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HomeMy WebLinkAboutCertificates of Insurance DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 11/30/2021 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 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 CONTACT HOUSE NAME: Kelly White&Associates Insurance, LLC AICN No, Ext: FAX A/c No): 1622 Hickman Road E-MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32216 INSURER A: RLI Insurance Co AM Best A+XI 13056 INSURED INSURER B: Travelers Property&Casualty Company 01205 Coffin Marine Services, Inc INSURERC: P O Box 430538 INSURER D: Everest National Insurance Company 10120 INSURER E: Water Quality Insurance Syndicate Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF21 1 1 301 4255465 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE F_X1 OCCUR PREMISES(Ea occurrence) $ 50,000 X P&I including Jones Act MED EXP(Any oneperson) $ 5,000 A X Salvors Liability X X MRP0200000 09/23/2021 09/23/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Approved Risk,Management GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC i I' PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: ' `� , �, ,� `I, ,y�fi� !, Protection&Indemnity $ $1,000,000 AUTOMOBILE LIABILITY j�. COMBINED SINGLE LIMIT $ 1 000 000 11-30-2021 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BA4902R108 08/17/2021 08/17/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED IX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Personal Injury $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ r $ WORKERS COMPENSATION X STATUTE X EORH Includes USL&H AND EMPLOYERS'LIABILITY Y/N D OFFICER/MEMBERANY EXC EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE NIA 9700000381-201 12/21/2020 12/21/2021 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule $1,000,000 E Vessel Pollution 55-83732 09/23/2021 09/23/2022 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certificate Holder is an Additional Insured with respects General Liability as per form (Blanket Additional InsuredAA/aiver of Subrogation)OMGL 624(11/07) and Auto Liability,with respects to insureds operations as required by written contract. Protection& Indemnity is proof of Jones Act coverage required by law. USL& H coverage is provided under Workers Compensation policy. 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. Marine Resources Office AUTHORIZED REPRESENTATIVE 2798 Overseas Highway Ste.420 Marathon FL 33050 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/27/2021 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 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 CONTACT HOUSE NAME: Kelly White&Associates Insurance, LLC a/CNNo Ext: 904-880-8881 FA//X No: P.O. Box 350909 E-MAIL ADDRESS: kelly@kwhiteinsurance.com kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32235 INSURERA: RLI Insurance Co AM Best A+XI 13056 INSURED INSURERB: Travelers Property&Casualty Company Coffin Marine Services, Inc INSURERC: P O Box 430538 INSURER D: Everest National Insurance Company INSURERE: Great American Insurance Company 16691 Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF21042709051004 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 50,000 X P&I including Jones Act MED EXP(Any oneperson) $ 5,000 A X Salvors Liability X MRP0200000 09/23/2020 09/23/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X ❑PRO- ❑ Approved Risk Management POLICY JECT LOC -7�i/ / PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: Protection&Indemnity $ $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANYAUTO 4-28-2021 BODILY INJURY(Per person) $ B OWNED SCHEDULED X BA4902R108 08/17/2020 08/17/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Personal Injury $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ r $ WORKERS COMPENSATION XJPER STATUTE X EORTH IncludeslUSL&H'. AND EMPLOYERS'LIABILITY Y/N D OFFICER/MEMBER/EXCLUDE/D ANY ECUTIVEPROPRIETORPARTNEREX � N/A 9700000381-201 12/21/2020 12/21/2021 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule $1,000,000 E Vessel Pollution OMH1440763 09/23/2020 09/23/2021 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is listed as Additional Insured as required per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 2798 Overseas Highway AUTHORIZED REPRESENTATIVE Ste 420 Marathon FL 33050 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 12/04/2020 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 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 CONTACT HOUSE NAME: Kelly White&Associates Insurance, LLC AICN No, Ext: FAX A/c No): P.O. Box 350909 E-MAIL ADDRESS: kelly@kwhiteinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32235 INSURER A: RLI Insurance Co AM Best A+XI INSURED INSURER B: Travelers Property&Casualty Company Coffin Marine Services, Inc INSURERC: P O Box 430538 INSURER D: Everest National Insurance Company INSURER E: Great American Insurance Group 190354 Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: COFF201 2041 1 0021 57 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE F_X1 OCCUR PREMISES(Ea occurrence) $ 50,000 X Protection& Indemn/Jones Act MED EXP(Any oneperson) $ 5,000 A X Salvors Liability X MRP0200000 09/23/2020 09/23/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PRO ❑ 1,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED X BA4902R108 08/17/2020 08/17/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED IX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Personal Injury $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ r $ WORKERS COMPENSATION XJPER STATUTE X EORH Includes USL&H AND EMPLOYERS'LIABILITY Y/N ANY D OFFICER/MEMBERPROPRIETOR/PARTNER/EXECUTIVEEXCLUDED? NIA 9700000381-191 12/21/2019 12/21/2020 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per co Schedule $1,000,000 E Vessel Pollution OMH1440763 09/23/2020 09/23/2021 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) 1 Certificate Holder is listed as Additional Insured as required per written contract. BY, i r 12/4/2020 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 2798 Overseas Highway AUTHORIZED REPRESENTATIVE Ste 420 Marathon FL 33050 0. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD