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Certificate of Insurance
A�D 4/28/2022® CERTIFICATE OF LIABILITY INSURANCE DATE /DD22 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 endorsement(s). PRODUCER NAME: Frank H. Furman, Inc. a/c No Ext: (954)943-5050 a/c,NO: (954)942-6310 1314 East Atlantic Blvd. E-MAIL ADDRESS: P. O. BOX 1927 INSURER(S) AFFORDING COVERAGE NAIC# Pompano Beach FL 33061 INSURERA:Houston Specialty Insurance Company 12936 INSURED INSURER B:Imperium Insurance Company 35408 Triple M Roofing Corp INSURERC:FRSA SIF/Evanston Insurance Company 35378 914 NW 19th Avenue INSURER D: INSURER E: Ft Lauderdale FL 33311 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 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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ X Contractual Included X Y CONHSGL000013100 5/1/2022 5/1/2023 MED EXP(Any one person) $ 5,000 APPROVED BY RISK MANAGEMENT 1,000,000 X XCU Included PERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: BY ==^----- '' '" GENERAL AGGREGATE $ 2,000,000 POLICY � PRO ❑ LOC DATE----- 3L202 PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WAVER NSA—YES— $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X Y CONIICCA000012600 5/1/2022 5/1/2023 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident) $ Personal Injury Protection $ 10,000 UMBRELLA LAB X OCCUR CONHSCX000010200 5/1/2022 5/1/2023 EACH OCCURRENCE $ 5,000,000 A X EXCESS LAB CLAIMS-MADE Coverage is Excess of the AGGREGATE $ 5,000,000 DED I I RETENTION $ GL AL and EL $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? i N i C (Mandatory in NH) y 870040140 1/1/2022 1/1/2023 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Monroe County Board of County Commissioners, their elected and appointed officers and employees are known as Additional Insureds with respect to General Liability and Automobile Liability as required by written contract or agreement and subject to policy terms and conditions. Waiver of Subrogation in favor of the Additional Insureds for General Liability, Automobolie Liability and Workers Compensation as required by written contract or agreement and subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Thompson-Stan@MonroeCounty-FI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street Key West, FL 33040 AUTHORIZED REPRESENTATIVE n , Dirk DeJong/JC "�� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMENTS/REMARKS conditions. Additional Insured Lessor of Leased Equipment is included under the GL as per CG2028 (12/19) ------------------------------------------------------------------ The Auto includes blanket additional insured as per CA2048 (10/13) , PNC as per CA0449 (11/16) and WOS as per CA0444 (10/13) as required by written contract or agreement and subject policy terms and conditions. ------------------------------------------------------------------ WC WOS is available as per WC000313 (4/14) (without additional charge) as required by written contract or agreement and subject to policy terms and conditions If the cert holder wants a copy of the WOS endorsement please advise CSR as they must be issued specific to each entity that wants one **All WC Certs must be forwarded to the FRSA for their file** ------------------------------------------------------------------ Loss Payee is available under the Scheduled Contractors Equipment &/or Leased Rented Equipment - Please give COI to CSR to order the endorsement Deductible is $1,000 AOP and Wind/Hail OFREMARK COPYRIGHT 2000, AMS SERVICES INC. POLICY NUMBER: CONHSGL000013100 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any person or organization in which the Named As per written contract or written agreement Insured has agreed in a written contract or written executed prior to loss agreement executed prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" pp y y property damage occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III —Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: CONHSGL000013100 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization in which the Named As per written contract or written agreement Insured has agreed in a written contract or written executed prior to loss agreement executed prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III —Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: CONHSGL000013100 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: CONHSGL000013100 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or written agreement excuted prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s)shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: CONHSGL000013100 HIIG CG 20 07 10 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Coverage Limit of Insurance Single Construction Project General Aggregate Limit Equal to General Aggregate Limit Cap For All Damages from All Ongoing Construction Projects $5,000,000 A. For all sums which the insured becomes legally obligated to pay as damages caused by 'occurrences" under SECTION I —COVERAGES, COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and for all medical expenses caused by accidents under SECTION I — COVERAGES, COVERAGE C — MEDICAL PAYMENTS, which can be attributed only to ongoing operations at construction projects away from premises owned by or rented to the insured: 1. The most we will pay will be capped at the Cap For All Damages from All Ongoing Construction Projects limit shown in the Schedule above, regardless of the number of: a. "Occurrences"; b. Insureds; C. Claims made or"suits" brought; d. Persons or organizations making claims or bringing "suits"; or e. Separate construction projects. 2. Subject to Paragraph A.1. above: A separate Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 3. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under SECTION I - COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under SECTION I -COVERAGE C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or C. Persons or organizations making claims or bringing "suits". 4. Any payments made under SECTION I - COVERAGE A for damages or under SECTION I - COVERAGE C for medical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. 5. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit HIIG CG 20 07 10 18 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by 'occurrences" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION I - COVERAGE C, which cannot be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Subject to Paragraph A.1. above, such payments shall not reduce any Single Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Single Construction Project General Aggregate Limit. D. If a single construction project away from premises owned by or rented to the insured has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. If endorsement CG 25 03, Designated Construction Project(s) General Aggregate Limit [or a similar construction project(s) aggregate endorsement] is also a part of this policy or coverage part, the most we will pay for all sums which the insured becomes legally obligated to pay as damages caused by 'occurrences" under SECTION I - COVERAGE A and all medical expenses caused by accidents under SECTION I - COVERAGE C, which can be attributed only to ongoing operations at: 1. Any construction project(s) designated in such CG 25 03 endorsement [or in a similar such construction project(s)aggregate endorsement]; 2. Any construction project(s)to which the provisions of this endorsement apply; and/or 3. Any construction project(s) to which the provisions of this endorsement and the provisions of such CG 25 03 endorsement [or a similar such construction project(s)aggregate endorsement] both apply; will be subject to Paragraph A.1. above. F. The provisions of SECTION III - LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. I HIIG CG 20 07 10 18 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. POLICY NUMBER: CONHSGL000013100 COMMERCIAL GENERAL LIABILITY CG20281219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or agreement executed prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, this insurance does not apply organization(s) shown in the Schedule, but only to any 'occurrence" which takes place after the with respect to liability for "bodily injury", "property equipment lease expires. damage" or "personal and advertising injury" C. With respect to the insurance afforded to these caused, in whole or in part, by your maintenance, additional insureds, the following is added to operation or use of equipment leased to you by Section III— Limits Of Insurance: such person(s)or organization(s). If coverage provided to the additional insured is However: required by a contract or agreement, the most we 1. The insurance afforded to such additional will pay on behalf of the additional insured is the insured only applies to the extent permitted by amount of insurance: law; and 1. Required by the contract or agreement; or 2. If coverage provided to the additional insured is 2. Available under the applicable limits of required by a contract or agreement, the insurance; insurance afforded to such additional insured will not be broader than that which you are whichever is less. required by the contract or agreement to This endorsement shall not increase the provide for such additional insured. applicable limits of insurance. CG 20 28 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: CONIICCA000012600 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Triple M Roofing Corp Endorsement Effective Date: 5/01/2022 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or written agreement executed prior to a loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Policy Number: CONIICCA000012600 COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance — Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under such an "insured" under your policy provided that: other insurance; and 1. Such "insured" is a Named Insured under such 2. You have agreed in writing in a contract or other insurance; and agreement that this insurance would be 2. You have agreed in writing in a contract or primary and would not seek contribution from agreement that this insurance would be any other insurance available to such primary and would not seek contribution from "insured". any other insurance available to such "insured". CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 POLICY NUMBER: CONIICCA000012600 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Triple M Roofing Corp Endorsement Effective Date: 5/01/2022 