Certificates of Insurance DATE(MMMD/YYYY)
aim"Rom CERTIFICATE OF LIABILITY INSURANCE
5111 r202
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; Stacy Cook
AWA Insurance Agency PHONE FAX
13700 Six Mile Cypress Pkwy (A/C,No, 239 418 11C1t7 (A/c No):239 41t3-11 4
E-MAIL _
Suite# 1 ADDRESS: stacy@awainsurance.cont
Ft.Myers FL 33912 _INSURER(S)AFFORDING COVERAGE NAIC III
INSURERA: Mt. Hawley Insurance Company 37074
INSURED MARICON-01 INSURER B.Auto-Owners insurance Company 18988
Marino Construction Group, Inc.
PO BOX 1706 INSURER C: FOCI Insurance Company 10178
KEY WEST FL 33041 INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:1401254007 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 t'O 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. A6.7DL 3UBR POLICY EFF POLICY EXP _
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDtYYYY MMIDDrYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY Y 9070583-A 5/12/2021 5/12/2022 EACH OCCURRENCE $1,000.000
DAMAGE TO R NTED
CLAIM&MADE X OCCUR Approved Risk Management PREMISES(Ea uecuarvrrwt $5U 000
-. -MED EXP(Airy one persrel) $5,000
YYLCe:2GG"e- PERSONAL is A.DV INJURY $i'000,000
GEN1 AGGREGATE LPAIT APPLIES PER � I GENERAL.AGGREGATE � $2,000,000
POLICY X_ J'EcT LOT: 6-30-2021 PRODUCTS-COMIC/IMP AGG _$2 00U 000
OTHER $
8 AUTOMOBILE LIABILITY Y 52.830030.00 5/12/2021 5/12/2022 COMBINED SINGLF LIMIT $1,UUd,000
X ANY AUTO '., BODILY INJURY(Per person) $.
OWNED i SCHEDULED ,..BODILY INJURY(Per acCSaertt) S
AUTOS ONLY AUTOS
X I4IRED X NON-OWNED PROPERTY DAMAGE $
AU 1 OS ONLY '..; AUTOS ONLY (Per arwdern) .....
A UMBRELLA LIAR X OCCUR 9072326-A 511212021 512/2022 I EACH OCCURRENCE $5,000,000
X EXCESS LIAR ClAIM&MADE AGGREGATE $5,000,000
DED RETENTION $
C WORKERS COMPENSATION 11113102'0 11/13221 ER OTHf 7T
AND EMPLOYERS'LIABILITY YIN __--
ANYPROPRIErOR#PARTNEWEXEGUTIVE ( N F EACH ACCIDENT $1,0KC100
OF FICERWEMBEREXCLUDLD� J N I A
(Mandatory In NH) '.. E,L DISEASE-EA EMPLOYEE. $1,000,000
If/n.,,do scribe undr'r
DES4,R PTION OF OPERATION`below E L DISEASE-POLICY LIMIT $1,000 000
C Inlarvd Manna-Cornmefc+al CM 100030408-02 9/26/2020 91,26/2021 Rentodtt eased Equ rp 150,000
DESCRIPTION OF OPERATIONS I LOCATIONS;VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
Certificate Holder is named as additional insured with respects to General Liability and Auto Liability,
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 POLICY PROVISIONS.
Monroe County BOCC Insurance Compliance
PO Box 100085-FX AUTHORIZED REPRESENTATIVE
Duluth GA 30096
fc71988-201+ACORD CORPORATION. All rights reserved,
ACORD 2 (2016103) The ACORD dame and logo are registered marks of ACORD
From: mail-server(gi),cs r24.email
To: monroecountyf! nioitroecotiiityflr,4,),Ebix.conI
CC:
Subject: Proof of Insurance for Marino Construction Group, Inc.
Date: 5/11/2021 12:54:29 PM
Attachment(s):