT APPUES PER: GENERALAGGREGATE S 2.000,000
POUCY D fog 0 LOC PRODUCTS-COMP/OPAGG 5 2.000,000
OTHER: S
AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT 5 1,000,000
483 acadann
X ANY AUTO 1 BODILY INJURY(Per person) S
g OWNED ®SCHEDULED 5181816000 05/16/2019 06/16/2020 i BODILY INJURY(Per amdentl S
AUTOS ONLY _ AUTOS
HIRED NON-OWNED PRO EPTY DAMAGE 5
AUTOS ONLY " AUTOS ONLY {par shdiM1
..i...._ _ PIP $ 10.000
UMBRELLAUAB OCCUR .''-.f Oa - EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADEV BY AT
/A(SK AlttN i AGGREGATE 5
lt
' DED I I RETENTION S - 5
WORKERS COMPENSATION f,., - -I PER1OTH•-
AND EMPLOYERS'LIABILITY Y/N DATA t!1-1 1 STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E NiA WA N/ ELEACHACCtDENT S
OFFICER/MEMBER EXCLUDED?
lenndatory in NH) - — EL DISEASE-EA EMPLOYEE S
II yea.deaaibe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UMIT S
Contractor's Pollution Liability General Aggregate 2,000,000
C G71164920 001 07/08/2018 07/0812019 Each Pollition Condition 1,000,000
Deductible 2.500
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD lot,Additional Remarks Schedule,may be snitched If more apace Is required)
Project Key West Lighthouse Keeper's Quarters Foundation Repair
Certificate Holder is listed as an additional insured with respects to General Liability and Auto Liability if required by direct written agreement Waiver of
Subrogation applies in favor of additional insured with respects to General Liability If required by direct written agreement,
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 ACCORDANCE WITH THE POLICY PROVISIONS.
1100 Simonton Street
AUTHORIZED REPRESENTATIVE �p
Key West FL 33040 „/r/fA.,.U/J Ud7 46: t,,,eD
CB 1988.2015 ACORD CORPORATION. All rights reserved.
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