COI 72/6/2024
E(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE
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
NAME: Steven Gallca
The James B. Oswald Company PHONE FAX
1100 Superior Avenue, Suite 1500 A/C No Ext: 216-306-0047 vc,No):216-839-2815
E-MCleveland OH 44114 ADDRESS: sgalica@oswaldcompanies.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:XL Specialty Insurance Co. 37885
INSURED MBIK2-1 INSURER B: Hartford Underwriters Ins. Co. 30104
K2M Design, Inc.
w
1150 Virginia St. suRERc: COVINGTON SPECIALTY INS CO 13027
Key West FL 33040 INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1565860439 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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD MM/DD
C X COMMERCIAL GENERAL LIABILITY Y Y VBA91095000 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $100,000
X AI Primary& APPROVED BY RISK MANAGEMENT MED EXP(Any one person) $5,000
d,
X Non-Contributory BY„,,, ,„,r.:-„' t"_...--- „;. .0 PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: DATE 2/6/2624 GENERAL AGGREGATE $2,000,000
POLICY PRO-
JECT LOC WAIVER N/A_YES_ PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
B AUTOMOBILE LIABILITY Y Y 45 UEC BM4123 SA 4/1/2023 4/1/2024 COMBINED SINGLE LIMIT $1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICE R/M EMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Professional Liability N Y DPR5014105 6/12/2023 6/12/2024 Each Claim $5,000,000
Claims Made Aggregate $10,000,000
Retro Date:09/01/2001 Pollution&Envir. Liability Included
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Additional Insured&Waiver of Subrogation as designated above is provided when required of the Named Insured by written contract or agreement.
Additional Insured
Monroe County Florida
1100 Simonton Street
Key West, FL 33040
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County Florida
1100 Simonton Street AUTHORIZED REPRESENTATIVE
Key West, FL 33040
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD