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Certificate of Insurance
Client#: 720292 AMERIEMPIR DATE(MMIDDIYYYY) ACORD., CERTIFICATE OF LIABILITY INSURANCE 1 01105/2024 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 IN'SURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ios)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 any rights to the certificate holder in lieu of such enclorsement(s). PRODUCER CONET I �I NAM . T Certificate Specialists Marsh &McLennan Agency PHONE FAX ,N .. [(AICo,E.,�:727 447-6481 ,No): Bouchard Region E-MAIL...... _LrA C_ ADDRESS: certificates@bouchardinsurance.com 101 N.Starcrest Drive - INSURER(S)AFFORDING COVERAGE NAIL# Clearwater, FL 33765 ....... :1 INSURERA:Landmark American Insurance Company 33138 INSURED INSURER B Landmark American Insurance Company 33138 American Empire Builders, Inc. INSURERC StarNet Insurance Company 40045 13776 SW 145th CT INSURER D;Allied World Assurance Company(U.S.)1 19489 Suite B INSURER E:Vantapro Specialty Insurance Company 44768 Miami, FL 33186 INSURER F: Travelers Property Casualty Co.of America 25658 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 WAY 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 POLICY FEE POLICY EXP I-TR TYPE OF INSURA NCE (�!M�t)—C)LYYYYJ.-IMMLQEIIY—YYYI I LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y LHA1 14319 1_ { .. ...... ..... 2108/2023 12108/211 EACH OCCURRENCE $1,000,000 AV6 TIF 1,1 CLAIMS-MADE OCCUR LPR ((E'a' $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE s2,000,000 POLICY JECT F-1 LOC PRODUCTS-COM`MCP AGG s2,000,000 OTHER: ------------- COMBINED SINGLE LIMIT E AUTOMOBILE LIABILITY Y 5087021301 1210812023 12108/2024 (Ea accide 0 ,1,000,000 X ANY AUTO BODILY INJURY(Per prson) S ............. ...... OWNED SCHEDULED AUTOS ONLY AUTOS 'BODILY IN JURY(Per ace6dent) S x HIRED x NON-OWNEDP��bPERTY DAMAGE AUTOS ONLY AUTOS ONLY B UMBRELLA LIAB J X accuR y y LH Al 05583 1 2/08/2 0 23 12 10812 0 24LEACH OCCURRENCE $5,990,900 X EXCESS LIAS CLAIMS-MACE AGGREGATE s5,000,000 L RETENTION S c WORKERS COMPENSATION Y KRM626582001 12/08/2023 12/08/2024 X PER _[OTH - AND EMPLOYERS'LIA81LITY YIN ER- ANY PIROPRIrTOR1PARTNPR1FXrOUTIVE �NIA, E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED-) (Mandatory in NH) DISEASE-'EA EMPLOYEE 51,000,000 If yes,describe under DESCRIPTIONCFOPERATIONS,below—, EL.DISEASE-POLICY LIMIT $1,000,000 D Pollution Liab. -Y-- —Y 031287 2-4 1,-2,1-08,/2024 $2M/$2M' Professional Liab Y y F Rent/Leased Equip I QT6608SS2240ATIL23 1210812023 12108/2024 $1,000,000 per item DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) If required by written contract,Certificate Holder is an additional insured with respect to General Liability,Auto Liability, Professional Liability, Pollution Liability,and Excess Liability,subject to the terms, conditions and exclusions of the policies.Additional insured with respect to General Liability includes ongoing and completed operations. Coverage with respect to General Liabilifil IQ nrimant nnr,11 16K, NT noncontributory. A (See Attached Descriptions) BY" CERTIFICATE HOLDER CANCELLATION 7.10.21" Monroe County Board of County SHOULD ANY OF TF WAMM Ktk: THE EXPIRATION Commissioners ACCORDANCE Wll, 1100 Simonton St Key West, FL 33040-0000 AUTHORIZED REPRESENTATIVE 0 198,8-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of The ACORD name and logo are registered marks of ACORD #S120947681M12092801 RCGAD DESCRIPTIONS (Continued from Page 1) When required by written contract,waiver of subrogation applies in favor of Certificate Holder with respect to General Liability,Auto Liability:,Workers Comp, Professional Liability, Pollution Liability, and Excess Liability subject to the terms,conditions and exclusions of the policy. There are no exclusions for Jib, Boom and/or Overload on the Rented/Leased Equipment policy. PROJECT: Bimini Drive Bridge(#904603) Replacement Project Duck Key Monroe County,Florida COMPLETE