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Certificates of Insurance --"•" COAST-1 .4C®R`C3 F-10-1/2912021 0ERTIFICATE OF LIABILITY INSURANCE (MMrDDaYYrv) 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(les)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 endorsements. PRODUCER 954-883-2900 COATACT Gail Fulmore Tanenbaum Farber of Florida PHONE 954-883.2900 FAX 954-517-7400 2900 SW 149th Avenue (Arc No,Cxt) (AIC,Not: Miramar,FL 33027-6605 �--Lss,gfulmore@thflorida.com Pat Murphy PDRE .-... ...-.... INSURER(s)AFFORDING COVERAGE ...-.... ..-...- NAIC# -... _INSURER A;Northfield Insurance Company 37987 �NSURE INSURER B:Hartford Underwriters Ins.Co. 30104 oasta1 Systems International,Inc. INSURER C,National Union Fire Insurance 19445 464 S.Dixie Highwayy INSURER D Beazley Insurance Co.lnc.USA 37540 Coral Gables,FL 33'146 INSURER E: INSURER F: COVERAGES C RTIFI T NUMBER: REVISION N MB R: 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 SUBJLCI" TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL w'UBR POLICY NUMBER POLICY FEE POLICY EXP ......... ......... L.1Mf'rs... ......... ...... LTH A X COMMERCIAL GENERAL LIABILITY 1,000,000.. '., EACHOCCURRI�=NCF $ CLAIMS-MADE X OCCUR WS445667 01/20/2021 01/20/2022 DAMAGE TO RENTED 300,000 Y PREMISES(Ea occurraixea '- - MLD EXP(Any ono person) 1 5,000 Approved Risk Management PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGG7"IEUFa I'E LIMIT AI'I'i.1E5 PER. I I '. GENERAL AQGRIeCi+,TE 2,000,000 .. POLICY X PRO oC 2,000,000 Jr CT PRODUCTS S COMR'OP AGC,. OTHER, 4-15-2021 B A.UTOMOSILE.LIABILITY COMB1NEI7SING-1- LIMIT 10001000 (L3_aY6d""D X ANY AUTO Y 21UECIN8962 01/20/2021 101/20/2022 BODILY INJURY(Po,Porlon, OWNED SCNEDULEt7 I I AUTO';ONLY AUTOS NO(}It_Y INJURY ON),air tbnnl) $ )( r9IRFj7 X N(7N-OWNED ---- AU' PhdUPEI'0en IJAM1AAf,;F= s ONLY ;AUTOS ONE.V (Pmr rrccidtanll )i C UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 51000,000 X EXCESS LIAB CLAIMS-MADE, EBU036021723 01/20/2021 0112012022 AGGREGATE 5,000,000 DER RETENTION$ WORKERS COMPENSATION PE OTF1` AND EMPLOYERS LIABILITY YIN STATUTE CAR _. ANY F t`tC13£"Ri6IORiI'RFtTPdERJFXECUTiVE E L CACIi ACCIDENT n/a t€FTC,,rLM M,A IQ E`YC UDCD7 MtA (6andatory in NNj C L.DISEASE-EA EMPLOYEE 7' n/a 11 6',d yCr fX £her n/a D $f;kIPTION OF QPF.RATIONS.lze..lq. F I.DISEASE POLICY LIMI F D Professional Liab V15RA2211401 01/30/2021 01/30/2022 Per Claim 1,000,000 Claims Made RETRO DATE N/A Aggregate 2,000,000 DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES(ACORD 101,Additionmi Remarks Schedule,may be attached if more space is required) Re: 320000.01 -Monroe County Monroe County BOCC is Addifional Insured on General Liability and Automobile Liability for operations performed by the insured as required by written contract. CERTIFICATE HOLDER CANCELLATION MONRO96 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe Count BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Insurance Compliance PO Box 100085-FX Duluth,GA 30096 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From: gfulmore(Wthflorida.com To: monroecountyfl monroecountylI(q)EIlix.com CC: mmarino(I coastalsystemsint.com,gperez(iil)coastalsystenisint.com,dospina(&,coastalsystemsi 11t.coill Subject: Coastal Systems International Inc. - Reference Number- FXOOOOOO16- Pill Number: 12126011 - FW: Monroe County Florida Certificate of Insurance Req Date: 1/29/2021 7:58:18 AM Attach men t(s): Attached please find renewal Certificate of Insurance to update your file on the referenced. Gail 1). Fulmore I AlAAl (.'oullylereial Account Manager Talletillaillik I larbor of Florida 1,11(: a.2900 S\X 1491h Avotme Suile 100 Nliranim% 11, 33027 t. 954-8,83-2900 1 41. 