COI Expires 11/02/2013ACORRV® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
8/28/2013
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 .
PRODUCER
Brown &Brown Insurance -Clearwater
P O Box 2456
Clearwater FL 33757-2456
CONCT
NAME DeborZ Gale
PHONE FAX -7695
WE No. Et)b727 461-6044 A/C No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A:Harfford Fore Insurance CO.
19682
INSURED
INSURER B:HartfOrd Casualty Insurance4
INSURER C:Contonental Casualty Co.
20443
Kisinger Campo & Assoc. Corp.
INSURER D :
KCCS, Inc
201 N. Franklin Street, Ste. 400
Tampa FL 33602
INSURER E :
INSURER F
CnVFRAnFA CERTIFICATE NUMBER: 111AAA171.r, 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDD
POLICY EXP
MMIDDIYYYY
LIMITS
B
GENERAL LIABILITY
Y
21UUNAG7547
/1/2013
/1/2014
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMA E RENTED
PREMISES Ea occurren
$100,000
MED EXP (An one person
$10,000
CLAIMS -MADE 15F] OCCUR
I ISK
MENT
$1,000,000
X Contractual
R
X
XCU Liability
GENERAL AGGREGATE
$2,000,000
n LTT7�PERSONAL&ADVINJURY
R rvin.](�
7
GEML AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
$
POLICY X JECT PRO- LOC
A
AUTOMOBILE LIABILITY
Y
21UENNE3246
/1/2013
/1/2014
Ea accident
1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NONAUT-OWNED
PPeOr acadenDAMAGE
$
B
X
UMBRELLA LIAB
X
OCCUR
21XHUAG7607
/1/2013
/1/2014
EACH OCCURRENCE
s3,000,000
AGGREGATE
$3,000,000
EXCESS LIAB
CLAIMS -MADE
4
DED X I RETENTION $10,000
$
A
WORKERS COMPENSATION
1WBNW1033
h0/3/2013
0/3/2014
X WC LIMITS j OR
AND EMPLOYERS' LIABILITY N
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? N❑
(Mandatory in NH)
N / A
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
E.L. DISEASE - POLICY LIMIT
$500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
C
Professional Liability
Claims Made
AEH288295813
1/2/2012
1/2/2013
Per Claim 2,000,000
Aggregate 5,000,000
Deductible 250,000
DESCRIPTION OF OPERATIONS I 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, omlapstund
underground hazard included in CGL.
ENGINEERING DESIGN & PERMITTING SERVICES FOR CARD SOUND BRIDGE REPAIR PROJECT LUED IN;Pg COUNTY,
FL. 60-DAYS NOTICE OF CANCELLATION OR NON -RENEWAL PER ATTACHED FORM IH-03020608. PROJ #t2fl1302.00)
- 1
CERTIFICATE HOLDER t.Arv�.cL ter► I TWIN - - - c a 41
MONROE COUNTY - BOCC
ATTN: JUDITH S. CLARKE,
SVCS
1100 SIMONTON STREET
KEY WEST FL 33040
PE, DIRECTOR OF ENG
SHOULD ANY OF THE ABOVE DESCRIBEDv6LIC1ES BgCANc , LED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WI -_ BE &LIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS. ICI
AUTHORIZED REPRESENTATIVE
42419 . R. SG.d&�
V 1VOtf-ZUIU AL;UKU L UKt-UKAI IUN. AU ngnL5 reserveo.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD