COI Expires 08/15/2004
ACORD~ CERTIFICATE OF LIABILITY INSURANCE CSR BC I DATE (MM/DDIYYYY)
MACET-3 03/01./04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
David Chapman Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5700 W. Mt. Hope Highway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lansing MI 4891.7-
Phone: 51.7-321.-4600 Fax:51.7-321.-9443 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Amerisure Insurance 1.5660
INSURER B: Employers Mutual Casualty
E. T. MacKenzie of Florida Inc INSURER C: Zurich
621.2 33rd Street E INSURER 0:
Bradenton FL 34203
INSURER E:
COVERAGES
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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
NSRI POLICY NUMBER PD~';!~1! EFf.!',E.'.'~E P!:?~LliY ~r.!.~Q,~N LIMITS
LTR TYPE OF INSURANCE DATE MM/DDIYY DATE'(MMlDDIYY
GENERAL LIABILITY EACH OCCURRENCE $1.,000,000
r---
A X COMMERCIAL GENERAL LIABILITY GL20021.1.5 08/1.5/03 08/1.5/04 PREMISES (E~~~~;~nce) $50,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $5,000
X PERSONAL & ADV INJURY $ 1., 000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I .Ixl PRO- nLOC
POLICY X JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1.,000,000
B ~ ANY AUTO 2M7829503 09/01./03 09/01./04 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS l t'1J'H T BODILY INJURY
$
X NON-OWNED AUTOS ~~1Ol~ (Per accident)
f---
'll 6~ : ((11 ~pROPERTY DAMAGE
f-- J' flU 0: ~ $
#-1 j~J) Per accident)
GARAGE LIABILITY UAI t __,"_, '" - ..,-", /-'-'- J AJJ\TO ONLY - EA ACCIDENT $
R ANY AUTO WAIVER N/A ~ ~_YES ~ ~CVu\ N-vvvl
V1)- !'9:l:!iERJ,HAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1.0,000,000
C ~ OCCUR D CLAIMS MADE AUC93061.3600 08/1.5/03 08/1.5/04 AGGREGATE $1.0,000,000
$
~ DEDUCTIBLE $
X RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I IU'H-
EMPLOYERS' LIABILITY ER
A ANY PROPRIETOR/PARTNER/EXECUTIVE WC1.381.601. 08/1.5/03 08/1.5/04 E.L EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED? ___________n ---.-
E.L DISEASE - EA EMPLOYEE $500,000
~~~~I~tS~~~J1s?6~s below EL DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Stock Island Sewer Expansion: K W Resort Utilites Corp, Wieler Engineering,
and Monroe County Board of County COIlDIlissioners are additional insured on
general liability, umbrella liability, and automobile liability as required
by contract.
CERTIFICATE HOLDER
CANCELLATION
Monroe County
Board of County COIlDIlissioners
Room 268
1.1.00 Simonton St
Key West FL 33040
MONRO CO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TlO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
AUTHO PRESENTATIVE
RD CORPORATION 198
ACORD 25 (2001/08~ _ _ .
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