951­883-2902 1 1'.954-517-7, 162 "I'vo%N11 v 11 I h Please be atl�ise(l ilial (-A)\erage cAnnol be bound.c1liatigeil(,r-anwwle4l ia im einail llwss age. Tanenbaum Harber makes it easy for you to make your premium payment with our ePay option.In today's uncertain environment,our e-Pay option gives you immediate notification that your payment has been received, helping to avoid potential lost checks or non-payment cancellation notices from insurance companies. You can pay by virtual check on our website or by our ePay app: Poyrrients ePay Flyer From:Customer Service<monroecountyfl@ebix.com> Sent.,Friday,January 22, 2021 3:08 PM To:Gail D. Fulmore<gf ul more @thf lorida.com> Subject: Monroe County Florida Certificate of Insurance Req at its A -4, r V2 The attached notice is being sent to you on behalf of Monroe County Florida by Ebix RCS, Monroe County Florida has engaged with Ebixu,manage insurance compliance verification on its behalf.You must be properly insured while doing business with Monroe County Florida and comply with insurance requirements. Auo[the date nf this notice wm have not received proper evidence ofinsurance coverage. Please review the attached notice as it includes the information needed for compliance and where/o send your Certificate ofInsurance, Vendor Instructions: The attached notice isbeing sent to you and your agent,ifwe havethei,emai|addressonfi|e. Agent Instructions: Please review the attached notice asn includes the info,mauo^ needed for compliance, Please send your Certificate of Insurance via*mai|ou if you have any questions, please contact Ebix6v calling(9SU92S-1213; thank you for your prompt attention to this matter, ���° "— 'X Eb|x,|nc. I One Eb|x way IJohns Creek, GA3OD97 1VVeb' This email has been scanned for email related threats and delivered safely by Mimecast. For more information please visit Insurance Compliance PO Box 100085-FX i Duluth,GA 30096 January 22, 2021 Reference Number-FX00000016 Pin Number: 12126011 Coastal Systerns International Inc. 464 South Dixie Highway Coral Gables,FL 33146 USA SUBJECT: CERTIFICATE OF INSURANCE REQUIREMENTS NOTIFICATION The terms of our agreement state that you must provide us with evidence of insurance coverage meeting our requirements while doing business with Monroe County Florida. According to our records,the evidence of your insurance coverage we received from Tanenbaum Herber of Florida, issued on 6/15/2020 requires your attention for the following reason(s): Deficiency Data Policy_ *Auto Liability-Expired Coverage. 01/20/2021 21UECIN8962 .Excess Liability-Expired Coverage, 01/20/2021 EBU020701254 *General Liability-Expired Coverage. 01/20/2021 WS411238 *Professional Liability-Expiring Coverage. 01/30/2021 V15R12201301 Included on the back of this notice is information about our certificate requirements. please contact your insurance agent or broker and ask them to provide us with a current Certificate of Insurance using one of the following methods: A. By uploading directly to our website: littr)s://www,ebi r etts.coiii using your reference number and pin number shown at the top right of this notice. B. By email to monroecountyflebix.com C. By fax to(770)325-5717 After using one of these methods, please do not send us the certificate by mail. We should receive your Certificate of Insurance within 15 days of the date of this notice in order to avoid further notices and possible interruption of your activities with Monroe County Florida. If you have questions about this notice or the correct coverage required you may call us at(951)925-1213. Sincerely, Insurance Compliance Department Incomplete Coverage 1 (IC11 CERTIFICATE OF LIABILITY INSURANCE Date MWDDtYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION!ONLY AND CONFERS NO RIGHTS UPON THE CER TIFIC ATE 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 '....... N1 U7EN"f RAtC BE t E'"NS ING INSL RER( j.,A kENTA LTIVEOR PIRDiaLI AND THE Ct Ft'Ih IHt7L(?ER 'IMPORTANT:If the certificates holder is an ADDITIONAL.INSURED