HomeMy WebLinkAboutCertificate of Insurance DATE(MMIDD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE
09/20/2024
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 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 Insurance Services,Inc. a/cNro 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. 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: 24-25 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 P-630-8254A604-COF-24 10/01/2024 10/01/2025 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 810-5N338364-24-43-G 10/01/2024 10/01/2025 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 2,000,000
OCCUR EACH OCCURRENCE $
C EXCESS LAB CLAIMS-MADE CUP-7J748484-24-43 10/01/2024 10/01/2025 AGGREGATE $ 2,000,000
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 UB-007J070308 10/03/2024 10/03/2025
(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 1,000,000
E Engineers E0000027205-10 10/01/2024 10/01/2025 Aggregate 1,000,000
Deductible 250,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Monroe County is an additional insured with respect to general liability and auto liability if required by contract.
IFry T'
DATE . - .10 3„24 „�
WAN" NA XYW--
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 33309
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