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Home My WebLink AboutCertificates of InsuranceACMD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) K2NCDESI 05 13 05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Talbot Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 38109 Euclid Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Willoughby OH 44094 Phone:440-942-2152 Fax:440-942-2204 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: CNA Insurance K2MINSURER B: State auto Insurance companies 25135 Har Reaggier Design Inc. INSURER C: Harry 408 West St. Clair, Suite 230 INSURERD: Cleveland OH 44113 INSURER E: 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 NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 10000000 B X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR BOP2202233 08/08/04 08/08/05 PREMISES(Eaoccurence) $ 300000 MED EXP (Any one person) $ 5000 X Business Owners PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 20000000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY B X ANY AUTO BOP2202233 08/08/04 08/08/05 COMBINED SINGLE LIMIT (Ea accident) $ 1 OOO OOO r r ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ fTjftLBY �ISK j1/�" GC A��,�`I' GARAGE LIABILITY : — --- AUTO ONLY - EA ACCIDENT $ HANY AUTO DATE __ _ ._ � � OTHER THAN EA ACC $ $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE MAI V I EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNEWEXECUTIVE BOP2202233 08/08/04 08/08/05 OFFICER/MEMBER EXCLUDED? SyECes, Idescribe under AL PROVISIONS below SP OTHER STATU TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , OOO , OOO E.L. DISEASE - POLICY LIMIT $ 1 , 000 , 000 A Architects E&O 25-401-87-62 04/13/05 04/13/06 Per Claim 3,000,000 Claims Made I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Aggregate 3,000,000 "REVISED" Ohio Worker's Comp #1372880 Term (1-1-05 to 8-31-06) as provided by Scott C. Maloney R2M Architect's Professional Errors & Omissions Liability Architect's office - consulting nvws=rt GANGtLLATIUN Monroe County 1100 Simonton St. Rey West FL 33040 MC.+1110 S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION O LIA, ITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPREi V I -C26 ACORD 25 (2001108) 1988 • CSR ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDM'YY) K2CSRS1 08/16/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Talbot Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 38109 Euclid Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Willoughby OH 44094 Phone:440-942-2152 Fax:440-942-2204 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURERA. CNA Insurance INSURER B state Auto insurance companies 25135 K2M Design Inc. Harry Keagg1er INSURERC 408 Rest St. Clair, Suite 230 INsuRERD. Cleveland OH 44113 INSURER E. rOVFRAnFA 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. NSR TYPE OF INSURANCE POLICY NUMBER DATE (MI DATE (MM/DDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 10000000 rB X COMMERCIAL GENERAL LIABILITY BOP2202233 08/08/05 08/08/06 PREMISES(Eaoccurence) $ 300000 CLAIMS MADE 1XI OCCUR MED EXP (Any one person) $ 5000 PERSONAL &ADV INJURY $ X Business Owners GENERAL AGGREGATE $ 20000000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG $ POLICY PRO LOC JECT B X AUTOMOBILE LIABILITY ANY AUTO BOP2202233 08/08/05 08/08/06 COMBINED SINGLE LIMIT (Ea accident) $ 1 , 000 , 000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY 'Pi.°- AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO `Yj^-,1+ _ - """'"- $ �) AUTO ONLY AGG EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE '" - - n _..... EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE BOP2202233 08/08/05 08/08/06 E.L.EACHACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , 0 0 0 , 0 0 0 OFFICEWMEMBER EXCLUDED? II yes, describe under SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $ 1 , 000 , 000 OTHER A Architects E&O 25-401-87-62 04/13/05 04/13/06 Per Claim 3,000,000 Claims Made I I I I Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS "REVISED" Ohio Worker's Comp #1372880 Term (7-1-05 to 2-28-06) as provided by Scott C. Maloney K2M Architect's Professional Errors & Omissions Liability Architect's office - consulting rFRTIFIrATF HOI nFR tm= CANCELLATION 1110 S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO HE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL Monroe County Hiciso IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 Simonton St. REPRESENTATIVES.Key West FL 33040AUTHORIZEDREPRESENTATIV 11 Waite E. Talbot, President ACUKD Z5 (LUUT/Ua) — - I v HL.UKU wrcrUrcH I lvn T yifii t STATE OF OHIO BUREAU OF WORKERS' COMPENSATION COLUMBUS, OHIO 43215-2256 CERTIFICATE OF PREMIUM PAYMENT This certifies that the employer listed below has paid into the State Insurance Fund as required by law. Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. For more information call 1-800-OHIOBWC. THIS CERTIFICATE MUST BE CONSPICUOUSLY POSTED. POLICY NO. AND EMPLOYER 1372880 www.ohiobwc.com PERIOD SPECIFIED BELOW 07/01/2005 THRU 02/28/2006 K2M DESIGN INC 408 W SAINT CLAIR AVE APT 230 CLEVELAND OH 44113-1520 C� Q-- ADMINISTRATOR '- THIS CERTIFICATE MAY BE REPRODUCED AS NEEDED OHIO BUREAU OF WORKERS' COMPENSATION REQUIRED POSTING Effective October 13, 2004, Section 4123.54 of the Ohio Revised C de requires notice of rebuttable presumption. Rebuttable presumption means that an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work -related injury. The burden of proof is on the employee to prove that the presence of alcohol or a controlled substance was not the proximate cause of the work -related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. THIS LANGUAGE MUST BE POSTED WITH THE CERTIFICATE OF COVERAGE mbi l-I<2m A R C H I T E C T U R E August 23, 2005 Monroe County Construction Management Division 1100 Simonton Street, Room 2-216 Key West, Florida 33040 Attn: Ms. Cheryl Ingraham Re: K2M Design (dba mbi I k2m Architecture) Dear Cheryl: Attached please find the multiple originals requested of our insurance certificates and workers compensation certificates. I hope and trust that this meets with Risk Management's and the County's approval. Should further communication be required, please do no hesitate to contact me directly. cc: file 604 WHITEHEAD STREET KEY WEST, FLORIDA 33040 1 PHONE: 305.294.4011 1 FAX: 305.294.7412 1 PROF. REG. NO.AA26000777 ACERTIFICATE OF LIABILITY INSURANCE OP ID S CORD DATE(MMIDD/YVYY) MBIK2-1 04 13 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Selvaggio, Teske 6 Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3401 Enterprise Pkwy. Ste. 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beachwood OH 44122 Phone:216-839-2800 Fax:216-839-2815 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Hudson Insurance Comp roe 54 INSURER B: oCIIBIBS DBV IlOpment INSURER C: mbi-k2m Architecture, Inc. INSURER D: 2530 Superior Ave. Suite 302 Cleveland ON 44114 INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOATWIffWK 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMSli . LTR OO' NSR TYPE OF INSUR/IN POLICY NUMBER E POLICYMMIDDm DATE POLICY EXPTFUU-16W DATE MM/DDM/ LIMITS j GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR _ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO ECT LOC Monroe FO IIIti AP TIME:— I County S eVe(o nne l�y -L 'j lY9 91001 w �j ( Y EACH