the,policy(ie+s)murt be endorsed If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy L,.edain policies may require ate ondorsoment A"state8rrsent on this certificate does,not confer rights to the certificate holder In heu of such endorsomentts)--------------------------- PRODUCER Phone: CONTACT NAME: Fax: PHONE FAX Name&Address of Producer (A/C.No,Ext). (A/C No)' E-MAIL ADDRESS: PRODUCER CUSTOMER ID 4: INSURER(S)AFFORDING COVERAGE NAIL INSURED INSURER A: AM Best Rating A-, Or BetterWpr Id INSURER B: AM Beat Rating A-,, Or Better OVI Name 8 Address of Insured INSUR R AM Best Rating A-, Or Better ___ pro e INSURER D AM Best Rating A-, Or Better vide COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT T14E POI IC'IES OF INSURANCE LISTED BELOW BEEN ISSUED TO T14E INSURED NAMED ABOVE FOR THE POLICY PERIOD DICACED NOTWITFiSTANOtNG ANY RPOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICR'THIS CERTIFICATE MAY BE ISSUED OR MAY ERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERIOS,EXCLUSIONS AND CONDr TIONS Or SUCH POL,GIES LIMITS SHOWN MA HAVE BEEN REDUCED BY PAID N' ODC SUBR POLICY Err IC Y EXP OR YPE Or INSURANCE POLICY NUMBER LIMITS INSR VD DATE(MMtt)DYY) il(MhhtDDfk'YYXf""� �« A GENERAL LIABILITY EACH O. CURRENCE $300,000 X COMMERCIAL GENERAL LIABILITY Y DA GE TO RENTED CLAIMS MADE �( OCCUR ,,,,, EMISES(Ea occurrence) MED EXP(Any one person) j I,. PERSONAL.A ADV INJURY GENERAL AGG LIABILITY APPLIES PE GENERAL AGGREGATE POLICY PROJECT PRODUCTS-COMPAC P AGG AUTOMOF11t E LIh iL[TY COMBINED SINGLE LIMIT $1000000 X ANY AUTO HIRED AUTOS ' ALL OWNED AUTOS Y Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) $500,000 i NON-OWNED AUTOS BODILY INJURY (Peraccident) $1,000,000 PROPERTY DAMAGE(Per accldents100.000 UMBRELLA LIAR "OCCUR j. EXCESS LIAR EACH OCCURRENCE DEDUCTIBLE C'L dS_. AGGREGATE RETENTION ---- ---- - - D WORKERS EOM'- NSATION AND }(_ WC,STATUTORY LIMITS OTHER EMPLOYER'S LI BILRY NX ANY PROPRO,I ORIPAHTNt..F4! N E t EAUi ACCIDENT $1,OEJ0,000 EXECUTIVE OFFICERf@�fR = EXCLUL)ED7 -° E.L,DISEASE-EA EMPLOYEE ItM7Er rFtlay n NH) _ - ' $1 000 000 iyexcrr +Fee s� E.L.DISEASE-POLICYLIMIT $1000000 RIPTION OFOPERATI s b�� - Watercraft Liability Aggregates $1,000,000 Builders Risk: Each Occurrence $1,000,000 Real Replacement Value Proof Of Coverage DESCRIPTION OF OPERATIONS IT LOCATIONS If VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more apace is required) -Required Additional Insured Language for General Liability and Auto Liability Monroe County BOC;C. -Workers Compensation: Must provide coverage for the following State(s): FL "Jonas Act Endorsement must be included or referenced on certificate when required by contract" CERTIFICATE HOLDER CANCELLATION ..Monroe County BOCC -SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Insurance Corry>IIanC� EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE i POLICY PROVISIONS. PO Box 100085-F}4 AUTHORIZED REPRESENTATIVE Duluth,GA 30096 Certificate Must be Signed Monroe County Florida Certificate R g,iirements Please note that the certificate requirements appearing in this notice are for certificate tracking purposes only,and do not alter your insurance obligations under our agreement in any way. The certificate must include: Coverage must be placed with carrier rated not less than A-, and show complete insurance carrier names as it appears in AM Best Property&Casualty wide(or include NAIL#or AMBest#). Binders are not acceptable. Required Certificate Holder Language: Monroe County BOCC. Additional Requirements: • Required Additional Insured Language for General Liability and Auto Liability Monroe County BOCC. • Workers Compensation: Must provide coverage for the following State(s): FL • ""Jones Act Endorsement must be included or referenced on certificate when required by contract`" If appropriate, please complete the following