Certificates of Insurance DATE(MM/DD/YYYY)
ACCOR" CERTIFICATE OF LIABILITY INSURANCE 4/25/2022
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 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
NAME: Certificate Department
Five County Insurance Agency Inc PHONE FAX
14120 Metropolis Ave A/C No Ext: 239-939-1400 A/C,No):239-939-3813
E-MFort Myers FL 33912 ADDRESS: certs@fivecountyinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:American Builders Insurance 11240
INSURED DECCO-1 INSURERB: Old Dominion Insurance 40231
DEC Contracting Group Inc
1560 Matthew Dr Unit B INSURERC:
Fort Myers FL 33907 INSURERD:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:162929421 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 MM/DD
A X COMMERCIAL GENERAL LIABILITY Y PKGO16751710 3/6/2022 3/6/2023 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $300,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY❑ PRO ❑
JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
X
OTHER: $
B AUTOMOBILE LIABILITY Y BlPO157N 5/8/2022 5/8/2023 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
A X UMBRELLA LIAB X OCCUR UMB018902307 3/6/2022 3/6/2023 EACH OCCURRENCE $2,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
A WORKERS COMPENSATION WCV016799208 3/6/2022 3/6/2023 X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICE R/M EMBER EXCLUDED? FN] N/A
(Mandatory in NH) 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)
Project: Key West International Airport Noise Insulation Program Construction of KWBTS Building A—Phase 2
Certificate holder is named as an additional insured when required per written contractual agreement with respects to General Liability and Auto Liability.
S 'T
MY
/ it >
CERTIFICATE HOLDER CANCELLATION WAMP WkxyW.,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County Board of County Commissioners
1100 Simenton St AUTHORIZED REPRESENTATIVE
Key West FL 33040
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