Certificates of Insurance DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE
O5/10/2021
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 endorsement(s).
PRODUCER CONTACT Krista Scarborough
NAME:
Caton-Nosey Insurance HCONN. Ext: (386)767-3161 a/c,No): (386)760-1770
3731 Nova Rd. E-MAIL Krista@catonhosey.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
Port Orange FL 32129 INSURERA: ICW Group 27847
INSURED
INSURER B
Affordable Asphalt,Inc, INSURER C:
94411 Overseas Highway INSURER D:
INSURER E:
Tavernier FL 33070 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL2151025917 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 TYPE OF INSURANCEAUULbUbK POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO TED
CLAIMS-MADE OCCUR -PREMISES Ea occurrence) $
q� MED EXP(Any one person) $
`�' ,1 PERSONAL&ADV INJURY $
GEN'LAGGREGATE LIMITAPPLIES PER: ^'"""� - -. GENERAL AGGREGATE $
PRO- p,� a
POLICY ❑JECT ❑ LOC l T _ "� PRODUCTS-COMP/OP AGG $
OTHER: 4 ' 9 . 13 2 021 $
/"'+ �— . �e,�- "OM BINED SINGLE LIMIT
AUTOMOBILE LIABILITY y $
Ea accident
ANYAUTO - BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accide nt) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION $ $
WORKERS COMPENSATION X STATUTE EORH
AND EMPLOYERS'LIABI LITY Y/N 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
AOFFICER/MEMBER EXCLUDED? N/A WFL 5055467 01 O5/08/2021 O5/08/2022
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
License CBC1262034
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.
2798 Overseas Highway
AUTHORIZED REPRESENTATIVE
Suite 300
Marathon FL 33050
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
ACCORV
DATE(MM/DD/YYYY)
CERTII LIABILITY INSURANCE
o7/20/2020
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 policy(ies)must 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 George A Zellner Co CONTACT Certificates
4114 Sunbeam Road PHONE 904 356-1492 FAX
tntr.Nfl_E4 ( )...--_._..__ (904)354-4328
Suite 101 E-MAIL certificates@zellnednsurance.com
Jacksonville FL 32257-
_ _ INSURER(S)AFFORDING COVERAGE _ - NAIC#
_-._.._ INSURERA:Auto-Owners Insurance Company 18988
INSURED INSURER B:Old Dominion Insurance Co 0231
Affordable Asphalt,Inc. INSURER_V:Western World Insurance Co. 524126
94411 Overseas Highway INSURER D: 1
Tavernier FL 33070-
...INSURER E: -----.— _----
IN
COVERAGES CERTIFICATE NUMBER: 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.
l TYPE OF INSURANCE IADDL SUBIRI POLICY R POLICY EFF PO ECYIL POLICY LIMITS
IN5R
C X COMMERCIAL GENERAL LIABILITY X X !NPP8716068 b7/20/2020 7/20/2021 (EAC_HOCCURRENCL $ 1,000,000
CLAIMS-MADE .�OCCUR DAMAGE TO RENTED 100,000
— - PREMI4E4(Ea_ncrurrence) $ -- ,� _—
MED EXP(Any one person) $ 1,000
PERSONAL&ADV INJURY $ 1,000,000
...._--- ..._.._..---
POLICY E LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
I _ AGGREGATE
X I PRO- [II LOG 2,000,000
--:. .-1 JECT �_—J -PRODUCTS-COMP/OP AGG '$
OTH $
B ,AUTOMOBILE LIABILITY X X IB1 P0948P '107/20/2020 P7/20/2021 (O,,cc de q)SINGLE LIMIT $ 1,000,000
I�.ANY AUTO ( BODILY INJURY(Per person) $
ALL OWNED � ]SCHEDULED BODILY INJURY Per accident) $
i_— AUTOS AUTOS ( )
HIRED AUTOS A�TOSWNED I^ .._—.... .----.. ..._.
r,, - - PROPERTY DAMAGE
UMBRELLA LIAR OCCUR 'I... ^ `" 4
EXCESS LIAR ' 8 28 2020 EACH OCCURRENCE $
CLAIMS-MADE _�,,,,�T_,�„, AGGREGATE $
T_. --- ,A
E RETENTION S WORKERS COMPENSATION 6, X - PER OTH-
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE _E,L.
OFFICER/MEMBER EXCLUDED? El N/A EACH ACCIDENT $DEN DEN --- ------"
(Mandatary in NH) - E.L.DISEASE-EA EMPLOYEE'.$
If yes,describe under ----""-"-
D RI ION OP RAT E.L.DISEASE-POLICY LIMIT '..$
A Equipment 78366062 'P7/20/2020 �07/20/2021 ;Limit 140,000
I I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,ma be attached If more space is required)
the Monroe County Board of County Commissioners,its employees and offices are dditonal Isnured wih respects to general Liability on all policies except
Work Comp. 30 day notice of cancellation applies except 10 days for non payment
CERTIFICATE HOLDER CANCELLATION AI 008844
Monroe County Board of county SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Commissioners ACCORDANCE WITH THE POLICY PROVISIONS.
2798 Overseas Highway
Suite 300 AUTHORIZED REPRESENTATIVE
„r... '.r .>�
Marathon FL 33050-
Fax:( ) - O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD