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Certificates of Insurance
ACO CERTIFICATE OF LIABILITY INSURANCE DATE E�12ROD2� rv1 t THIS CERTIFICATE IS ISSUED AS 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 INSURERS',AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. R the Certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and condigois 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 endoreemende). CT Jordan Delmante m opuCER e:TA Marshall&Sterling,Inc �EPRONE (MI PRE NaY (B45)4e5-7e04 110 Main Street ADDRESS ibelmonte®marM811SterIng.o301 IN WREIIISIAFFORONG COVERAGE new il Poughkeepsie NY 12601 IRSURERA: StarNet Insurance C Mpany 40045 INSURED INSURERS: Lower Keys Marine Tovnng&Salvage Inc. INSURERC: DBA TowEoatUS Big Pine Key INSURER D: PO BOX431 B54 INSURER!: _ Big Pine Key FL 33043 INWIRERF: COVERAGES CERTIFICATE NUMBER: C12112295023 REVISION NUMBER: THIS IS TO CF 11FY THAT TIE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL DIE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MP rases RANCE D PouCY NUMBER (MWDLDYYYY) (SEN Y En EDD(YY� LW NS NW UNITS C0aERCM!ffNERAL IIANLRY EACH OCCURRENCiniciAtw E 1,000,000 CWS6NADE OIXLOR PREMISE-51Ea[N,LrWO ml 2,SOD )( Marine General Liablityl MEDExP Mynrepnml 500 A - Marina Operators Legal Liability Y BOUMM210242 01(31/2021 01/31/2022 PERsoNAL&Ace INJURY — n£MAGGREGATE OMIT APPLIES PER GENERAL AGGREGATE 2,000,000 Pour❑,P,Ec"GT n La I 4 Approved Risk Managerrent PRODUCTS-CWPAY AGO OTHER: �/'/" AVTUPOui IJAatITY yy P, / G'il / Da=wenSINGIE LIMIT V AUTO x�✓ L. cJCO!/frG BODILY NJURV wernerynl — OVER SCNEWLED BODILY IIOURY(PxaoYhnl) AUTOSONLY AUTOS_ FIRED _ AUTOS ONLY —AUTOS ONLY 5-4-2021 PRRA *I GE DUN IMBREIALIM OCCUR EACH MOLRRENGE a EXCESS Wa OUINSN OE AGGREGATE 4 CED RETENTION a $ — WICNISERS COMPENSATION PER EFM ANo PNLOYORS LNMun ANY PROPNETOPAARTNERIExECUrrE 'FIR SATIATE N,A E.L.EACH ACCIDENT S iMp.4A.�y„Arv" 1 EL DSEASE-EA EMPLOYEE $ IOES(I flON OPERATIONS below EL GSEASE-P11c UNIT a RotxeOn and indemnity A BOUMM210242 01/31/2021 01131/2022 LIMIT S1,030,000 DESCRIPTION OF OVERARMS;LOCAT NSIVEHICLES NCpN IB1.AM1WwW Renews YleduN,an be saws x nenepm Sr.ynM) MOTMB County BOCC is an addional Insured,if reailred by a wtmen contRC1. 'SP-23 PSI Form including liabilities to crew under the Merchant Maine Act of 1920(the'JanesARO is provided under the Protection&Indemnity,a don o'Prolec ion&In emnity sect On of the policy provides'Polygon Exclusion Buyback A caverage^ "Protection&Indemnity sepbn of policy provides VS Longshoreman and Harbor Workers Act Coverage" "'Alain General Liability section of Nor policy provides'Pollution Limitation Endorsement coverage.— CERTIFICATE HOLDER CANCELLATION SHOULDANT OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC Insurance Compliance ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 100005-EX AUTHORIZED LFRESENTATIVE Duluth CA 30095 ft—t-Jam. 1 6198E-2015 ACORD CORPORATION. All lights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD CI CW A021011 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It codifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can It be used, In any way,to modify coverage provided by such policies.Mention of this certificate does not change the teens,exclusions or conditions of such policies.Coverage Is subject to the provisions of the policies, including any exclusions or conditions, regard- less of the provisions of any other contract,such as between the certificate holder and the Named Insured.The limits shown below are the limits provided at the policy inception.Subsequent paid claims may reduce these limits. Certificate Holder Named Insured: MONROE COUNTY BOARD OF COMMISSIONERS LOWER KEYS MARINE TOWING b SALVAGE 2798 OVERSEAS HWY INC MARATHON, FL 33050-4277 PO BOX 431854 BIG PINE KEY FL 33043-1854 Automobile Liability InnserName: Allstate Insurance Company Policy Number. 