OCCURRENCE $ PIIRM SES (Ea ocwrence) $ VIEDI(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per eccitlenp $ PROPERTYAGE (Par accitlen,d.nt) q $ i GARAGE LIABILITY ANV AUTO AUTO ONLY - EA ACCIDENT $ —-� — OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ (( EACH OCCURRENCE 8 AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below TORY LIMITS I J I E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ �E. L. DISEASE - POLICY LIMIT - $ A OTHER Professional Liab. Claims -Made AEE7204500 04/13/07' 04/13/08 Ea. Claim $3,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holden, Monroe County *30 Day Cancellation applies, except for 10-Day Notice for non-payment of premium. LICK I III I i HULUI CANCELLATION Monroe County Attn: Paulette Harper 1100 Simonton Street Key West FL 33040 MOLAR-04 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 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. GC ACORD MBI K2 - CERTIFICATE OF LIABILITY INSURANCE OID IS 04 13 07 DATE (MMIDD/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Selvaggio , Teske S Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3401 Enterprise Pkwy. Ste. 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beachwood OH 44122 Phone: 216-839-2800 Fax:216-839-2815 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA. HudsonInsurance Company 25054 INSURER B. mbi-k2m Architecture, Inc. INSURERC. _ 2530 Superior Ave. Suite 302 INSURER o. Faclll Cleveland 0'H 44114 -- rnveo A r_ce Inn n .. 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 �fp,I UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CON POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RECEIVED BYINbR LTRINSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFEC DATE MM/DDIYV POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY RAL LIABILITY CLAIMS MADE E`� OCCUR / TIME: RECEIVE Monroe Coun acllifles Develop APR 19 20 y enf ] EACH OCCURRENCE $ PREMCOMMERCIAL (Ea acmnence) MED EIXPS(Any one e son) $ PERSONAL B ACV INJURY $ GENERAL AGGREGATE - -" $ GEN'L AGGREGATE LIMIT APPLIES PER'. POLICY PRO- LOC JECT BY: PRODUCTS - COMPIOP AGG $ - --- AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS / r / 1 U COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Par person) $ BODILY INJURY (Per accident $ PROPERTY DAMAGE (Per aooident) $ GARAGE LIABILITY ANV AUTO AUTO ONLY - EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY'. AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ � EACH OCCURRENCE $ AGGREGATE 1 $ Is $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' If yea, describe under SPECIAL PROVISIONS below TORV LIMITS ER _ E L EACH ACCIDENT EL DISEASE EA EMPLOVEE�$ - E.L. DISEASE -POLICY LIMIT Is - - - - - - - - $ A OTHER Professional Liab. Claims -Made AEE7204500 04/13/07 04/13/08 Ea. Claim $3,000,000 I Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder: Monroe County / Facilities Development Dept. *30 Day Cancellation applies, except for 10-Day Notice for non-payment of premium GERTIFIGATE HOLDER CANCELLATION MONR-05 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Facilities Development Dept NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Ann M. Rigger -Contractor Admin IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 Simonton St., Room 2-216 Key West FL, 33040 REPRESENTATIVES. ACORD 25 (2001AS) G_ iFk18 From. Salena Sitter At. Selvaggio, Teske & Associates FaxID: 216-839-2815 To. Ann Riger / Monroe County Date: 8/1B/L007 11:20 AM Page: 2 of 3 ACORD CERTIFICATE OF LIABILITY INSURANCE OPID S DATE IMM/DD MBIK2-1 08/16/07/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Selvaggio , Teske & Associates 3401 Enterprise Pkwy. Ste. 101 