CERTIFICATE HOLDER(S): Monroe County Board of County Commissioners If required by written contract, Certificate Holder is an additional insured with respect to General Liability,Auto Liability, and Excess Liability,subject to the terms,conditions and exclusions of the policies. SAGITTA 25.3(2016103) 2 of 2 #5120947711M12092801 Client#:720292 AMERIEMPIR DATE(MMIDDNYYY) ACORD_ CERTIFICATE OF LIABILITY INSURANCE 12/14/2022 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Certificate Specialists Marsh&McLennan Agency PHONE 727 447 6481 FAx A/C,No,Ext): (A,fC,N,oy,'i Bouchard Region ADDRESS. certificates@bouchardinsurance.com 101 N.Starcrest Drive INSURER(S)AFFORDING COVERAGE NAIC# Clearwater, FL 33765 INSURER A:Landmark American Insurance Company 33138 INSURED- - �- ------ INSURER B StarStone Specialty Insurance Company 44 776 _ American Empire Builders,Inc. INSURER c StarNet Insurance Company 4004. p y 5 13775 SW 145th CT INSURER D:Allied World Assurance Company(U.S.)1 19489 Suite B ......... .......... INSURER E:Vantapro Specialty Insurance Company 44768 Miami,FL 33186 Charter Oak Fire INSURER F: Insurance Co 25615 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 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 ADDLSUBR POLICY EFF POLICY EXPK LIMITS ..... ......... ......._ __....--- ... ..... ........ A X Y Y LHA113621 12/08/2022 12108/202 EACH OCCURRENCE $1,000 000 CLAIMS-MADE U X OCCUR ( AMA�„1,F T11 RENTED � LTR IN SR WVL7 POLICY NUMBER MMIDDIYYYY MM/PJOIYYY, COMMERCIAL GENERAL LIABILITY � dEh1pSSGEaacouvvwn )„ $100,000 erson) $5 000 ................ ..... .......... PERSONAL&ADV INJURY $1,000,000. ..MP An one„. , FwHER: 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ',$2,000,000 POLICYd X JECI' LOC PRODUCTS-,COMP/OPAGG $2,000 000 ----........ ...... . ...... ......$............................................................. ' E AUTOMOBILE LIABILITY t.WT Tv Y Y 5087027304 12/08/2022 12/08/2023 COMBINED Ea ice denD..... I$1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ .1111,- '�AUTOS ONLY AUTOS"�'" HIRED NON-OWNED DAMAG(= AUTOS ONLY ,,�F"�r arcad�nC) - j PROarvden AUTOS ONLY $ X.. 1 $ .....,,,. ..... ...,.,n.. ............ ......... - a...... .....__ ....- ........ $5 OOO OOO EXCESS LIAB B X UMBRELLA LIABEACH X OCCUR MADE Y Y 89186A222ALI '12/08/2022 12/08/202 AGGREGATE OCCURRENCE m ..... .m 5,000,000 DED -, RETENTION$ ? ... ......... .............. ......... .......... ......... ..._..... C ;WORKERS COMPENSATION Y KEY0145742 12/08/2022 12/08/2023 X I PER iOTH OFFICEOPRIET ER EXCLUDED N I N I A I STATUTE 1 ...� AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE'Y/N E.L.EACH ACCIDENT .$1,000,000 (Mandatory in NH) ;E.L.DISEASE-EA EMPLOYEE I$1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below -E.L DISEASE POLICY LIMIT $1,000,000 D Pollution Liab. Y Y 03128724 12/08/2022 1210812023 $2M/$2M Professional Liab Y Y F Rent/Leased Equip QT6608S92240ATIL 12/08/2022 12/08/202 $1 000,000 per item DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) If required by written contract,Certificate Holder is an additional insured with respect to General Liability,Auto Liability,Professional Liability, Pollution Liability,and Excess Liability,subject to the terms,conditions and exclusions of the policies.Additional insured with respect to General Liability includes ongoing and completed operations.Coverage with respect to General Liability is primary and noncontributory. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION13y, 12 N5 % 2 SHOULD ANY OF THE DATL Monroe County Board of County THE EXPIRATION DAT Commissioners ACCORDANCE WITH T 1100 Simonton St Key West,FL 33040-0000 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S12094770/M12092801 RCGAD DESCRIPTIONS (Continued from Page 1) When required by written contract,waiver of subrogation applies in favor of Certificate Holder with respect to General Liability,Auto Liability,Workers Comp,Professional Liability,Pollution Liability, and Excess Liability subject to the terms,conditions and exclusions of the policy. There are no exclusions for Jib,Boom and/or Overload on the Rented/Leased Equipment policy. Complete Certificate Holder: Monroe County Board of County Commissioners and FDOT Project: Boca Chica Road Repairs Explosion,Collapse&Underground Hazard(XCU)coverage included in the GL policy.It is agreed by endorsement to the general liability,auto&workers comp policies that this policy shall not be cancelled by the insurance carrier without first giving thirty(30)days prior written notice except for nonpayment of premium. SAGITTA 25.3(2016103) 2 of 2 #S12094770/M12092801 Client#: 720292 AMERIEMPIR DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 8/02/2022 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Certificate Specialist Marsh&McLennan Agency PHONE 727 447-6481 FAX A/C,No,Ext: (A/C,No): Bouchard Region ADDRESS: certificates@bouchardinsurance.com 101 N.Starcrest Drive INSURER(S)AFFORDING COVERAGE NAIC# Clearwater, FL 33765 Landmark American Insurance Company 12833 INSURER A: P Y INSURED INSURER B:StarStone Specialty Insurance Company 44776 American Empire Builders, Inc. StarNet Insurance Company 40045 INSURER C: p Y 13775 SW 145th CT INSURER D:Allied World Assurance Company(U.S.)1 19489 Suite B INSURER E:Vanta ro Specialty Insurance Company 44768 Miami, FL 33186 INSURER F: Charter Oak Fire Insurance Co 25615 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 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y LHA113163 12/08/2021 12/08/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR PREMISES(ERENTED rr nce) $100,000 X BI/PD Ded:$5,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ E AUTOMOBILE LIABILITY Y Y 5087027303 12/08/2021 12/08/202 Ea MINED accS id.nlINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ B UMBRELLA LIAB X OCCUR Y Y 89186A211ALI 12/08/2021 12/08/2022 EACH OCCURRENCE s5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5 00O 000 DED RETENTION$ $ C WORKERS COMPENSATION Y KEY0145742 12/08/2021 12/08/2022 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � 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 D Pollution Liab. Y 03128724 12/08/2021 12/08/202 $2mil/$2mil$15k Ret Professional Liab Y 03128724 $2m/$2m $25k Retention F I Rent/Leased Equip QT8S92240ATIL21 12/08/2021 12/08/202 $250k Per Item$5k Ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) If required by written contract, Certificate Holder is an additional insured with respect to General APPROVED BY RISK MANAGEMENT Liability,Auto Liability, and Excess Liability,subject to the terms,conditions and exclusions of the BY policies.Additional insured with respect to General Liability includes ongoing and completed operations. DATE Coverage with respect to General Liability is primary and noncontributory. WAVER N/A YES (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Monroe Count Board of Count SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton St Key West, FL 33040-0000 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S11594197/M10461054 RFRCS DESCRIPTIONS (Continued from Page 1) When required by written contract,waiver of subrogation applies in favor of Certificate Holder with respect to General Liability, Auto Liability,Workers Comp, Professional Liability, Pollution Liability, and Excess Liability subject to the terms, conditions and exclusions of the policy. There are no exclusions for Jib, Boom and/or Overload on the Rented/Leased Equipment policy. Complete Certificate Holder: Monroe County Board of County Commissioners Project Name: Bimini Drive Bridge (#904603) Replacement Project Duck Key Monroe County, Florida If required by written contract, Certificate Holder is an additional insured with respect to General Liability,Auto Liability,and Excess Liability, subject to the terms, conditions and exclusions of the policies. SAGITTA 25.3(2016/03) 2 of 2 #S11594197/M10461054