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Certificates of Insurance AC a CERTIFICATE OF LIABILITY INSURANCE DATE ,Q" TI 1 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 pollcyges)must 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). MW000ER CONTACT NAME: Mitllelle Rushing Bowen,Miclette Si Britt of Florida,LLC PHONE FAX 1020 N. Orlando Avenue,Suite 200 EwF I407)6474616 rAA:xe'.(4W)628-1635 Maitland FL 32751 ADDRESS, mrusI1IIKI bmbinc.com INSURER(S)AFFORDING COVERAGE WPCY INSURER A:Amerisure Insurance Company 19488 WSURED PEDROFALCO Meune B:Amerlsure Mutual Insurance Company 23396 Pedro Falcon Electrical Contractors,Inc. 31160 Avenue C INSURERC: Big Pine Key FL 33043-4516 INnMERD: INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:1924792931 REVISION NUMBER: I 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. I8R ADDLTUDR POLICY EfF POLICY EXP LTR TYPE OF INSURANCE MO WW2 POLICY MIMBEA IIMLCDtYWYI IYEYDwYYWI UNITS A X I COMMERCIAL GENERAL UASIUTY Y Y GL209254106 11M020 11Rrz021 EACH OCCURRENCE $1,[00,011] CLAIMS-MADE X OCCUR DAMAGE TO ROVED PREMISES(ES GLnenc) $ICOAW MED EXP(APT m*Pmm) $5.000 • PERSONAL$ADV WJURY $1.000.000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $203O.00 PCLIcy X Tg LOC PRODUCTS•COMP/OP AGG $2,WO.OGJ • OTHER: $ A AUTOMOBILE LIABILITY Y Y CA20529300E 11212020 I1/2/2021 COSMINED SINGLE LIMIT 1Eavmdynq $1ACegp X ANY AUTO BODILY INJURY Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS _ µUTOS m Pa SoddPERTYe DAMAGE B X 'UMBRELLA LIAR X OCCUR Y Y CU200294208 1122020 1122021 EACH OCCURRENCE $4OCO.mO EXCESS WB CLAIMS-MADE AGGREGATE Dm RETENTION $ B WORKERS COMPENSATION Y WC209452806 11R2020 11Z2021 X PER OM AND EMPLOYERS'UABEPY yIN aTATUTE ER ANY PROPHIETOWPARTNEWEXECUTIVE • EL.EACH ACCIDENT $t000.0.O OFFICER/MEMBER EXCLUDED? N/A (MandaNry In NH) 07.0( N ALMT EL.DISEASE.EA EMPLOYEE stecepa O al/moo OF here-noes below EL. l EL.DISEASE-POLICY LIMB $1,000,020 BY 1/17/2002 w/ attachments WOMDESCRIPTOR OF OPERATIONS/LOCATIONS 1 VEHICLES ..d `' required) The following policy provisions and/or endorser WAIVIA N/A Yflo 'certificate of Insurance. The terms contained In the policies and/or endorsements supersede Ui ` provisions and/or endorsements listed below are available by @mailing: certifcates@gbmbinc.com When required by written contract,those parties listed in said contract,including the Certificate Holder,are added as additional insureds with respect to the General Liability including ongoing and completed operation,Auto Liability,and Umbrella Liability as afforded by the policy and/or endorsements. When required by written contract,waiver of Subrogation is granted with respect to the General Liability.Auto Liability,Workers Compensation,and Umbrella See Attached.,. 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 Board of County Commissioners 1100 Simonton Street Suite 2-213 AUTHORIZED REPREBEXrANE Key West FL 33040 rv44 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PEDROFALCO LOC 8: ACCFR Oe ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Bowen,Midette S Britt of Florida,LLC Pedro Falcon Electrical Contractors,Inc. 31160 Avenue C POLICY EMBER Big Pine Key FL 33043-4516 CARMEN NAM CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF UABILITV INSURANCE Liability to those parties listed in said contract,including the Certificate Holder. The General Liability and Umbrella Liability codified herein are primary and non-contributory to other Insurance available,but only to the extent required by written contract. Workers Compensation policy covers the state of Florida. ACORD 101 (2008/01) ®2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OCTi 2019 DATE(MMIDD/YYYY) ACc RO 1 CERTIFICATE OF LIABILITY I SOIRTANdE2019 10/28/2019 THIS CERTIE1 .T �tEED•�rs••A 1l ATTER OF INFORMATION ONLY AND CONF=R O RIGHTS UPON THE ERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND 0R�R°THE•G.OVERAGE.AF ORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINt, INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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 Bowen, Miclette&Britt of Florida, LLC NAME: Michelle Rushing X 1020 N. Orlando Avenue, Suite 200 (A//cc."N .Ext): (407)647-1616 (q/c,Not:(407)628-1635 Maitland FL 32751 ADDARESS: mrushing@bmbinc.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amerisure Insurance Company 19488 INSURED PEDROFALCO INSURER B:Amerisure Mutual Insurance Company 23396 Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C INSURER C: Big Pine Key FL 33043-4516 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:825555661 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. INSRT ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE NSD WVD, POLICY NUMBER LT R (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GL209294105 11/2/2019 11/2/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y CA209293905 11/22/2019 11/2/2020 COMBINED SINGLE LIMIT-_ 5 __ _ _ _ (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per accident) _ 5 B X UMBRELLA LIAB X OCCUR Y Y CU209294205 11/2/2019 11/2/2020 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ B WORKERS COMPENSATION Y WC209452605 11/2/2019 11/2/2020 X PER OTH- AND EMPLOYERS'LIABILITY Y/NANY STATUTE ER OFFICER/MEMBER PROPRIETOR/ FFICER/MEMER/EXCLUDED?ECUTIVE N N/APARTNER/EX E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) GEMENT E.L.DISEASE-EA EMPLOYEE 51,000,000 If yes,describe under APPR�r V 1D'B i?''7t I DESCRIPTION OF OPERATIONS below RV ` / �'�+ /u E.L.DISEASE-POLICY LIMIT $1,000,000 DATE ■CI= y1 WAIVER N/A Y DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing: certificates@bmbinc.com When required by written contract,those parties listed in said contract,including the Certificate Holder,are added as additional insureds with respect to the General Liability including ongoing and completed operations,Auto Liability,and Umbrella Liability as afforded by the policy and/or endorsements. When required by written contract,waiver of Subrogation is granted with respect to the General Liability,Auto Liability,Workers Compensation,and Umbrella See Attached... 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 Board of County Commissioners 1100 Simonton Street Suite 2-216 Key West FL 33040 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f 4 AGENCY CUSTOMER ID: PEDROFALCO LOC#: AE D ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMED INSURED Bowen,Miclette&Britt of Florida,LLC Pedro Falcon Electrical Contractors,Inc. 31160 Avenue C POLICY NUMBER Big Pine Key FL 33043-4516 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS • THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Liability to those parties listed in said contract,including the Certificate Holder. The General Liability and Umbrella Liability certified herein are primary and non-contributory to other insurance available,but only to the extent required by written contract. Project:Marathon Tax Collector's Structural Shoring • • • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT - FORM A This endorsement modifies insurance provided under the following' COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number -Agency Number Policy Effective Date GL209294105 0845507 11/2/2019 Policy Expiration Date Date Account Number 11/2/2020 11228245 Named Insured Agency Issuing Company PEDRO FALCON ELECTRICAL BOWEN M,ICLETTE & BRITT OF AMERISURE INSURANCE CONTRACTORS INC FLORIDA, LLC COMPANY 1. a. SECTION II-WHO IS AN INSURED is amended to add as an additional insured any person or organization: (1) Whom you are required to add as an additional insured on this policy under a written contract or written agreement relating to your business; or (2) Who is named as an additional insured under this policy on a certificate of insurance. b. The written contract,written agreement. or certificate of insurance must: _ _ _ (1) Require additional insured status for a time period during the term of this policy;and (2) Be executed prior to the"bodily injury","property damage", or"personal and advertising injury" leading to a claim under this policy. c. If, however: (1) "Your work"began under a letter of intent or work order;and (2) The letter of intent or work order led to a written contract or written agreement within 30 days of beginning such work; and (3) Your customer's customary contracts require persons or organizations to be named as additional insureds; we will provide additional insured status as specified in this endorsement. 2. The insurance provided under this endorsement is limited as follows: a. That person or organization is an additional insured only with respect to liability caused, in whole or in part, by: (1) Premises you: (a)Own; (b) Rent; (c) Lease; or (d)Occupy; (2) Ongoing operations performed by you or on your behalf. Ongoing operations does not apply to "bodily injury"or"property damage"occurring after: Includes copyrighted material of Insurance Services Office, Inc. CG 70 48 10 15 Pages 1 of 4 Policy#GL209294105 Effective Dates: 11/2/2019-11/2/2020 (a) All work to be performed by you or on your behalf for the additional insured(s) at the site of the covered operations is complete, including related materials, parts or equipment(other than service, maintenance or repairs); or • (b) That portion of"your work"out of which the injury or damage arises is put to its intended use by any person or organization other than another contractor working for a principal as a part of the same project. (3) Completed operations coverage, but only if: (a) The written contract,written agreement, or certificate of insurance requires completed operations coverage or"your work"coverage;and (b) This coverage part provides coverage for"bodily