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or written agreement executed prior to a loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/28/2022 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 endorsement(s). CONTACT PRODUCER NAME: FAX PHONE (954)942-6310 (954)943-5050 Frank H. Furman, Inc. (A/C, No): (A/C, No, Ext): E-MAIL 1314 East Atlantic Blvd. ADDRESS: P. O. Box 1927 INSURER(S)AFFORDINGCOVERAGENAIC# Pompano BeachFL33061 Houston Specialty Insurance Company12936 INSURER A : INSURED Imperium Insurance Company35408 INSURER B : Triple M Roofing Corp FRSA SIF/Evanston Insurance Company35378 INSURER C : 914 NW 19th Avenue INSURER D : INSURER E : Ft LauderdaleFL33311 INSURER F : COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY X 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) XY CONHSGL0000131005/1/20225/1/2023 5,000 MEDEXP(Anyoneperson)$ X Contractual Included 1,000,000 PERSONAL&ADVINJURY$ X XCU Included 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ 1,000,000 (Eaaccident) BODILYINJURY(Perperson)$ X ANY AUTO B ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ CONIICCA0000126005/1/20225/1/2023 XY AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ XX HIRED AUTOS (Peraccident) AUTOS $ 10,000 Personal Injury Protection UMBRELLA LIAB X CONHSCX0000102005/1/20225/1/2023 EACHOCCURRENCE$ 5,000,000 OCCUR EXCESS LIAB Coverage is Excess of the CLAIMS-MADEAGGREGATE$ X 5,000,000 A GL AL and EL $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ 1,000,000 N / A OFFICER/MEMBER EXCLUDED?N C 8700401401/1/20221/1/2023 (Mandatory in NH) Y E.L. DISEASE - EA EMPLOYEE$ 1,000,000 Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Monroe County Board of County Commissioners, their elected and appointed officers and employees are known as Additional Insureds with respect to General Liability and Automobile Liability as required by written contract or agreement and subject to policy terms and conditions. Waiver of Subrogation in favor of the Additional Insureds for General Liability, Automobolie Liability and Workers Compensation as required by written contract or agreement and subject to policy terms and conditions. CERTIFICATE HOLDERCANCELLATION Thompson-Stan@MonroeCounty-FL.Gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West, FL 33040 Dirk DeJong/JC ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401) COMMENTS/REMARKS conditions. Additional Insured Lessor of Leased Equipment is included under the GL as per CG2028 (12/19) ------------------------------------------------------------------ The Auto includes blanket additional insured as per CA2048 (10/13), PNC as per CA0449 (11/16) and WOS as per CA0444 (10/13) as required by written contract or agreement and subject policy terms and conditions. ------------------------------------------------------------------ WC WOS is available as per WC000313 (4/14) (without additional charge) as required by written contract or agreement and subject to policy terms and conditions If the cert holder wants a copy of the WOS endorsement please advise CSR as they must be issued specific to each entity that wants one **All WC Certs must be forwarded to the FRSA for their file** ------------------------------------------------------------------ Loss Payee is available under the Scheduled Contractors Equipment &/or Leased Rented Equipment - Please give COI to CSR to order the endorsement Deductible is $1,000 AOP and Wind/Hail COPYRIGHT 2000, AMS SERVICES INC. OFREMARK POLICYNUMBER:CONHSGL000013100COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED –OWNERS, LESSEES OR CONTRACTORS –SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations Any person or organization in which the NamedAs per written contract or written agreement Insured has agreed in a written contract or written executed prior to loss agreement executed prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II –Who Is An Insured is amended toB.With respect to the insurance afforded to these include as an additional insured the person(s) oradditional insureds, the following additional organization(s) shown in the Schedule, but onlyexclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1.All work, including materials, parts or 1.Your acts or omissions; or equipmentfurnished in connection with such 2.The acts or omissions of those acting on yourwork, on the project (other than service, behalf;maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the in the performance of your ongoing operations for location of the covered operations has been the additional insured(s) at the location(s) completed; or designated above. 2.That portion of "your work" out of which the However: injury or damage arises has been put to its 1.The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a principal as a part of the same project. 