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beachwood ON 44122 Phone:216-839-2800 Fax:216-839-2815 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A. Hudson Insurance Company 25054 INRURFR R EE::i INSURERCI mbi-k2m Architecture, _Inc. 2530 Superior Ave. Suite 302 Cleveland OH 44114 INSURERD INSURER E — 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 ON ICE DOCUMENT WILL I RESPECT TO WI IICI I TI 113 CERTIFICATE MAY DC 13GUED OR MAY PER IAIN IHE NSURANGE AFFURDEU BY IHE VOLIL ES UEbCRIBEU HEREIN IS SUBJECI IO ALL IHE IERMS, EXCLUSIONS ANN CONUI IIONS OF SUCH POLICIES. AGf-.REGATE LIMITS SHOW V MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSIRC TYPE OF INSURANCE POLICY NUMBER DATE( DATE (MM/DD/W) LIMITS GENERAL LIABILP Y EACH OCM IRRFNCF $ PREMISES (Ea occureoce) $ COMMED AL GEINERAL LIABILITY MED EXP (My one porron) If CLAIMS MADE OCCUR PCR30NAL & ADV INJURY $ GFNFRAI AGCRFGATF $ _,ENO AGGREGATE LIMITAPPLIES PER PRGDLICT5-11MPNPAGG $ POLICY F JPRO- ECT LUr- AUTOMOBILE LIABILIN ANY AUTO COMBINED SINGLE LIMIT (Ea oeed,nt) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED Aurus BODILY INJURY (Per accident) $ HIRED AUTOS NONOWNEDAUTOS PROPFRT'v' DAMAGE (Per amldont) $ GARAGE LIABILITY AUTOONLY- EAACCIDENT $ OTIERTI IAN EA ACC $ ANY AUTO $ AUTO ONLY. AGO EXCESS(UMSRELLA LIABILITY JCCUR CLAIMS MADE EACH OCCI IRRFNCF $ AJGREGATE $ DEDUCTIDLC _. __.. $ RETENTION $ $ WORKERS COMPENSATION AND I TORV LIMIT$ ER EMPLOYERS' LIABILITY ANY PROPMETORTARTNER/EXECUTIVE E. L. EACH ACGUENI $ EL DISEASE-EAEMPLOYEE $ OFFICEWMEMBER EXCLUDED' If yrvr. Jxsnlbx rider SPECIAL PROVISIONS be1OW E. L. DISEASE -POLICY LIMIT $ OTHER A Professional Liab. AEE7204500 04/13/07 04/13/08 Ea. Claim $3,000,000 Claims -Made I Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate Holder: Monroe County / Historic Gato Cigar Factory *30 Day Cancellation applies, except for 10-Day Notice for non-payment of premium MONR-06 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Historic Gato Cigar Factory NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO$HALL Ann M. Rigger -Contractor Admin IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. US AGENTS OR 1100 Simonton St., #2-216 Hey West FL 33040 REPRESENTATIVES. - - - - Monroe County ■u LO CC: �, •J AUG 16 21711 1988 I, _ From. Salena Siner At Selvaggic, Teske & Associates FaxID. 216-839-2815 To. Ann Riger / Monroe County Date: 8/162007 11.20 AM Page: 3 of 3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively of negatively amend, extend or alter the coverage afforded by the policies listed thereon. Monroe County =aci! Iles neveloomen+ AUG 16 100;; ACORD From: Salena Sine, At. Selvaggio,, Teske 8 Associates F.AD. 216-839-2815 To: Ann Riger / Monroe County 3401 Enterprise Parkway, Ste. Beachwood, OH 44122 216-839-2800 / www.stassociates.nel Selvaggio, Teske From: Salena Siner 3 Fax Cover letter To: Ann Fax: (3( Date: 8/16/2007 11,20 AM Page. 1 of 3 Phone: (216) Fax: (216h 3 )er / Monroe County 295-4321 Date: 8/16/2007 11:20:44 AM Phone: ( ) - Subject: Certificate for mbi-k2m Architecture, Inc. Message: Attn: Ann Riger - Monroe County/Historical Gato Cigar Factory Attaching evidence of Professional Liability Insurance for the captioned insured. Should you require additional insurance information or amendments to the attached certificate, please feel free to contact me direct - 216/839-2805. Kindest regards, cc: Dee McK(?nzie/dmckenzie@mbi-k2m.com CONFIDENTIALITY NOTICE This fax transmission contains confidential information belonging to the sender which is legally privileged. The information is intended only for the use of the individual named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this fax in error, please notify us by telephone to arrange for return of the documents to us. ACORD,. CERTIFICATE OF LIABILITY INSURANCE OP ID Y K2MDES1 11111 DATE(/21/r 08 21 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Talbot Insurance Partners HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9930 Johnnycake Ridge Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Mentor OH 44060 Phone: 440-942-2152 Fax:440-942-2204 INSURERS AFFORDING COVERAGE INSURER A. State Auto Mutual Ins. Co. NAICp INSURED 25135 mbi / k2m .Architecture, Inc. Scott C. Maloney, R.A. INSURER B. -INSURER 2530 Superior Ave #k302 Cleveland OH 44114 INSURER --- ---------- —- -- --- INSURER E 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. - POLICY EFFECTIVE PDLT E IMM RATI N I LTR NSR TYPE OF INSURANCE I POLICY NUMBER DATE MMIDOM') GATE MRVDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 — COMMERCIAL GENF: RAL LIABILITY GENERAL BOP2202233 ' DAMAGE TO RENTED PREMISES (Ea occurence) _ $300000 CLAIMS MADE 0 OCCUR MED E%P(Any one Person) $ 5000 A X 1Business Owners 08/08/07 08/08/08 PERSONAL aADV INJURY $ 1000000 GENERAL AGGREGATE 1 $ 2000000 GEN L AGGREGATE LIMIT APPLIES PER '' PRODUCTS - COMPIOP AGG 1 $ 2000000 f POLICY I PRO JECI' LOC j I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 A ANY AUTO (BOP2202233 08/08/07 08/08/08 (Eaamident) II _. S ALL OWNED AUTO BODILY INJURY $ SCHEDULED AUTOS (Per parson) XI HIRED AUTOS i BODILY INJURY $ X NON -OWNED AUTOS /\�^�f'r.(/ (Psraccitlent) PROPERTY DAMAGE $ • � (Par accitlent) LIABILITY —0 AUTOONLV EAACCIDENT $ _RAGE ANY AUTO V OTHER THAN EA ACC $ -� lT - AUTO ONLY AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ , OCCUR [ CLAIMS MADE �/ ln( ' AGGREGATE $ - -I // qq 4 (DEDUCTIBLE I$_ WORKERS COMPENSATION AIID � R V LIMITS TOER �EL A EMPLOYERS' TOLIABILITY ANY BOP2202233 PROPRNERIE%ECUTIVE 08/08/07 08/08/08 EACH ACCIDENT III s _ 1000000 -- - OFFICER/MEMBER EXCLUDED I 1 F L DISEASE EA EMPLOVEEI $ If yes describe under SPECIAL PROVISIONS below 1- _" - -- -- E. L. DISEASE POLICY LIMIT -- _ $1000000 OTHER IT Monroe Ccvnty DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS _ ,. EyCrommen Certificate Holder is named as Additional Insured. ZdoI Monroe County Attn: Ann M. Riger The Historic Gato Cigar Factor 1100 Simonton St., Suite 2-216 Key 111est FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Yvonne M. Kinnev ACORD 25 (2001108) acoRD- CERTIFICATE OF OP 55 LIABILITY INSURANCE 1Ds 1 D.re IMMDDInnI D4,09,06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PROD.cER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Selvaggio, Teske 6 Associates ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3401 Enterprise Pkwy. Ste. 101 Beachwood OH 44122 INSURERS AFFORDING COVERAGE NAIC # Phone: 216-839-2800 Fax: 216-839-2815 —5054 INSURED wsURERA Hudson Insurance Company _- JT_ _ NPOR L mbi-k2m Architecture, Inc. -- ---' 2530 Superior Ave. Suite 302 i® Cleveland ON 44114 C) INSURERE COVERAGES THE POLICIES OF INSURANCE LISTED BELOWNPVE BEEN ISSVEDTO ILS INSURED NPMEOPRI FOR THE POLICY PERIODWISCA D. NOTMMOTPNDING T„ ANY REQUIREMENT TERM ON CON. iOX OF FNY LOMRRCTOR OTHER WCVMENT VATH RESINECT1,RHISCH IS CERTIFICATE MAYBE ISSUED OR MP VPERTPIN, THE INSURANCE PFFORGEO BY THE POLICIES DE5Cfl0EDHERENS SVBJECTTO ALL 11 TERMS IXCLV50NS AND CONDITIONS OF SUCH -. _.. _... POLICIES AGGREGATE LIMITS SHGMi M1NV HPVEBEEN REDUCED OV PAID<LAIMB.