Certificates of Insurance AC"" CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
05/02/2024
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 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: Amanda Katullch
FAX
PGI of West Central Florida,LLC PHONE(A/C,No,Ext): 941-242-9619 (A/C,No): 941-242-9621
608 15th St W ADDRESS: amanda@pgiofwestcentralflorida.com
INSURER(S)AFFORDING COVERAGE NAIC#
Bradenton FL 34205 INSURERA: National Trust Insurance Company 20141
INSURED INSURER B: FCCI Insurance Company 10178
Grader Mike,LLC. INSURER C:
2 Bay Dr. INSURER D:
INSURER E:
Key West FL 33040 INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 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
LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE � OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5,000
A Y GL10007180102 08/23/2023 08/23/2024 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY ElPRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: Employee Benefits $ 1,000,000
AUTOMOBILE LIABILITY UUML31NEU,'�INULE LIMIT
(Ea accident) $ 1,000,000
x ANY AUTO BODILY INJURY(Per person) $
B AUUTOSS AUTOS A O SCHEDULED Y CA10005902803 08/23/2023 08/23/2024 BODILY INJURY(Per accident) $
NON-OWNED $
HIRED AUTOS AUTOS (Per accident)
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION X PER
STATUTE ER
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
B OFFICER/MEMBER EXCLUDED? ❑Y N/A WC010005902903 08/01/2023 08/01/2024
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
B Schedule Equipment CMI0007415402 08/23/2023 08/23/2024 Limit:$215,704
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Monroe County Board of County Commissioners is listed as additional insured on a blanket basis as required by written contract in regards to General Liability and
Automobile Liability.
5.2.24
a,
CERTIFICATE HOLDER CANCELLATION WAMP
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE4VILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County BOCC
1100 Simonton St. AUTHORIZED REPRESENTATIVE
Key West FL 33040 �T9�'Zl,PCt? 7
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