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Certificate of Insurance
DATE(MMIDD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 09/20/2023 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 Vicky Van Wormer NAME: Brown&Brown of Florida,Inc. a/cNr o Ext: (727)461-6044 a/c,No): (727)442-7695 140 Fountain Parkway N E-MAIL Vicky.VanWormer@bbrown.com ADDRESS: Suite 600 INSURER(S)AFFORDING COVERAGE NAIC# St.Petersburg FL 33716 INSURERA: The Charter Oak Fire Insurance Company 25615 INSURED INSURER B: The Travelers Indemnity Company of America 25666 Kisinger Campo&Associates,Corp.KCCS,Inc.,DBA:Campo& INSURER C: Travelers Property Casualty Company of America 25674 201 N Franklin St,Suite 400 INSURER D: Travelers Casualty and Surety Company 19038 INSURER E: Admiral Insurance Company 24856 Tampa FL 33602 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 Cert 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDreme $ 300,000 MED EXP(Any one person) $ 10,000 A Y Y P-630-8254A604-COF-23 10/01/2023 10/01/2024 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y 810-5N338364-23-43-G 10/01/2023 10/01/2024 BODI LY I NJ U RY(Pe r accide nt) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist $ 1,000,000 UMBRELLA LIAB X 20,000,000 OCCUR EACH OCCURRENCE $ C EXCESS LAB CLAIMS-MADE Y CUP-7J748484-23-43 10/01/2023 10/01/2024 AGGREGATE $ 20,000,000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION X1 SPER TATUTE EORH AND EMPLOYERS'LIABI LI TY Y/N SOO,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ D OFFICER/MEMBER EXCLUDED? N/A Y UB-007J070308 10/03/2023 10/03/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability-Architects& Per Claim 2,000,000 E Engineers E0000027205-09 10/01/2023 10/01/2024 Aggregate 2,000,000 Deductible 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Monroe County and FDOT are additional insured with respect to general liability,auto liability and umbrella liability.Endorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation&employers liability.Explosion,Collapse&Underground hazard included in CGL.Sixty(60)day notice of cancellation applies,except for non-payment,which is ten(10)days. FOP SK T' Monroe County—Mosquito Creek Bridge Replacement;KCA Contract#1202241.01 by DATE-1-1 2§—23— ---. WA X — CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West FL 33040 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Campo & Associates, PLLC Doing Business As Campo & Associtates LLC Campo & Associtates, PLLC KCCS, Inc. OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Employee Benefits AGG Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 2,000,000 Ref# Description Coverage Code Form No. Edition Date Rental Reinbursement Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Statutory Ref# Description Coverage Code Form No. Edition Date Medical payments MEDPM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 5,000 Ref# Description Coverage Code Form No. Edition Date Underinsured motorist combined single limit UNCSL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date Experience Mod Factor 1 EXP01 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Increased employer's liability INEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001,AMS Services,Inc. DATE(MMIDD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 11/01/2022 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 Vicky Van Wormer NAME: Brown&Brown of Florida,Inc. a/cNr o Ext: (727)461-6044 a/c,No): (727)442-7695 83 Park Place Blvd,Suite 101 E-MAIL Vick .VanWormer bbrown.com ADDRESS: y INSURER(S)AFFORDING COVERAGE NAIC# Clearwater FL 33759 INSURERA: The Charter Oak Fire Insurance Company 25615 INSURED INSURER B: The Travelers Indemnity Company of America 25666 Kisinger Campo&Associates,Corp. INSURER C: Travelers Property Casualty Company of America 25674 201 N Franklin St,Suite 400 INSURER D: Travelers Casualty and Surety Company 19038 INSURER E: Admiral Insurance Company 24856 Tampa FL 33602 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 Master 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDreme $ 300,000 X Contractual Liability MED EXP(Any one person) $ 10,000 A Y Y P-630-8254A604 10/01/2022 10/01/2023 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y 810-5N338364 10/01/2022 10/01/2023 BODI LY I NJ U RY(Pe r accide nt) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist $ 1,000,000 UMBRELLA LIAB X 20,000,000 OCCUR EACH OCCURRENCE $ C EXCESS LAB CLAIMS-MADE Y CUP-7J748484 10/01/2022 10/01/2023 AGGREGATE $ 20,000,000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION X1 SPER TATUTE EORH AND EMPLOYERS'LIABI LI TY Y/N SOO,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ D OFFICER/MEMBER EXCLUDED? N/A Y UB-7J070308 10/03/2022 10/03/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability-Architects& Per claim 2,000,000 E Engineers E0000027205-09 10/01/2022 10/01/2023 Aggregate 2,000,000 Deductible 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Monroe County and FDOT are additional insured with respect to general liability,auto liability and umbrella liability.Endorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation&employers liability.Explosion,Collapse&Underground hazard included in CGL.Sixty(60)day notice of cancellation applies,except for non-payment,which is ten(10)days. Monroe County—Mosquito Creek Bridge Replacement;KCA Contract#1202241.01 By ., � Doi CERTIFICATE HOLDER CANCELLATION WAMM K?A-Xy"-- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West FL 33040 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD