COI Expires 09/01/2014'--wi ®
ACOR" CERTIFICATE OF LIABILITY INSURANCE
DATE (MMMD/YYYY)
11/1/2013
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 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 .
CONT CT
PRODUCER
Brown & Brown Insurance - Clearwater
NAME:Deborah Gale
PHONE 461-6044 FAX _
ac No
E-MAIL DDR
AESS:
P O Box 2456
Clearwater FL 33757-2456
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A:HartfOrd Fire Insurance CO.
19682
INSURED
INSURER B:Hartford Casuallyn r nT9424
INSURER C:Continental Casually Co.
20"31
Kisinger Campo & Assoc. Corp.
KCCS, Inc
201 N. Franklin Street, Ste. 400
Tampa FL 33602
INSURER D :
INSURER E :
INSURER F
Ii V Y CRNV G.7 v im.. .. .-- . — 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
IN R
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MM/DDIYYYY
LIMITS
B
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
Y
21UUNAG7547
'
P
DA
/1/2013
EMENT
/1/2014
EACH OCCURRENCE
$1,000,000
DAMAGE T RENTED
PREMISESoccurrence)$100,000
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$1,000,000
X Contractual
WAIV /A
GENERAL AGGREGATE
$2,000,000
X
XCU Liability
PRODUCTS - COMP/OP AGG
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO- jECTLOCCOMBINED
LiMIT
$
A
AUTOMOBILE LIABILITY
Y
21 UENNE3246
11/2013
!1/2014
Ea accident
1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON-OX HIRED AUTOS X AUUTOSWNED
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
B
X
UMBRELLA LIAB
OCCUR
21XHUAG7607
/1/2013
/1/2014
EACH OCCURRENCE
$3,000,000
N
AGGREGATE
$3,000,000
EXCESS UAB
CLAIMS -MADE
X WC STATU- OTH-
$
A
NIA
1 WBNW1033
10/3/2013
0/3/2014
DED X RETENTION $10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PPI— TIVF Y 1 N
OFFICER/MEMBER UDED?'r N
(Mandatory in NH)
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE -EA EMPLOYE
$500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
C
Professional Liability
Claims Made
AEH288295813
1/2/2013
1/2/2014
Per Claim 2,000,000
Aggregate 5,000,000
Deductible 250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability. Explosion, collapse and
underground hazard included in CGL. .
ENGINEERING DESIGN & PERMITTING SERVICES FOR CARD SOUND BRIDGE REPAIR PROJECT LOCATED IN MONROE COUNTY,
FL. 60-DAYS NOTICE OF CANCELLATION OR NON -RENEWAL PER ATTACHED FORM IH-03020608. (KCA PROJECT #1201302.00)
C= ~;
G!
113
MONROE COUNTY - BOCC
ATTN: JUDITH S. CLARKE, PE, DIRECTOR OF ENG
SVCS
1100 SIMONTON STREET
KEY WEST FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES fiftAN(RLLED BEFORE
THE EXPIRATION DATE THEREOF, _ NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROM9ANS. 3
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD