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HomeMy WebLinkAboutCertificate of Insurance 7331/2025 (MMIDDIYYYY) .4►C"R"� CERTIFICATE OF LIABILITY INSURANCE 16. �..-'- 4/1/2026 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). CONTACT PRODUCER Lockton Companies,LLC NAME: DBA LOckton Insurance Brokers,LLC In CA PHONE FAX CA license#OF15767 E-MAIL o Ext: A/C No 3280 Peachtree Rd.NE,Ste. 1000 ADDRESS: Atlanta GA 30305 INSURER(S)AFFORDING COVERAGE NAIC# 404 460-3600 INSURER A:Great American Insurance Company 16691 INSURED Midcoast Construction Enterprises LLC INSURER B:U.S. Specialty Insurance Company 29599 1528434 501 Brookes-Creek Boulevard INSURER C:Sentry Insurance a Mutual Company 24988 Oldsmar FL 34677 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 20775584 REVISION NUMBER: XXXXXXX 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 ADDLTYPE OF INSURANCE INSD WVDSUB POLICY NUMBER POLICY EFF POLICY EXP LTR MMIDD/YYYY MMDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000 000 A X Y N OML 50733�0 02 5/1/�025 5/1/2026 CLAIMS-MADE � OCCUR PREM SESOEa oNcur ante $ 100,000 'T MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1000 000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 NPOLICY PELT LOC A -'"� - PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Y N 90-19964-002 AOS) 4/1/2025 4/1/2026 Ea accident 000 $ 5 000 C X ANY AUTO 90-19964-003�MA Only) 4/1/2025 4/1/2026 BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ XXXxXXX $ XXXXXXX B UMBRELLA LIAB X OCCUR N N CXS1 2805.005 5/1/2025 5/l/2026 EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I I RETENTION$ $ XXXXXXX WORKERS COMPENSATION PER OTH- C AND EMPLOYERS'LIABILITY N 9019964001 (AOS) 4/l/2025 4/l/2026 X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 9019964004(WI) 4/1/2025 4/l/2026 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? � N I A (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 A Protection&Indemnity N N OML 5073320 02 5/l/2025 5/I/2026 See Attached Hull DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Project Name:INCLUDES USL&H.ISSUE 07-22-24(KLT) Monroe County BOCC is included as additional insured if required by written contract with respect to General Liability and Automobile Liability per the terms and conditions of the policy.Federal Jones act coverage is included under the Marine General Liability policy.Watercraft liability is included in the Marine General Liability coverage. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20775584 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County BOCC 1100 Simonton Street Key west FL 33040 AUTHORIZED REPRESENTp.TIV a ' n 14 ©1 86-201 ACdRQ CORPOWATION, All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Great American Insurance Company Attachment Code: D630156 Master ID: 1528434,Certificate ID:20775584 600149 GAI 2248 (Ed. 01/01) Policy No. OML 5073320 02 OCEAN MARINE COVERAGE LEVEL DECLARATIONS PAGE AND VESSEL SCHEDULE NAMED INSURED: MIDCOAST MARINE GROUP LLC DBA: MIDCOAST MARINE GROUP LLC POLICY#: OML 5073320 POLICY EFFECTIVE DATE: 05/01/2025 POLICY EXPIRATION DATE: 05/01/2026 HULL COVERAGE INFORMATION: HULL COVERAGE FORM: FORM #: GAI 2206 FORM NAME: TAYLOR FORM (SP-39C) TOTAL HULL PREMIUM: $ 24,969 WARRANTED THAT NO LAYUP RETURNS WILL BE ALLOWED UNDER THIS POLICY. PROTECTION &INDEMNITY COVERAGE INFORMATION: P & I COVERAGE FORM: FORM #: GAI 2211 FORM NAME: SP 38 PROTECTION AND INDEMNITY CLAUSES TOTAL P & I PREMIUM: $ 76,487 AS RESPECTS TO THE PROTECTION & INDEMNITY COVERAGE EACH VESSEL IS DEEMED TO BE SEPARATELY INSURED. WITH REGARDS TO THE PROTECTION & INDEMNITY