Certificates of Insurance DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 12/10/2021
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 Nathan Jensen
NAME:
One Source Advisory PHONEo (813)949-8636 FAX
N Ext: C,No
(813)909-8743
A/C A/
203 Crystal Grove Blvd E-MAIL nathan@onesourceadvisory.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
Lutz FL 33549 INSURERA: Hartford Insurance Group A0075
INSURED INSURER B: Travelers Indemnity of America(TIA) 25666
Early Alert,Inc. INSURERC: Am WINS
722 SW Pinetree Lane INSURER D:
INSURER E
Palm City FL 34990 INSURER F:
COVERAGES CERTIFICATE NUMBER: 21-22 Certificate 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
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ "000,000
MED EXP(Any one person) $ 10,000
A 21SBMBT0155SA 04/22/2021 04/22/2022 PERSONAL&ADV INJURY $ 2,000,000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000
X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 4'000'000
JECT
OTHER: Employment Practices $ 10,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 21SBMBT0155SA 04/22/2021 04/22/2022 BODI LY I NJ U RY(Pe r accide nt) $
AUTOS ONLY AUTOS
X HIRED �/ NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY X AUTOS ONLY Per accident
APPROVED BY RISK MANAGEMENI $
UMBRELLA LIAB HOCCUR BY EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE DATE09/08/99 AGGREGATE $
DED I I RETENTION $ WAIVER N/AX YES_ �/ $
WORKERS COMPENSATION X STATUTE OTH-
ER
AND EMPLOYERS'LIABI LITY Y/N 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
B OFFICER/MEMBER EXCLUDED? ❑ N/A UB-1L345963 07/03/2021 07/03/2022
(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 $
Cyber Policy Occurence/Agg: 1,000,000/1 M
C Professional Liability Policy 661561401 12/08/2021 12/08/2022 6803-3916 11-16-21/22
Occurence/Agg: 2,000,000/2M
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The Monroe County Board of County Commissioners,its employees and officials will be included as"Additional Insured"on all policies,except for Workers'
Compensation and Professional 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 Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS.
1100 Simonton Street
AUTHORIZED REPRESENTATIVE
Key West FL 33040
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