Certificates of Insurance
ACORDT",
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DATE (MM/DD/YY)
09/10/04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
Aon Risk services, Inc of Florida
1001 Brickell Bay Drive
suite 1100
Mi ami FL 33131
PHONE - (866) 283-7124
INSURED
community Asphalt Corp.
14005 N.w. 186th Street
Hialeah FL 33018 USA
FAX - (866) 430-1035
COMPANY
A
Illinois National Insurance Co
COMPANY
8
National union Fire Ins Co of pittsburgh
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOlWlTHSTANDING 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 CONDITlONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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DESCRlPTlQN..QE OPERATIONSlLOCATlONSlVEHlCLESlSPEClAL ITEMS .
Re: CA ~j45 Cargo Apron Resurraclng, Florloa Keys Marathon Alrport AlP 3-12-0037-2204.
Monroe County Board of commissioners and URS Corporation is named as Additional Insured excluding workers'
compensation and Employers' Liability as required by written contract but limited to the operations of the Insured
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE
Monroe County Board of commissioners
Key west International Airport
3491 S. Roosevelt Boulevard
Key West FL 33040 USA
EXPIRATION DATE THEREOF, THE ISSUING COMPANY Will I5NDE^'10R TO MAil
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT F^llURE TO M^.ll SUCH ~IOTICE SH^llI!IPOSE NO OBlIG.^.TION OR lI'\BllITY
OF A"4Y KI~JD UPON THE COMpHIY. ITS .^CE~JTS OR REPRESE~IT^TI""S.
AUTHORIZED REPRESENTATIVE
Attachment to ACORD Certificate for communi ty Asphalt Corp.
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The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
community Asphalt Corp.
14005 N.w. 186th Street
Hialeah FL 33018 USA
COMPANY
COMPANY
COMPANY
COMPANY
COMPANY
ADDITIONAL POLICIES
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
POLICY POLICY
co TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS
LTR POLICY DESCRIPTION DATE DATE
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DESCRIPTION OF OPERATIONSlLOCA TlONSlVEHICLESlSPECIAL ITEMS
under said contract, and always subject to the policy terms, conditions and exclusions.
cancellation provision shown herein is subject to shorter or longer time periods depending on the
jurisdiction of, and reason for, the cancellation.
Certificate No:
570010964932