section and return this form to the address shown on the front of this notice. Reference Number FX00000016 Coastal systems International Inc. My Company is no longer doing business with Monroe County Florida. Automobile-No company owned autos. Workers'Compensation-I certify that my company has no employees that fall within the jurisdiction of any state(s) Workers'Compensation taws in which work is to be performed. Authorix.ed Signature bate Printed Name Title Phone Number --------------- Cgntact Information If any of the information shown below is a)missing or b)incorrect,please complete or correct it and return it along with your certificate. Your Email Address:acabrera@coastaI system sint.corn Your Agent's Email Address:gfulmore@thflorida.com Your Telephone#:(305)669-8651 Your Agent's Telephone#: (954)883-2900 Your Fax#: Your Agent's Fax#:(954)517-7400 Client#:89861 COASSYST DA (MMfUD1YYYY) ACORD., CERTIFICATE OF LIABILITY INSURANCE 10/TE28/2020 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 pollcy(les)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 any rights to the certificate holder In lieu of such endorsement(s). PRODUCER N MF: Nicole Larsen Greyling Ins.Brokerage/EPIC PHONE 770-220-7686 FAX 866.550-4082 _(AfC,No,Ext): (AIC,No) 3780 Mansell Rd.Suite 370 E-MAIL Nicole.Larsen re com Alpharetta,GA 30022 ADDRESS;__ @9 Ylln J• INSURER(S)AFFORDING COVERAGE NAIL 0 INSURER A:Hartford Ins Co of the Midwest 37478 INSURED INSURER 8 Coastal Systems International,Inc. INSURER c 464 South Dixie Highway INSURER D Coral Gables,FL 33146 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: 20-21 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. VTR TYPE OF INSURANCE NSR D POLICY NUMBER (ADDLSUBR Mk tDONYYY) (MMiDCDtYY'YY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ANI CF pt,#RENTED C,LAiMS•t i,A4:4€ii OCCURRF.I�tI�r _Ear,&rmnw.) Approved Risk Management DIED EXP(,V,y d"e pemn) PERSONAL&ADV.INJURY GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPRO $ POLICY J>zrUT LOG PRODUCTS COMP0!AGG ,..$ 01H R: 4-15-2021 $ AUTOMOBILE LIABILITY cdmb INrb y,NCLE E!@ril l (Ea au.ldent) $ ''....ANY AUTO BODILY INJURY{Pena'pe'z $ CS'A+NEG AUTOS ONLY AD IC)SCHES DtlLcD BODILY INJURY{Per tta,udent)-..$ ''.... �.HIRED NON OWNED PROPERTY DAMAGE ...� AUTOS ONLY AUTOS ONLY (P,,,acc,dent) UMBRELLA LIAR �OCCUR '... EACH OCCURRENCE $ EXCESS LEAK GLAWAS--MADE A OREOATE .._$ DED- BE"IFRI IONS _ _$ A WORKERS COMPENSATION 20WBGAC2XS7 11J0112020 11l01l2021 X PER oTII AND EMPLOY ERS'LIABILITY SIATUTE ER ANY PROPRiETOEUPAr TINCRrEXECUTIVE Y I N E!-EACH ACCIDENT $1,000,000 OFFIGER/10EMBER EXCLUDED" i NIA (Mandatary in NH) N '.,. EL DISEASE EA EMPLOYEE,.$1,000,000 If yvrr,descnbo undor DESCRIPTION OF OPERATIONS tx°low E' DISEASE•POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re: FX00000016. Jones Act coverage is included. CERTIFICATE HOLDER CANCELLATION Monroe Count BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Insurance Compliance ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 100085-FX Duluth,GA 30096 AUTHORIZED REPRESENTATIVE 0 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2437002/M2382291 NLAR1 This page has been left blank intentionally. From: noreplyC4).epicbrokers.com To: monroecountyfl; nicole.larsen(ti')greyling.com motiroecotitityflr&,Ebix.coin,nicole.larsen nagreyling.com CC: Subject: Proof of Insurance Coverage- Monroe County BOCC; Insurance Compliance Date: 10/28/2020 9:45:21 AM Attachment(s): Please see attached documentsO The information in this email is intended for the sole use of the addressees and may be confidential and subject to protection under the law. If you are not the intended recipient, you are hereby notified that any distribution or copying of this email is strictly prohibited. If you have received this message in error, please reply and delete your COPY.