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 12 19© Insurance Services Office, Inc.,2018Page 1of2 C.With respect to the insurance afforded to these2.Available under the applicable limits of additional insureds,the followingis added toinsurance; Section III –Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or Page 2of2© Insurance Services Office, Inc.,2018CG 20 10 12 19 POLICYNUMBER:CONHSGL000013100COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED –OWNERS, LESSEES OR CONTRACTORS –COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE NameOf Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations Any person or organization in which the NamedAs per written contract or written agreement Insured has agreed in a written contract or written executed prior to loss agreement executed prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II –Who Is An Insuredis amended toB.With respect to the insurance afforded to these include as an additional insured the person(s) oradditional insureds, the following is added to organization(s) shown in the Schedule, but onlySection III –Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included 1.Required by the contract or agreement; or in the "products-completed operations hazard". 2.Available under the applicable limits of However: insurance; 1.The insurance afforded to such additional whichever is less. insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable limits of insurance. 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19© Insurance Services Office, Inc.,2018Page 1of1 COMMERCIAL GENERAL LIABILITY Policy Number: CONHSGL000013100 CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2)You have agreed in writing in a contract or Conditionand supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution from any other insurance available to the Primary And Noncontributory Insurance additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1)The additional insured is a Named Insured ; and under such other insurance CG 20 01 12 19© Insurance Services Office, Inc., 2018Page 1 of 1 POLICYNUMBER:CONHSGL000013100COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OFTRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US(WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICYDESIGNATED TANKS SCHEDULE Name Of Person(s)Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or written agreement excuted prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Usof Section IV –Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19© Insurance Services Office, Inc.,2018Page 1of1 Policy Number:CONHSGL000013100 HIIG CG 20 0710 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMITENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule CoverageLimit of Insurance Single Construction Project General Aggregate LimitEqual to General Aggregate Limit Cap For All Damages from All Ongoing Construction Projects$5,000,000 A.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under –BODILY INJURY AND PROPERTY DAMAGE LIABILITY,and SECTION I –COVERAGES,COVERAGE A for all medical expenses caused by accidents underSECTION I –COVERAGES, COVERAGE C–MEDICAL premises PAYMENTS,which can be attributed only to ongoingoperations at construction projects away from owned by or rented to the insured: 1.The most we will pay will be capped at the Cap For All Damages from All Ongoing Construction Projects limit shown in the Scheduleabove, regardless of the number of: a."Occurrences"; b.Insureds; c.Claims made or "suits" brought; d.Persons or organizations making claims or bringing "suits"; or e.Separate construction projects. 2.Subject to Paragraph A.1.above: A separate Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 3.The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under SECTION I -COVERAGE A,except damages because of "bodily injury" or "property damage" included inthe "products-completed operations hazard", and for medical expenses under he number of: SECTION I -COVERAGE Cregardless of t a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits". 4.Any payments made under SECTION I -COVERAGE A for damages or under SECTION I -COVERAGE Cformedical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in theDeclarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate construction project away from premisesowned by or rented to the insured. 5.The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit HIIG CG 20 0710 18Includes copyrightedmaterial of Insurance Services Office, Inc., Page 1of 2 with its permissio n. shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. B.For all sums which the insured becomes legally obligated to pay as damages caused by"occurrences" under SECTION I -COVERAGE A, and for all medical expenses caused by accidents under SECTION I - COVERAGEC,which cannot be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: expenses 1.Any payments made under COVERAGE Afor damages or under COVERAGE Cfor medical shallCompleted reduce the amount available under the General Aggregate Limit or the Products- Operations Aggregate Limit, whichever is applicable; and 2.Subject to Paragraph A.1.above, such payments shall not reduce any Single Construction Project General Aggregate Limit. C.When coverage for liability arising out of the "products-completed operations hazard" is provided, any paymentsed for damages because of "bodily injury" or "property damage" included in the "products-complet operationshazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Single Construction Project General Aggregate Limit. D.If a single construction project away from premises owned by or rented to the insured has been abandoned, delayed,plans, or abandoned and then restarted, or if the authorized