64 8161419 1-Any Auto 2-Owned Autos Only 3-Owned Pdv.Pass.Autos Only 4-Owned Autos Other Thanpdv. 5-Owned Autos Subject to Na X 8-Owned Autos Subject too Compulsory UM Law •Pass.Autos Only Fault X 7-Spedfcally Described Autos iX 8-Hired Autos Only X 9-Non-owned Autos Only ----- Po&y-ENective Date: 04-28-2021 PaticyEp(mtion Dale: 09-28-2022 Limits Of 3 1,000,000 Combined Single Limit(each accident) Insurance: &Per Person BIPerAcddent PD Per Accident Desoiptlon of OperetensiLmationsfYehidestEndomemenbISpecial Provisions Approved Risk Management use 5-d-2n71 Interested Party Type: ADDITIONAL INSURED - OTHER THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR(OGHTS TO THE CEXIIFICATE HOLDER IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN AD DITIONAL INSURED,THE POLICY(IES) M UST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS.THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED M SUCH POLICY IANGUAGE OR ENDORSEMENT. Producer MaK AGENCY INC Authorized representative: Date:34-26-21 Includes copyrighted material of Insurance Services Office,Inc.,with its permission CI CW A021011 Allstate insurance Company Page 1 of 1 Car to Copy 20 Ira P4inon MONROE COUNTY,FLORIDA REQUEST FOR WAIVER OF INSURANCE REQUIREMENTS It is requested that the insurance requirements,as specified in the County's Schedule of Insurance Requirements,be waived or modified on the following contract. Connlacmr/Vendor: L saff&J‘Ct\ lS VNA,zi,t_(our �/sf7 fr S AZWIS"ct _1? 4 Project or Service: CA'rake--T UUS�c-\3 Addrss&Phone �� e '*•3 Adders&Phoned: ` ]? G, ctc(" c., Fi , 3lc$ 3 General Scope of Work: Of-t't Qs(� VG"SSE S 0Ont:S Reason for Waiver or iJE 1} 42F IA SL. A _Q__'SD fuES A - —IIsE ARE Modification: raa,\\y cruse° 4 r _ .,ram r _t6c:.<< p Perstrukismss, S%wYTf t eat--Corn) /uoN- -eia h \fmala fnr yyrMla2 -,^,Qc aMtr 1 Policies Waiver or Modification will apply to: K 11 ,,E //._. Signature of Conlractodvendor. ..�G sn-,(aadZ _— Dam: 12-30-2020 Approvedo�e X Not Approved Risk Management Signature: ///� L � Dale: County Administrator appeal: Approved: _., Not Approved: Date: Board of County Commissioners appeal: Approved: Not Approved: Meeting Date: Administrative Instruction 7500.7 104 AC" " CERTIFICATE OF LIABILITY INSURANCE DATE(M 12/30//2020 Y) 020 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 NAME: Marshall&Sterling,Inc. a/CNr o Ext: (845)454-0800 FAX,No): (845)485-7804 110 Main Street E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Poughkeepsie NY 12601 INSURERA: StarNet Insurance Company 40045 INSURED INSURER B Lower Keys Marine Towing&Salvage INSURER C: DBA:Tow Boat US Big Pine Key INSURER D: PO Box 431854 INSURER E: Big Pine Key FL 33043 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2013079622 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AUUL5UbK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_]OCCUR PREM SES Ea occurrDence $ 2,500 X Marine General Liability/ MED EXP(Any one person) $ 500 A Marina Operators Legal Liab. Y BOUMM200242 01/31/2020 01/31/2021 PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PECT ❑ LOC PRODP1UCTS-COMP/OPAGG $POLICY ❑ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED -& h�^ PerOPERTY accident) DAMAGE $ A AUTOS ONLY AUTOS ONLY UMBRELLA LAB �F � OCCUR T -. _:. _ - 1., EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE DATE1.2/3 2 2�. W, „,�a..:�::: rliTle tCSEGATE $ DED RETENTION $ $ WORKERS COMPENSATION WAW l X — PER OTH- AND EMPLOYERS'LIABILITY Y/N I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE El E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Protection and Indemnity A BOUMM200242 01/31/2020 01/31/2021 LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Monroe County BOCC is an additional insured,if required by a written contract. 