injury"or"property damage"included within the"products-completed operations hazard". However,the insurance afforded to such additional insured only applies to the extent permitted by law. b. If the written contract,written agreement, or certificate of insurance: (1) Requires"arising out of"language;or (2) Requires you to provide additional insured coverage to that person or organization by the use of either or both of the following; (a) Additional Insured—Owners, Lessees or Contractors—Scheduled Person Or Organization endorsement CG 20 10 10 01;or (b) Additional Insured—Owners, Lessees or Contractors—Completed Operations endorsement CG 20 37 10 01; then the phrase"caused, in whole or in part, by"in paragraph 2,a. above is replaced by"arising out of". c. If the written contract, written agreement, or certificate of insurance requires you to provide additional insured coverage to that person or organization by the use of: (1) Additional insured—Owners, Lessees or Contractors—Scheduled Person Or Organization endorsement CG 20 10 07 04 or CG 20 10 04 13; or (2) Additional Insured—Owners, Lessees or Contractors—Completed Operations endorsement CG 20 37 07 04 or CG 20 37 04 13;or (3) Both those endorsements with either of those edition dates; or (4) Either or both of the following: (a) Additional Insured—Owners, Lessees or Contractors—Scheduled Person Or Organization endorsement CG 20 10 without an edition date specified; or (b) Additional Insured—Owners, Lessees or Contractors—Completed Operations endorsement CG 20 37 without an edition date specified; then paragraph 2.a.above applies. d. Premises,as respects paragraph 2.a.(1)above, include common or public areas about such premises if so required in the written contract or written agreement. • e. Additional insured status provided under paragraphs 2.a.(1)(b)or 2.a.(1)(c)above does'not extend beyond the end of a premises lease or rental agreement. f. The limits of insurance that apply to the additional insured are the least of those specified in the: (1) Written contract; (2) Written agreement; • (3) Certificate of insurance;or (4) Declarations of this policy. The limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. Includes copyrighted material of Insurance Services Office, Inc. Page2of4 CG70481015 • Policy#GL209294105 Effective Dates: 11/2/2019-11/2/2020 g. The insurance provided to the additional insured does not apply to "bodily injury", "property damage",or "personal and advertising injury"arising out of an architect's,engineer's,or surveyor's rendering of,or failure to render,any professional services,including but not limited to: • (1) The preparing,approving, or failing to prepare or approve:, (a) Maps; (b) Drawings; (c) Opinions; (d) Reports; (e) Surveys; (f) Change orders; (g) Design specifications; and (2) Supervisory, inspection, or engineering services. h. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS. paragraph 4.Other Insurance is deleted and replaced with the following: 4. Other Insurance. Coverage provided by this endorsement is excess over any other valid and collectible insurance available to the additional insured whether: a.Primary; b. Excess; c.Contingent; or d.On any other basis: __ _ v_ but if the written contract, written'agreement,or certificate of insurance requires primary and non- contributory coverage,this insurance will be primary and non-contributory relative to other insurance available to the additional insured which covers that person or organization as a Named Insured,and we will not share with that other insurance. i. If the written contract,written agreement, or certificate of insurance as outlined above requires additional insured status by use of CG 20 10 11 85,then the coverage provided under this CG 70 48 endorsement does not apply except for paragraph 2.h.Other Insurance. Additional insured status is limited to that provided by CG 20 10 11 85 shown below and paragraph 2.h.Other Insurance shown above. ADDITIONAL INSURED-OWNERS,LESSEES OR CONTRACTORS(FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL..GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Blanket Where Required by Written Contract,Agreement,or Certificate of Insurance that the terms of CG 20 10 11 85 apply (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of"your work"for that insured by or for you. CG 2010 11 85 Copyright,,Insurance Services Office. Inc., 1984. Includes copyrighted material of Insurance Services Office, Inc. CG 70 48 10 15 Pages 3 of 4 a T Policy#GL209294105 • Effective Dates: 11/2/2019-11/2/2020 j. The insurance provided by this endorsement does not apply to any premises or work for which the person or organization is specifically listed as an additional insured on another endorsement attached to this policy. • Includes copyrighted material of Insurance Services Office, Inc. Page 4 of 4 CG 70 48.10 15