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Certificates of Insurance 71TO/28/2021 E(MM/DDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 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). CONTACT PRODUCER NAME: Mary Anne Parrish KOUWENHOVEN &ASSOC AICON No, Ext: 407 774-5556 EA No: 407 774-7820 365 Wekiva Springs Rd #251 ADMDRESS: ma anne kouwen.com Longwood, FL 32779 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Ascot Specialty Insurance Company 45055 INSURED INSURER B: Everest National Insurance Co. 10120 Nabors, Giblin& Nickerson, P.A. INSURERC: 2502 N. Rocky Point Dr.,Suite 1060 INSURER D: Tampa, FL33607 INSURERE: INSURER F: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD IY MMIDDYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 X CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES'Ea occurrence $ X Lawyers Prof Liab ME EXP(Anyone person) $ A (Primary) LPPL2110000323-02 11/1/2021 11/1/2022 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMPIOP AGG $ OTHER: $ C MINED AUTOMOBILE LIABILITY APPROVED BY RISK MA AGEMENI Ea accide.'SINGLE LIMIT $ ANY AUTO BY l�5_"_<::)_ BODILY INJURY(Per person) $ OWNED AUTOS ONLY AUTOSSCHED DATE01/06/202 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY WAIVER N/AX YES Peraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 B X EXCESS LIAB X CLAIMS-MADE PL5EX00092-211 11/1/2021 11/1/2022 AGGREGATE $ 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EX ❑ECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Retroactive Date: None(Full Prior Acts) Deductible: $75,000 Per Claim Other Locations: 1500 Mahan Drive,Suite 200,Tallahassee,FL 32308 8201 Peters Road,Suite 1000,Plantation,FL 33324 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1111 12th Street, Suite 408 AUTHORIZED REPRESENTATIVE Key West, FL 33040 Alary Anne Parrish ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY F 10/12/2021 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(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 I this certificate sloes not confer rights to the certificate holder in lieu of such endorselment(s), PRODUCER CONTACT NAME: Mary Anne Parrish KOUWENHOVEN &ASSOC PHONE N 497 774-555 FAX PHO,N.n, xt): �__. ) _-. _(A/C,No); (407}77�•-7820 365 Wekiva Springs Rd 2 1 ADDRESS: rn,aryanne@kouwen_.com _ Longwood, FL 32779 INSURER(S)AFFORDING COVERAGE _ NAIC# INSURERA: Ascot Specialty Insurance Company 45055 INSURED INSURERS: QBE Specialty insurance Co., 11515 Nabors, Oiblin &.Nickerson, P.A. INSURER C: 2502 N. Rocky Paint Dr., Suite 106 INSURER D Tampa, FL 33607 INSURER E - INSURER F: 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 01-HER 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 Ti.-RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR -...... ..._.. _.___ __. 'ADDL SUBR- _._. _-_ _. POLICY EFF POLICY EXF' LTR TYPE OF INSURANCE INSD We POLICY NUMBER ;MM/DD/YYYY) IMMQD/YY_YY LIMITS COMMERCIAL GENERAL LIABILITY ',. EACH OCCURRENCE ?; 5I000,0Ial0-.} - DAMAGE TC R N c `�// X', CLAIMS-MADE OCCUR PR MISE-S(E occ,_ncnce) $ X Lawyers Prof Liab MED LXP I r y cino peison7 A (Primary) LPPL2010000323-01 11/1/2020 11/1/2021 PERSONAL&ADV INJURY GEIV AiE LIMIT PRO- PRODUCTS PER GENERAL AGGREGATE S __5,0OQ"q.o 3 POLICY L JECT APPLIES LOPRODUCTSCCt�4P/GP;�GG i _.. _. -- OTHER: AUTOMOBILE LIABILITY ._ -% °"°` '" J� COMBINED SINGLE I T11 $ 10 . 1 . 2021 (Ea aedde u) I ANY AUTO _ -.. .� ...».��. BODILY INJURY{Per person) $ OWNED SCHEDULED 13011L`/INJURY(Per r cioe'it, s AUTOS ONLY . AUTOS °' - HIRED NON-OWNED '� Y PROPERTY DAMAGE £} AUTOS ONLY AUTOS ONLY (Per accident) I UMBRELLA LIAB OCCUR EACH OCCURRENGE .$ 3,0,0 c,0u0 X EXCESS.LIAB X CLAIMS-MADE. ..'.,,. QBE100010360 11/1/2020 11/1/2021 AGGREGATE '..., S 3,000,000 I DED RE HE NTION b WORKERS COMPENSATION PER OL H- ; AND EMPLOYERS'LIABILITY „TAT I1�- ER YtN ANY PROPRIETOR/PARTNER/EXECUTIVE l El EACH ALCIDLN r S I OFFICER/MEMBER EXCLUDED? J :NIA --- --- - --- - - (Mandatory in NH) E L DISEASE EA EMPLOYEE. ti If yes,describe under ---_--- - -- _-- DESCRIPTION OF OPERATIONS below E.L.DISEASE POL C,Y LIN,11` ' W DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is roquired) I i Retroactive Date: None(Full Prior Acts) Deductible: $75,000 Per Claim Other Locations: 1500 Mahan Drive,Suite 200,Tallahassee,FL 32308 8201 Defiers Road,Suite 1000,Plantation,FL 32308 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I Monroe County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 11,1 Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1111 12th Street, Suite 408AUTHORIZED REPRESENTATIVE � � Key Wiest, FL 33040 a i O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD