Certificate of Insurance
tt..,'.'"""""",."""""".", "',....,",....,'<<,~.". ~!~%::~~::::::<,::::::~d~h::~~::::~::::::::~;~;~:,:,' . ....<,~~:"~:db,,,::,:',.,"~~::~~~m:dm::::~::::::::::~:::::::::::t:m::~~::~~::<~~,:,:,"", ,~:,,::::::::~W'^~N<<~< W,' ,:<::<<d~f:~~l~:~~::!lllirllllilliilllillllllllllll.~.:'~;;~'~;;~~;:';":!:I
'PRo'DucER" """"" "."..., , ". """., '" ,. ,...",,,,,,,,. . .,."",,,....",,,,,, .. """'"'''''''' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
ALTAMURA,MARSH
P.O. BOX 60287
FORT MYERS, FL
&ASSOC
33906-6287
COMPANY
A
RELIANCE INSURANCE COMPANY
Lodge Construction, Inc.
Cabot & Sylvia Dunn
2161 McGregor Blvd #B
Fort Myers, FL 33901
COMPANY
B EMPLOYERS SE
INSURED
COMPANY
C
COMPANY
D TIME:
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,
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIVY) DATE (MMIODIVY)
LIMITS
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
X SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
SN1653190
GENERAL AGGREGATE $1,000,000
PRODUCTS - COM PlOP AGG $1,000,000
PERSONAL & ADV INJURY $1,000,000
11/18/98 11/18/99 EACH OCCURRENCE $1,000,000
FIRE DAMAGE (Anyone fire) $50,000
MED EXP (Anyone person) $5,000
COMBINED SINGLE LIMIT $
1,000,000
BODILY INJURY $
(Per person)
11/18/98 11/18/99 BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
HI CLAIMS MADE [K] OCCUR
A OWNER'S & CONTRACTOR'S PROT S N 1 65 31 9 0
A
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
B ;~~;NRE~7~~~TIVE INCL
OFFICERS ARE: EXCL
OTHER
83010196
... . ..... ............ .....
OTHER THAN AUTO ONL Y HmWlmmllHlMllll~f
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $ 3, 0 0 0 , 0 0 0
11 / 18 / 9 8 11 / 18 / 9 9 AGGREGATE $ 3, 0 0 0 , 0 0 0
$
oJ~- .~illlnMllHlMMMlntm
$1,000,000
04/01/99 04/01/00 $1,000,000
,$,l 0 0,000
EXCESS LIABILITY
A X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
SX1653190
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESlSPECIAL ITEMS
LIMITS SHOWN ARE THOSE IN EFFECT AT POLICY INCEPTION. WI,'VER: j';,;'
*30 DAYS RE: WORKERS COMPENSATION - STATE OF FL OPERATIONS ONLY.
MONROE COUNTY IS LISTED AS AN ADDITIONAL INSURED AND CERTIFICATE HOLDER.
MONROE COUNTY DOCC
5100 COLLEGE ROAD
KEY WEST, FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF