Certificates of Insurance
ACORDTM
THIS CERTIFICATE IS ISSUED AS A M,
ONLY AND CONFERS NO RIGHTS UFo
HOLDER. THIS CERTIFICATE DOES NOT
ALTER THE COVERAGE AFFORDED BY TH..
COMPANIES AFFORDING COVERAG.
PRODUCER
Aon Risk Services, Inc of Florida
1001 Brickell Bay Drive
Suite 1100
Miami FL 33131
PHONE. (305) 372-9950
INSURED
Community Asphalt Corp.
14005 N.w. 186th Street
Hialeah FL 33018 USA
FAX - (305) 372-1455
COMPANY
A
Commerce & Industry Ins Co
COMPANY
B
National Union Fire Ins Co of Pittsburgh
COMPANY
C
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE poue',' 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.
lYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRA TIO LIMITS
DATE (MMIDDIYY) DATE (MMlDDIYY)
A GL9332694 07/01/03 07/01/04 GENERAL AGGREGATE
COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE o OCCUR PERSONAL & ADV INJURY
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE
FIRE DAMAGE(Any one fire)
MED EXP (Anyone person)
A CA826144Q 07/01/03 07/01/04 COMBINED SINGLE LIMIT
BUSINESS AUTO
ALL OWNED AUTOS APP T BODILY INJURY
( Per person)
BY SODIL Y INJURY
DATE (Per accident)
WAIVER NIA. __. YES PROPERTY DAMAGE
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
------, AGGREGAT
B BE3205769 07/01/03 07/01/04 EACH OCCURRENCE
COMMERCIAL UMBRELLA AGGREGATE
OTHER THAN UMBRELLA FORM Retained Limit Amoun
A WORKER'S COMPENSATION AND 7165790 07/01/03 07/01/04
EMPLOYERS' LIABILITY WORKERS COMPENSATION
THE PROPRIETORI X INCL EL DISEASE-POLICY LIMIT
PARTNERs/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE
$2,000,000
$2,000,000
$1,000,000
$1,000,000
$100,000
$10,000
$1,000,000
$5,000,000
$5,000,000
$10,000
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlSPECIAL ITEMS
RE: Resurfacing Runway 9-27 and Drainage_, Key West International Airport, Monroe County, Florida 33040. AlP
No.: 3-12-0037-2103. Item No.; 25437519401. PFC Application No.4 & 7. CAC #5065. XCU coverage is included.
Monroe County Board of County Commissioners, its employees and officials is named as additional insured
Monroe County Board of
County Commissioners
Key West International Airport
3491 S. Roosevelt Boulevard
Key West, FL 33040 USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Certificate No:
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDE.^,'OR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
B"T r;^ILURE TO /I^ll SblCM NOTICE SMAll I/1POSE ~jO OBliGATION ORE L11':~Bll:TY
gr; A~jY KI'j[l IJpml TME C0/1P^~IY. ITS ^CE~ITS OR REPRES_N+._+l~ e;~
AUTHORIZED REPRESENTATIVE
<'~.~-'~m'
570006839783
Holder Identifier:
Attachment to ACORD Certificate for Community Asphalt Corp.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
Community Asphalt Corp.
14005 N.w. 186th Street
Hialeah FL 33018 USA
COMPANY
COMPANY
COMPANY
COMPANY
COMPANY
ADDITIONAL POLICIES
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
POLICY POLICY
co TYPE OF INSURANCE POLlCY NUMBER EFFECTIVE EXPIRATION LIMITS
LTR POLICY DESCRIPTION DATE DATE
DESCRIPTION OF OPERA TIONSlLOCA T10NSlVEHICLESlSPECIAL ITEMS
excluding Workers' Compensation and Employers' Liability as required by written contract but limited to
the operations of the Insured under said contract, and always subject to the policy terms, conditions and
exclusions. Cancellation provision shown is subject to shorter time periods depending on the jurisdiction
of, and reason for, the cancellation_
Certificate No:
570006839783