Certificates of Insurance Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MA'Ct-ER OF iNFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT
AN INSURANCE POL CY AND DOES NOT AMEND. EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POE CIES LISTED BELOW.
This is to Certify that
IGeneral Asphalt Company, Inc.
4850 N.W. 72nd Avenue
Miami, FL 33166
Name and LibertX
address of
Insured. ~ ~[utl.l~L
Is, at the issue date of this certificate, insured by the Company under the policy(les) listed below. The insurance afforded by the listed policy(les) is subj
to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to wh
this certificate may be issued.
TYPE OF POLICY EXP. DATE POLICY NUMBER LIMIT OF LIABILITY
WORKERS []CONTINUOUS COVERAGE AFFORDED UNDER EMPLOYERS LIABILITY
COMPENSATION [] EXTENDED WC2-15G-410483-322 wc LAW OF THE FOLLOWING
STATES: Bodily Injury By Accident
[] POLICY TERM $500,000 Each
01/01/2003 Florida Accident
Bodily Injury By Disease
$500,000 Policy
Limit
Bodily Injury By Disease
$500,000 Each
Person
GENERAL LIABILITY 01/01/2003 TB2-151-410483-192 General Aggregate - Other than Products/Completed Operations
$2,000,000
Products/Completed Operations Aggregate
$1,000,000
~OCCURRENCE !~.~ ~M~ I~'~r and Pr°perty Damage Liability Per
E~CLAIMS MADE } ,~ ! ~j_ $1,000,000
fi! "71 '),,~ Personall~ury
)ATE I I ,~,~ ~ nn~ Per p~,~
· - - Organization
RE'FRO DATE .....
IVAIVER N/A..~'"'yI ~lt[,F.J~a~egal - $100,000 Other Med. Pay - $5,000
AUTOMOBILE LIABILIT' ' 01/01/2003 AS2-151-410483-332 $1,000,000 Each Accident - Single Umit
B.I. and P.D. Combined
[] OWNED Each Person
[] NON-OWNED Each Accident or Occurrence
[] HIRED Each Accident or Occurrence
DTHER
Umbrella Excess 01/01/2003 TH1-151-410483-172 $2,000,000 Single Limit for Bodily Injury and Property
Liability Damage Liability over Underlying Limit
~,DDITIONAL COMMENTS
RE: ,
THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS, ITS EMPLOYEES AND OFFICIALS WILL BE INCLUDED AS
ADDITIONAL INSURED ON ALL POLICIES EXCEPT FOR WORKERS' COMPENSATION.
* If the cerlfficate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date.
SPECIAL NOTICE.OHIO: ANY PERSON WHO, WI'TH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN
APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
IMPORTANT NONCE TO FLORIDA FOI.IOYHOLDER~ AND CERTIFICATE HOLDER~N THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION
ABOUT THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER~'HO~E NAME AND TELEPflONE NUMBER APPEARS IN THE LOWER RIGHT HAND
CORNER OF THIS CER'nRcA'rE. THE APPROPRIATE LOCAL SALES OFFICE MAIUNG AI:)DRESS MAY ALSO BE OBTAINED BY CAI.LING THIS NUMBER.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELO~V.) BEFORE
THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED
UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS
NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO:
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
James R. Fiet
AUTHORIZED REPRESENTATIVE
542-0005 12/18/01
I
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companie
PHONE NUMBER DATE ISSUED
BS1501
This certificate is executed bv Libl:rtv Mutual Insurance Groun as resnec tssuch insurance as is aITordedb thosecoIDuanies BM0068
Certificate of Insurance
This certificate is issued as a matler of infonnation only and confers no rights upo .-ty! M-{ 'C 1\ IL.I,snOlanmsuran policy and does not amend, extend, or alter the coverage
affordedbvthennlicieslistedbelow.
This is to certify that (Name and address ofInsured) I\LVl.-IVl.-LI
General Asphalt Co" Inc. ~ Libert):
4850 N.W. 72 Ave DEe 2 0 ...,_:0,""
Miami, FL 33166 Mutual..
'---.
MONROE COUNTY
is, at the issue date of this certificate, insured by the Company under the policy(ies) sted below. The i =e listed policy(ies is subject to all theirtenns, exclusions and conditions and
is not altered bv any reauirement, term or condition of any contract or other docume ssue.
Expiration Tvne EIf.lExp. Tho'''') Pnlicv Numbetis) Limits of l.iahilitv
Continuous* 01/0112007/0110112008 WA6-15D-410483-327 Coverage afforded under we law of Employers Liability
I- the following statt'S: Bodily Injury By Accident
I- Extended
X Policy T errn FL $500,000 Each Accident
Bodily Injury By Disease
$500,000 Policy Limit
Workers Compensation Bodily Injury By Disease
$500,000 Each Person
01101/2007/0110112008 TBl-151410483-197 General Aggregate-Other than Prod/Completed Operations
General Liability $2,000,000
] Products/Completed Operations Aggregate
~ ~laims Made ('f .~ $2 000,000
X Occurrence Bodily Injury and Property Damage Liability Per
't~~ 1 $1,000000 Occurrence
I Retro Date j Personal and Advertising Injury Per Person /
"A- $1 000,000 Or~ani:attion
Other Liability I ~ther Liability
$100,000 Premises Rentd to you $5,000 Medical Pavments
01/0112007/01/0112008 AS1-151-410483-337 Each Accident - Single Limit - B. I. and P. D. Combined
Automobile Liability $1.000,000
Each Person
..! Owned ]
..! Non-Owned Each Accident or Occurrence
X Hired
Each Accident or Occurrence
01/01/2007/0110112008 TH2-651-410483.177 $] ,000,000 Per Occurrence
Umbrella Excess Liabilitv $1 000.000 Aggregate
C Project Number: C-90S Project Name: Roadway Improvements
0 The certificate holder is also named as additional insured with respect to General Liability and Auto Liability coverage.
M Umbrella coverage is a follow form coverage that increases the underlying coverage limits, therefore there is no coverage gap in the workers compensation
M limits
E
N
T
S
-If the certificate expiration date is continuous or extended tenn, you will be notified if coverage is tenninated or reduced before the certificate expiration date However, you will not be notified annually of
the continuation of coverage.
Special Notice - Ohio: Any person who, with intent to defraud or knowing that he I she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or
deceptive statement is guilty of insurance fraud.
Important information to Florida policyholdrrs and certiliCIIle holders: in !h\'" C"('n! yO!! Imve any q!!e~ticns or need information about this ccrtiflcat~ fOf dflY IcliMlll, vlea~e coniac[ your lucal saies produceI',
whose name and telephone number appears in the lowei' left comer of this ~rtifi.cate. The appl"opriate local sales office mailing address may also be obtained by calling this number.
Notice of cancellation: (not applicable tmless a number of days is entered below). Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above
policies lUltil at least 30 days notic;e of such cancellation has been mailed to:
Office: FT. LAUDERDALE, FL Phone: 800-542-0055 1\-~O ~ \I/'''-'~
-
Certificate Hold.er: MARY VOSSEN
Monroe County Board of County Commissioners Authorized ReDresentative
1100 Slffionton Street
Key West. FL 33040
DateIssued: 12/19/2006 PreparedBy: DB