contracting parties deviate from blueprints,designs, specifications or timetables, the project will still be deemed to be the same construction project. E.If endorsement CG 25 03, Designated Construction Project(s) General Aggregate Limit \[or a similar constructionproject(s) aggregate endorsement\]is alsoa part of thispolicy or coverage part, the most we will payfor all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" underSECTION I -COVERAGE Aand all medical expenses caused by accidents under SECTION I - COVERAGE C, which can be attributed only to ongoing operations at: 1.Any construction project(s) designated in such CG 25 03endorsement \[or in a similar such construction project(s) aggregate endorsement\]; 2.Any construction project(s) to which the provisions of this endorsement apply; and/or 3.Any construction project(s) to which the provisions of this endorsement and the provisions of such CG25 03endorsement \[or a similar such construction project(s) aggregate endorsement\]both apply; will be subject to Paragraph A.1.above. F.The provisions of SECTION III -LIMITS OF INSURANCEnot otherwise modified by this endorsement shall continue to apply as stipulated. II HIIG CG 20 0710 18Includes copyrightedmaterial of Insurance Services Office, Inc., Page 2of 2 with its permission. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CONHSGL000013100 CG 20 28 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – LESSOR OF LEASED EQUIPMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or agreement executed prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II – Who Is An Insured is amended toB.With respect to the insurance afforded to these include as an additional insured the person(s) oradditional insureds, this insurance does not apply organization(s) shown in the Schedule, but onlytoany "occurrence" which takes place after the with respect to liability for "bodily injury", "propertyequipment lease expires. damage" or "personal and advertising injury" C.With respect to the insurance afforded to these caused, in whole or in part, by your maintenance, additional insureds,the following is added to operation or use of equipment leased to you by Section III – Limits Of Insurance: such person(s) or organization(s). If coverage provided to the additional insured is However: required by a contract or agreement, the most we 1.The insurance afforded to such additionalwill pay on behalf of the additional insured is the insured only applies to the extent permitted byamount of insurance: law; and 1.Required by the contract or agreement; or 2.If coverage provided to the additional insured is 2.Available under the applicable limits of required by a contract or agreement, the insurance; insurance afforded to such additional insured whichever is less. will not be broader than that which you are required by the contract or agreement to This endorsement shall not increase the provide for such additional insured. applicable limits of insurance. CG 20 28 12 19 © Insurance Services Office, Inc., 2018Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CONIICCA000012600 CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Triple M Roofing Corp Named Insured: Endorsement Effective Date: 5/01/2022 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or written agreement executed prior to a loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II– Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13© Insurance Services Office, Inc.,2011Page 1of 1 COMMERCIAL AUTO Policy Number:CONIICCA000012600 CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following is added to the Other InsuranceB.The following is added to the Other Insurance Condition in the Business Auto Coverage FormCondition in the Auto Dealers Coverage Form and and the Other Insurance – Primary And Excesssupersedes any provision to the contrary: Insurance Provisions in the Motor Carrier Form'sCovered Autos Li This Coverage ability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liabilityother insurance available to an "insured" under Coverage is primary to and will not seekyour policy provided that: contribution from any other insurance available to 1.Such "insured" is a Named Insured under such an "insured" under your policy provided that: other insurance; and 1.Such "insured" is a Named Insured under such 2.You have agreed in writing in a contract or other insurance; and agreement that this insurance would be 2.You have agreed in writing in a contract orprimary and would not seek contribution from agreement that this insurance would beany other insurance available to such primary and would not seek contribution from"insured". any other insurance available to such "insured". CA 04 49 11 16© Insurance Services Office, Inc.,2016Page 1of 1 POLICY NUMBER: COMMERCIAL AUTO CONIICCA000012600 CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Triple M Roofing Corp Named Insured: Endorsement Effective Date: 5/01/2022 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization in which the Named Insured has agreed in a written contract or written agreement executed prior to a loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. TheTransfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13© Insurance Services Office, Inc.,2011Page 1of 1