DEDUCTIBLES LISTED BELOW, THE MAXIMUM DEDUCTIBLE FOR ANY ONE CASUALTY OR OCCURRENCE SHALL NOT EXCEED THE GREATER OF THE TWO DEDUCTIBLE AMOUNTS SHOWN BELOW. WARRANTED THAT NO LAYUP RETURNS WILL BE ALLOWED UNDER THIS POLICY. CREW PREMIUM: $ 41,924 VESSEL SCHEDULE FOR GAI 2206 -TAYLOR FORM (SP-39C) LIMIT OF LIABILITY AGREED VALUE/ AMOUNT VESSEL# VESSEL DESCRIPTION COVERAGE INSURED DEDUCTIBLE 1 2015 28 Steel Dock barge HULL $ 50,000 $ 2,500 Name: MICHAELA ROSE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 2 25 Steel Dock barge HULL $ 52,000 $ 2,500 Name: JENNY LEIGH P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 GAI 2248 (Ed. 01/01) (Page 1 of 3) OML 5073320 02 Great American Insurance Company Attachment Code: D630156 Master ID: 1528434,Certificate ID:20775584 600149 VESSEL SCHEDULE FOR GAI 2206 -TAYLOR FORM (SP-39C) LIMIT OF LIABILITY AGREED VALUE/ AMOUNT VESSEL# VESSEL DESCRIPTION COVERAGE INSURED DEDUCTIBLE 3 24 Aluminum Barge HULL $ 10,000 $ 1,000 Name: SUPPLY BARGE #1 P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 4 201 E 40 Steel Sectional Barge HULL $ 30,000 $ 2,500 Name: #1 B&R SECTIONAL BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 5 201E 40 Steel Sectional Barge HULL $ 30,000 $ 2,500 Name: #2 B&R SECTIONAL BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 6 40 Steel Sectional Barge HULL $ 30,000 $ 2,500 Name: #3 B&R SECTIONAL BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 7 201 El 40 Steel Sectional Barge HULL $ 30,000 $ 2,500 Name: #4 B&R SECTION BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 8 40 Steel Sectional Barge HULL $ 30,000 $ 2,500 Name: #5 B&R SECTIONAL BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 9 201 E 18 Steel Anchor barge HULL $ 50,000 $ 2,500 Name: BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 10 200 30 Aluminum Crewboat HULL $ 100,000 $ 2,500 Name: RAZORHEAD P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 11 2017 20 Steel Barge HULL $ 100,000 $ 2,500 Name: STEEL BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 12 2017 20 Aluminum Barge HULL $ 14,000 $ 2,500 Name: STEEL BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 13 2013 20 Aluminum Sectional Barge HULL $ 30,000 $ 2,500 Name: SHUGART SEC-BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 14 2013 20 Aluminum Sectional Barge HULL $ 30,000 $ 2,500 Name: SHUGART SEC-BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 15 2013 20 Aluminum Sectional Barge HULL $ 30,000 $ 2,500 Name: SHUGART SEC-BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 16 20 Aluminum Sectional Barge HULL $ 30,000 $ 2,500 Name: SHUGART SEC-BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 17 2013 20 Aluminum Sectional Barge HULL $ 30,000 $ 2,500 Name: SHUGART SEC-BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 GAI 2248 (Ed. 01/01) (Page 2 of 3) OML 5073320 02 Great American Insurance Company Attachment Code: D630156 Master ID: 1528434,Certificate ID:20775584 600149 VESSEL SCHEDULE FOR GAI 2206 -TAYLOR FORM (SP-39C) LIMIT OF LIABILITY AGREED VALUE/ AMOUNT VESSEL# VESSEL DESCRIPTION COVERAGE INSURED DEDUCTIBLE 18 2016 20 Aluminum Sectional Barge HULL $ 25,000 $ 2,500 Name: SHUGART SEC-BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 19 201 20 Aluminum Sectional Barge HULL $ 20,000 $ 2,500 Name: SHUGART SEC-BARGE P&I $ 1,000,000 BI $ 2,500 PD $ 2,500 GAI 2248 (Ed. 01/01) (Page 3 of 3) Attachment Code: D652574 Certificate ID:20775584 Addendum Coverage: Pollution Liability Carrier: Ascot Specialty Insurance Company Policy Number: ENPR2110000406-02 Eff: 5/3/2024 - 5/3/2027 Limit: $25,000,000 aggregate