Certificates of Insruance
Approved Risk Management
7-19-2021
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.4COR®� CERTIFICATE OF LIABILITY INSURANCE0/2021
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 endorsements .
PRODUCER CONTACT HOUSE
NAME:
Kelly White&Associates Insurance, LLC PrtoNE Extli 904-880 8881 ,Fvc No
P.O-Box 350909 EDDREMAIL SS: y�kell kwhiteinsurance.com
A
INSURERS AFFORDING COVERAGE NAIC#
Jacksonville FL 32235 INSURER A: Security National Insurance Company
INSURED INSURER B: Travelers Property&Casualty Company
Coral Construction Company INSURER C: Nautilus Insurance Company
Po Box 500582 INSURER D: Wesco Insurance Company
INSURER E: Kinsale Insurance Company 38920
Marathon Shores FL 33050 INSURERF: RLI Insurance Company
COVERAGES CERTIFICATE NUMBER: CORA2106100934071 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 l S R POLICY NUMBER MW POLICY
POLICY EFF DYYYY MI LTR DfYYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
X CLAIMS-MADE OCCUR PREMISES I- iEagccurrn ,$ 100,000
MED EXP(Any oneperson) $ 5,000
A X X SES179464600 10/31/2020 10/31/2021 PERSONAL xADVINJURY `>; 1,000,000
G Approved Management EN'L AGGREGATE LIMIT APPLIES PER: -7,,� GENERAL AGGREGATE $ 2,000,000
X POLICY PRO- Y��Ce ue 2,000,000
JECT LOC PRODUCTS-COMPIOP AGG
OTHER_ $
AUTOMOBILE LIABILITY 7®1 1 COMBINED SINGLE LIMIT $ 1,000 000
.<n�2.,t1............................................................-....................................:.....................................
ANYAUTO BODILY INJURY(Per person) $
B OWNED X SCHEDULED X BA4P029528 01/16/2021 01/16/2022 BODILY INJURY(Per accident} $
AUTOS ONLY AUTOS
X HIRED V NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident
PIP $ 10,000
X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000
C EXCESS LIAB CLAIMS-MADE AN059226 10/31/2020 10/31/2021 AGGREGATE $ 1,000,000
QEQ I I RETENTION 5 $
WORKERS COMPENSATION X S'ATUrE X T OT H ER USL&H 6006E
AND EMPLOYERS'LIABILITY Y t N
ANY PROPRIETORIPARTNERtEXECUTI'JE E L EACH ACCIDENT $ 1,000,000
D OFFICERIMEMBER EXCLUDED? Y N t A WWC3500602-20 12/12/2020 12/12/2021
(Mandatory in NH) EL-DISEASE-EA EMPLOYEE $ 1,000,000
If yes.describe under 1,000,000
DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $
E Contractor's Pollution X 0100119011-0 06/24/2021 06/24/2022 Per Occurrence $1,000,000
Aggregate $2,000,000
F Protection&Indemnity HUL0200301 05/26/2021 05/26/2022 Per Occurrence $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Monroe County BOCC are included as Additional Insured as respects General Liability and Auto Liability policies, pursuant to and subject to the policy's
terms,definitions, conditions and exclusions. All as required per written contract.Waiver of Subrogation on behalf of the certificate holder as required by
written contract. Longshoreman Coverage is included under Worker's Compensation. Jones Act is included under the Protection &Indemnity Liability
(Watercraft Liability).
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.
Insurance Compliance
AUTHORIZED REPRESENTATIVE
PO Box 100085-FX
Duluth GA 30096
Oc 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
From: karinna.,kwhiteinsurance.com
To: monroecountyfl monroecountyfl(q�,Ebixxom
CC: chelseamiyons(w,yahoo.com
Subject: Copy of Certificate for Monroe County BOCC
Date: 6/10/20216:23:12 AM
Attachment(s):
Good Morning, Attached is the Ceritifate of insurance reflecting the Contractors Pollution
coverage for 2021-2022 renewal. Please let us know if anything additional is needed. Thank you,
Karin Sprague Kelly White & Associates Insurance, LLC RO. Box 350909 Jacksonville, FL
32235 904-880-8881 x 10') 904-544-0307 c www.kwhiteinsurance.col-n The best compliment
you can give, is a referral!