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Certificate of Insurance ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 1~ DATE (MMlDDIYYYY) CARRS-1 03/01/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Robert H. Clarkson Agency, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 70129 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. Louisville KY 40270 Phone: 502-585-3600 Fax:502-585-8819 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: h'aveJ.ers property casuaJ.ty INSURER B: Maxum Indemnity Company The Corradino Grou~ Inc. INSURER c: Jlmarican International. Group 200 S. Fifth .Stree 300 N. INSURER D: Hartford Insurance Company Louisville KY 40202 INSURER E: Westch..ster Fir.. :Insurance Co COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRI TYPE OF INSURANCE POLICY NUMBER DATEiMM~ DATE IMMIDDIYYl LIMrrs GENERAL LIABILITY EACH OCCURRENCE $1,000,000 '-- B X ~ COMMERCIAL GENERAL LIABILITY GLP6000398-02 07/17/04 07/17/05 I PREMiSES (Ea occurencel $ 300,000 - ~ CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2, 00e-, 000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $2,000,000 I POLICY !Xl ~r8r n LOC Emp Ben. 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 - A ~ ANY AUTO p810526D0930 05/01/04 05/01/05 (Ea accident) ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS j\PP:4ro') 1~~I"~.fT f\GEMErf1 (Per person). - ..... . . ,~. .t- , ht~::" ~ HIRED AUTOS \. II f:i ,{ n' .,_ _ ,'- BOOIL Y INJURY $ ~ NON-OWNED AUTOS ~3:?1:0~ j.-- (Per accident) X 500 ded comp r'~/Y!- -::" .' .... _.j--~ k?--- PROPERTY DAMAGE "'P - ~...~. $ X 500 ded coIl V' (Per accident) GARAGE LIABlLITY .if I' IV ,.~ [Ni", ....L...yt:. P ..._-_. AUTO ONLY - EA ACCIDENT $ ==i PN'( AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000 , !J OCCUR D CLAIMS MADE C BE7233218 05/01/04 05/01/05 AGGREGATE $2,000,000 $ ~ DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND ITORYLIMITS I I U~k'" . C EMPLOYERS' LIABILITY WC9696084 05/01/04 05/01/05 $1,000,000 ANY PROPRIETORIPARTNERlEXECLmVE E.L EACH ACCIDENT OFFICER,lMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under . $1,000,000 SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER D Crime Section 33BDDCW4024 05/01/04 05/01/05 E.. PROF. 4,000,000 A Leased Eauipment P630526D0548 - $450,000 05/01/04 05/01/05 LIABILITY 100,000de DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER IS ADDITIONAL INSURED WITH REGARDS TO WORK PERFORMED BY THE INSURED. CERTIFICATE HOLDER CANCELLATION PROOF-- SHOUL!> ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATlO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYSWRlTTEN .. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO~DREPRESENTATIV MONROE COUNTY 2798 OVERSEAS HIGHWAY SUITE 410 Ml\RATHON FL 33050 ACORD 25 (2001/08) ~ @ACORD CORPORATION 1981 A CORD_ :CERTIFICA TEO:FL1ABILITYINSURAt.4CE OP ID Aq DATE (MMlDDIYYYY) CARRS-1 0.7/21/0.5 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Robert H. Clarkson Agency, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 70.129 SEP 0 9 ,,,~TERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. Louisville KY -40.270. :uu::r Phone: 50.2-585-360.0. Fax:5C2-S85-8819 INSURERS AFFORDING COVERAGE 'NAlC # INSURED INSURER A: ~:ra_l_a Propllrty caaual ty INSURER B: American .International. Group ----m----~5. ~~r~r?Ji~s~~~~~-!~8o INSURER C: Maxum Indemnity Company -N.; .--.-.----...--... -- -.. -INSURERO," 'We$tches-ter-Surolu~l'Lines-'- ---- ---.------------ Louisville KY 40.20.2 INSURER E: COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AtN REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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. AGGREGATE LIMITS SHOWN MAY H,6,VE BEEN REDUCED ,BY PAID CLAIMS. LTR iNSRf TYPE OF INSURANCE POLICY NUMBER "D~~Tri~.r,w;e DATE"MMJDDIYY\- UMITS ~NERAL LIABILITY EACH OCCURRENCE n.DDo..ODD C X ~ OMMERCIAL GENERAL LIABILITY GLP6o.DD398 0.3 0.7/17/0.5 0.7/17/0.6 ~~~~'Es Ea oCOJrence\ $50.,0.0.0. I-- CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,0.0.0. PERSONAL & ADV INJURY $ 1 .0.0.0 .000 I-- GENERAL AGGREGATE $2,0.00.,0.00. I-- n'LAGGRE~ LIMIT AnS PER: PRODUCTS - COMP/OP AGG $2,0.0.0,0.00 POLICY X ~rg: LOC Emp Ben. "1,00.0.0.00 ~TOMOBILE LIABIUTY COMBINED SINGLE LIMIT $1,0.00.,0.00. .A ~ ANY AUTO 81052600930. 0.5/0.1/0.5 05/0.1/0.6 (Ea accident) - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS ~~~~~~~. :~ < MA 'EMf. 4 \ (Per person) - ~ HIRED AUTOS MI.J.__'~ BODILY INJURY -' (Per accident) .$ ~ NON-QWNED AUTOS -- .....l.1-.{i:-Q; ~ COMP DED $50.0. DATE .... '-- PROPERTY DAMAGE .. $ X COLL DED .$10.00 :" (Per accident) GARAGE LIABILITY WAI\!F:H ,. "\..-__ Y r:.') ____ --- AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $ 200.0. , 000 B tl OCCUR D CLAIMS MADE BE 476683 0.5/0.1/05 05/0.1/06 AGGREGATE $2, DOC ,COD $ ~ DEDUCTIBLE $ X RETENTION $10.,0.0.0. $ WORKERS COMPENSATION AND hORYLIMITS I IU~~- B EMPLOYERS' LIABILITY WC968 5546 0.5/0.1/05 0.5/01/0.6 $1,000,0.00 ANY PROPRIETORlPARTNERlEXECUTIVE E.L EACH ACCIDENT OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1...000.,000 If yes, describe under $1.0.00. .0.00 SPECIAL PROVISIONS below E.L, DISEASE - POLICY LIMIT OTHER A Property Section P630 526D0548 0.5/0.1/05 0.5/01/06 BLDGS 3,1.00,000. D Professional Liab EONG216460760C1 0.8/20./04 08/20./0.5 PROF LIAB 4.000..0.00. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS re: STOCK ISLAND CERTIFICATE HOLDER IS ADDITIONAL INSURED WITH REGARDS TO WORK PERFORMED BY THE INSURED. CO ~~'. ~ 'i'Q. "( ~ CERTIFICATE HOLDER MONROE COUNTY 2798 OVERSEAS HIGHWAY SUITE 410. MARATHON FL 330.50 CANCELLATION PROOF-- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATlON OR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO REPRESENTA ACORD 25 (2001/0B)