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4th Change Order 05/11/2021 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/20/2021 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 w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AOn Risk services, Inc Of Florida -NAME,PHONE FAX i 1001 Bri ckel l Bay Drive (A/C.No.Ext): (111) 283-7122 A/C.No.: (800) 363-0105 Suite 1100 E-MAIL p Miami FL 33131 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: United Educators Ins, a Reciprocal RRG 10020 University of Miami INSURER B: Old Republic Union Insurance Company 31143 1320 S. DIXIE HIGHWAY,SUITE 1200 Coral Gables FL 33146 USA INSURER C: National Union Fire Ins Co of Pittsburgh 19445 INSURER D: AIU Insurance Company 19399 INSURERE: New Hampshire Insurance Company 23841 INSURER F: COVERAGES CERTIFICATE NUMBER: 570087375728 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. Limits shown are as requested IN SR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF P LI Y EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY 8220001115864 111202 2020 11 0112021 EACH OCCURRENCE $1,500,000 SIR applies per policy terms & COndl ions DAMAGE TO RENTED CLAIMS-MADE x1 OCCUR PREMISES Ea occurrence) Included Ap xoved Risk Managem'e/n with Atta hments MED EXP(Any one person) Excluded PERSONAL&ADV INJURY Included GENIAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $1,500,000 X POLICY ❑PRO- ❑LOC 5-20-2021 PRODUCTS-COMP/OPAGG Included 00 LUJ C OTHER: C C CA 4594503 11/01/2020 11/01/2021 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY - - $1,500,000 Fleet B Ea accident C X ANYAUTO CA 459-45-02 11101120201110112021 BODILY INJURY(Per person) O SCHEDULED Fleet A/Ph sical Damage Z OWNED y g BODILY INJURY(Per accident) a) AUTOS ONLY AUTOS HIREDAUTOS NON-OWNED PROPERTY DAMAGE W ONLY AUTOS ONLY Per accident w_ 0) A UMBRELLA H OCCUR 14688Z 11/01/2020 11/01/2021 EACH OCCURRENCE $10,000,000 L) EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED XRETENTION D WORKERS COMPENSATION AND wc046912979 11/01/2020 11/01/2021 X I PER STATUTE I OTH- EMPLOYERS'LIABILITY YIN ADS ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT $1,000,000 E OFFICER/MEMBEREXCLUDED' N/A wc046912980 11/01/2020 11/01/2021 (Mandatory in NH) MA OH WA E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—_ C Excess WC XWC6559421 11/01/2020 11/01/2021 EL Each Accident $500,000— FL EL Disease - Policy $500,000 SIR applies per policy terms & condi ions EL Disease - Ea Emp- $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Monroe County Board of County Commissioners are included as Additional Insured in accordance with the policy provisions of the General Liability and Auto Liability policies. �~y 4� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE =:z POLICY PROVISIONS. 0E- Monroe County AUTHORIZED REPRESENTATIVE Board of County Commissioners 1100 Simonton Street �- Key West FL 33040 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000037109 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services, Inc of Florida University of Miami POLICY NUMBER See Certificate Number: 570087375728 CARRIER NAIC CODE See Certificate Number: 570087375728 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. In SR ADDL SUBR POLICY NUMBER POLICY POLICY LIMITS LTR TYPE OF INSURANCE EFFECTIVE EXPIRATION INSD R'VD DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) WORKERS COMPENSATION D N/A wc046912978 11/01/2020 11/01/2021 Workers Comp - CA ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD