Loading...
Certificates of Insurance �•—� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 08/30/2023 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 w 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 R NAME: Aon Risk services central, Inc. PHONE FAX W Omaha NE Office (A/C.No.Ext): (402) 697-1400 (A/C No): (402) 697-0017 'a 0 17807 Burke street E-MAIL x Suite 401 ADDRESS: Omaha NE 68118 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Travelers Property cas co of America 25674 Musco Sports Lighting, LLc INSURER B: Sentry casualty company 28460 c/o Musco corporation 100 1st Ave W INSURERC: Sentry Insurance company 24988 Oskaloosa IA 52577 USA INSURERD: Indian Harbor Insurance company 36940 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570101335930 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 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. Limits shown are as requested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM N/ODYYY LIMITS C X COMMERCIAL GENERAL LIABILITY 9016877004 07/01/2023 07 01 2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED $1 000 000 PREMISES Ea occu rrence APPROVED BY RISK MANAGEMENT MED EXP(Any one person) $10,000 BY ,fir'•. %y�, PERSONAL&ADV INJURY $1,000,000 0 GEN'LAGGREGATE LIMITAPPLIES PER: DATE 9/5/9093 GENERAL AGGREGATE $10,000,000 u" POLICY PRO F"LOC PRODUCTS-COMP/OP AGG $2,000,000 M JECT WAIVER N/A YES 0 OTHER: o r C AUTOMOBILE LIABILITY 90 16877 003 07/01/2023 07/01/2024 COMBINED SINGLE LIMIT $1,000,000 `O Ea accident X ANYAUTO BODILY INJURY(Per person) 0 O OWNED S AUTOS CHEDULED BODILY INJURY(Per accident) z AUTOS ONLY "M HIREDAUTOS NON-OWNED PROPERTY DAMAGE tp ONLY AUTOS ONLY (Per acciden t) U i" W A X UMBRELLA LIAB X OCCUR cUP3s63336023NF 07/01/2023 07/01/2024 EACH OCCURRENCE $10,000,000 U EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I RETENTION B WORKERS COMPENSATION AND 9016877001 07/01/2023 07/01/2024 X I PER STATUTE I JOTH- EMPLOYERS'LIABILITY Y/N A05 ER B AN PROPRIETORE ART ED7EXECUTIVE EN N/A 9016877002 07/01/2023 07/01/2024 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) AZ, WI E.L.DISEASE-EA EMPLOYEE $1,000,000 D ESCdescribe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below D Architects & Engineers CEo742113903 07/01/2023 07/01/2024 Aggregate $5,000,000 Professional claims-Made SIR $250,000=_ SIR applies per policy ter s & condi ions Each claim $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: Musco project 224237 - Big Pine Key Park Phase 2. Monroe county Board of county commissioners, with its employees and officials are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. - L CERTIFICATE HOLDER CANCELLATION y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 1. POLICY PROVISIONS. Monroe county Board AUTHORIZED REPRESENTATIVE of county commissioners 500 Whitehead St. Key West FL 33040 USA I4 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks ofACORD 'L LIABILITY POILICY14UMBER' 9016877004 CO ME MRCIAL GEN ERA CG 20 10 12 19 THII IENC ORSEMENTCHA MINE S THE, POLICY. PLEASE READ IT CAREFULLY., ADDITIONAL INSURED 1- OWNERS, LESSEES OR CONTRACTORS 1- SCHEDULED PERSON OR, ORGANIZATIGN This endolrsernpant modifies in,suraince provided under the fol lowin '. C"MMERCIAL GENERAL.LABILITY COVERAGE PART SCHEDULE NIame Of Additianal llinsuured Person(s� Or Orgianization,(s), Locaflion,(s)()f Covered Operations As required by written contract linfon-nation required to complete this Schedule, lif not shown above W 11 be shown iin the Declarations. X Sectibn Ilil - Who Is An IInsured lira arneinded to B. With respect to the insurance afforded to these include as an addificmal iinSUire-d the Iperson(s) or addifianal MISUreads, the, following additional arganiizatillon(s) shown in the SchedLlle�, bUt 0111Y exclusions,apply.: with respect to liaUlit for "bodily iinjury":, This insuraince idoe,,,r,,, not apply to "Ibodily injury"or property darnage" or "persoinal and adveirtising "propertV darnage" occurding alter,' injUr/' MKISP-d, iin w.hale or in part, by�� I. AHi work, iin,cludunlg matehals, 1parts or 1. 'dour acts or ornmsions" or eqUipmeinil furnished iin con,'nectian with such 2. The acts or omissions of those acting on your work, on the project (otheir than service, behalf" maintenance.m.or repaliirs)to be performed by or in the pei-formance Of YOU r oingoi ng operations for Guinn behalf of flie additional insuired(s) at the the additional illSlllired(s) at the location(s) location of the covered operatims has, beein compl ;,eted or desiginated above. I However, 2,. That portion Of "Your work." out of which the iinjury or danizage arises,, has (been Put to sits 1. The linsuurainnuce afforded to SUch additional irtenideld use Iby any person or organizaticin iinsuired only applies to the extant perm itted by other than another cantractor or law, aind SLI b1contractor engaged in performing 2. 11' coverage provided to the additicinal ilISUred operabans for a principal as a part of the,sarne is required by a contract or agreement, the, project- iinsura,nee, afforded to SLICII additional insured wMi not be broader than thizat w1lich YOU are required by the contract or agreement to provide forsouch add itilanall lirnsuured.. CG 20 10 12 19, @)Illinisuranuce Services(D,fflcp.-:, I,nc., 2018, Pager I of 2 9016,877 0&212023 Sent7y limsurance Comparry 0MC,, MCCUMW 231,74 1: N C., WAh respect to the iinsurance, afforded to the 2,. AvaEable Ulider the applicaNe limAs of additianal insureds, the following is added to insurance; Section III - Limits,Of Insurmice: whichever i Iless. If coverage provided to the additional insured Its This eniclorslempaN shall not iincrease the ire,qL,Iiire,d by aI cointract or agreenieN, the most we applicable [imits of iinsur-Liince. will Ilpay oin Ibehnalf of the additional inSUred is the aniou,nt of iinsuiralice, 1® Required by the coirnft-Lict or agreement, or �Page 2 ,of Illine5Uanooe Inc., 2018 C Gi 2,011, TO 12:19, 90 16877 0&2,12.023 Sentry Insurance Cw,npamy POLICY NUMBER: 9016877004 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization you are required to add as All Locations an additional insured by written contract or agreement See Continuation Page Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured applicable limits of insurance. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Pagel of 2 9016877 06/23/2023 Sentry Insurance Company 1 00001 0000000000 23174 0 N 24937384-bf3e4e60-9a45-647961dcfd3b Continuation Page in effect prior to any loss or damage. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 37 12 19 9016877 06/23/2023 Sentry Insurance Company IL 70 58 02 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s)or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s)or organization(s)shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s)or Organization(s) including mailing address: Per the listing of certificate holders provided by the Broker upon our request. 30 day notice of cancellation applies. All other terms and conditions of this policy remain unchanged. IL 70 58 02 14 Page 1 of 1 9016877 Sentry Insurance Company 1 00001 0000000000 21179 0 N b48fe660-6afd-4e5f-891f-6873dca09543 CO MMEIRC IAL AUTO ,CA 80 07 0618 THI IENDORSEIf ENTCHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL, INSURED - AUTOMATIC STATUS, WHEN REQUIRED BY CONTRACT OR AGREEMENT WITH YOU This endorsernent modifies insurance provilded under thfe fol lowhlg:� AUTO,DEALERS COVERAGE FORM BUS1111NIESS AUTO COVERAGE IFORMI MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provi&Dns of the, Coverage Form apply Linliess modified by thins endarserneinI. A. The Who, Is An Insured provismi of Covered Autos ILiahatliiry Coverage is amended to iiinflUde as an adlditional insuired any persoin or orgainization for WhOM YOU are perforimrng operations when you and such person or orgainizettion Ihave agreed in writing iiin a contrzact or agirelement that such person or orgalIzation be added as an addRiona1 insured on your poicy. The status Of aim additional insUired Under this endorsement eirds when your operations for that additiodial insured One,COMPIPtGd. IB. The imost we will pay oin behalf of the additional insured is,the Illesser of the 3 MOU It poiyable under the LinAt of Insurance for Covered Autos Liability Coverage, or the 9rilotrnt of ilnSLIrance required by the,contract or agreement. C. Notwithstanding any requirement, term of condition of any contract or agreerneiv with respect to which this eindorsement imay pedain, the inslff3ince afforded to the'additionall insured i's subject to al,11111 the temis,exc[usions and coinditions of the COMMERCIAL AUTO C'OVERAGE IFORIM to wNch this endorsement is attached. CA 80,G7 0618 includes copyrighted material Of IIISUrance SeNces Office, inc., Page,I of 1 90 1 5B77 Wth its pemiissil on. De,12-1V202213 Spntry InSUrame Cconpiry DMC Ik MOMMMO.3174�D N THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION-CERTIFICATE HOLDERS WORKERS COMPENSATION The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to you. Such copies of the notice will be mailed as soon as practicable to the address or addresses provided by your broker or agent. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s)or organization(s)shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. SCHEDULE Person(s)or Organization(s) including mailing address: Per the listing of certificate holders provided by the Broker upon our request. 30 day notice of cancellation applies All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium: Insurance Company Countersigned by Change effective 07/01/2022 WC 99 06 72 (Ed. 09 11) Page 1 of 1 9016877 09/23/2022 Sentry Casualty Company 1 00001 0000000000 22266 0 N 6af336b54e7f-4332-96c0-6cf68a2d7241