'SP-23 P&I Form,including liabilities to crew under the Merchant Marine Act of 1920(the"Jones Act")is provided under the Protection&Indemnity section of policy' "Protection&Indemnity section of the policy provides'Pollution Exclusion Buyback A'coverage.- -Protection&Indemnity section of policy provides'US Longshoreman and Harbor Workers Act Coverage'*** "'Marine General Liability section of the policy provides'Pollution Limitation Endorsement'coverage."" 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 Insurance Compliance ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 100085-FX AUTHORIZED REPRESENTATIVE Duluth GA 30096 7 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00116386 LOC#: ACCPR" ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Marshall&Sterling,Inc. Lower Keys Marine Towing&Salvage,DBA:Tow Boat US Big Pine Key POLICY NUMBER 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 (This Certificate Supersedes the previously issued Certificate on 11/02/2020) ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 20 ig Edultun MONROE COUNTY,FLORIDA REQUEST FOR WAIVER OF INSURANCE REQUIRE MENTS It is requested that the insurance requirement,,;, as specified in the Caunty's Schedule of Insurance Requirements,be waived or modified on the following contract. CongractoriVendor L-) Project or Service.- ContracwriVendor r�l Address&Phone A: General Scope of Work, Reason for Waiver or modificatiow P- Policies Waiver or Modification will apply to: Signature of Contractor-Tendor: Date: 12-30-2020 Approved Not Approved Risk Management Sigmiture:_, Dale: County Administrator appeal, Approved: Not Approved. Date: Board of County Commissioners appeal: Approved: Not Approved- Meeting Date- —------ Administrative Instruction 7500.7 a, You`.In pad hrr& Cl CW A02 10 11 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard- less of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception.Subsequent Paid claims may reduce these limits. Certificate Holder. Named Insured: MONROE COUNTY BOARD OF COMMISSIONERS LOWER KEYS MARINE TOWING & SALVAGE 2798 OVERSEAS HWY INC MARATHON, FL 33050-4277 PO BOX 431854 BIG PINE KEY FL 33043-1854 Automobile Liability Insurer Name: Allstate Insurance Company Pol___icyNumber 648161419 1 —An Auto,_ 2—Owned Autos Only 3—Owned Priv.Pass.Autos Only 4—Owned Autos Other Than Priv. X 5—Owned Autos Subject to No Pass.Autos Only Fault 6—Owned Autos Subject to a Compulsory UM Law X 7—Specifically Described Autos X 8—Hired Autos Only X 9—Non-owned-Autos Only __- Polf-cy Effective Date: 0 4•-2 8-2 0 2 0 Policy Expiration Date: 0 4-2 8-2 0 21 Limits Of $ 1,000,000 Combined Single Limit(each accident) Insurance: ,,..... BI Per Person �. mmm BI Per Accident PD Per Accident Description of Aperations/Locations/Vehides/Endorsements/SF±dal Provisions M A ISK I C44T ��.. A 12/22/2020 Interested Party Type: ADDITIONAL INSURED OTHER_ THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS.THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. MILANES INS GROUP INC Authorized Representative: Date: 05-21-20 includes copyrighted material of Insurance Services Office, Inc., with its permission Cl CW A02 10 11 Allstate Insurance Company page 1 of 1 ertdcate Copy