- POLCY E%PIRLMIH PoLICY EFFECTIVE AN O.l pMICV NVNMt .GTE IMM90TI mTE 1MM'DM"YI LIMITS LTR NBWri SE EACH OCCURRENCE b PMPGE rO RENTED OREMISES IEe ouuren/e b �_ LIABILITY i El OCCUR ME. oPIAnYa Plvn_ _ ERsoNUBAov wLUm CLAIMS ' GENERAL AGGREGATE I PPODULrS�COMP/OP AGC _. CENL AGG'DLREGATE LIMIT APPLIES PER'. PROF LEFT Au TOM.PPE LIABIIIn FACIL6fES .EVELOK".ENT COMBINED SINGLE LIMIT b IF .A�CmII Y Auro ANY �DILMY LOVMEDNli05 AI-'2 ;J IN,VRV b 2,,66 IP.I A^ AVTOB -r SCHEDULED ED AUTOS eoOLV rvNRY S ON OVMED AU705 FAGPEROPMPGE A A.-.) _ONLY._ A¢I_r - s ..GE MA III I— ANY A 7 rva EA ADO s TDOHi A PCG 3 C OCCURRENCE —.._ xCE08lUSBRELLA LIAe NTV I` rE G E S b 'rr ]OCCUR �L CWMB MA.E- I Y_ OE. ISLE y RETENTION 3 3 rC PN OTX- WDRNERBPoP9EWrY-0 � P NB ER. EMPLOVERe WB.ITV I CIOE 5 - - - PNV PROER ETOR/PPRTNER/ENECUT VE DISEASE -EAE E 3 OF, CERMEMBER EXCLUDED? _ FEL DISEASE-, S _ aw -- OTHER Liab. AEE7204501 04/13/08 04/13/09 Ea. Claim $3,000,000 A Professional I Aggregate $3,000,000 Claims -Made i DEBCMPTIONOFOPENBTIONS, LOCATgNeI VEHCLIS I BACILLI ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder: Monroe County / Facilities Development Dept. A30 Day Cancellation applies, except for 10-Day Notice for non-payment of premium Monroe County Facilities Development Dept Ann M. Higger-Contractor Admin 1100 Simonton St., Hoom 2-216 Hey West FL 33040 MONR-05 NOTICE AFIYOFTNE"R TOES MBe O MLCIE$OE—N ELLEDBEPONETBEERTON ATE THERBOE THE ISSUING wSURER SALL ENDEAVOR TO MAIL 30 DAYS WRITTEN TO THE CERTIFICATE HOLDERBANNED TO mE LIFT PUT FA.uRE TO DO SO SNALL IMPOSE NOOBDOATON OR LIABILITY BE ANY BIND UPON THE INeURER.OS AGENTS ACORD 25 ACORD CERTIFICATE OF LIABILITY INSURANCE OF ID PC DATE(MMDDIYYYY) MBIK2 1 07 09 08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Selvaggio, Teske 6 Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3401 Enterprise Pkwy. Ste. 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beachwood OH 44122 Phone:216-839-2800 Fax:216-839-2815 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A'. Hudson Insurance Company25054 INSURER B'. mbi-k2m Architecture, Inc. INSURERC, 2530 Superior Ave. Suite 302 INSURER D: Cleveland OH 44114 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 IRNUSUR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMOD/YY POLICY DATE MMDDfY EXPIRATION LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE $ PREMISES Ea occurence $ MED EXP (Any one person) $ PERSONAL A ADV INJURY $ GENERAL AGGREGATE $ GEHL AGGREGATE LIMIT APPLIES PER. PRO LOC POLICY O- PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOE HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO 1/ y1 I I AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ /`L I` EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/E KECUTIVE OFFICER/MEMBER EXCLUDED':' If yes, describe under SPECIAL PROVISIONS below TORV LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A OTHER Professional Liab. Claims -Made AEE7204501 I 04/13/08 I 04/13/09 I Ea. Claim $3,000,000 I Aggregate $3 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION MONR-06 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Monroe County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Ann Riger 1100 Simonton St., IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Key est FL 33040 REPRESENTATIVES. AUTMORQ REPRESENTATIVE G G1 1"C&I AL:URU ZO (ZUUT/U8) — -- — I - 9 AGORO CORPORATION 788H ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID PC DATE(MIODIWYY) 1 NBI&2-1 07 09 08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Selvaggio, Teske 6 Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3401 Enterprise Pkwy. Ste. 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beachwood OR 44122 Phone:216-839-2800 Fax:216-839-2815 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hudson Insurance Company 25054 INSURER B: INSURERQ mbi-k2m Architecture, Inc. 2530 superior Ave. Suite 302 Cleveland OH 44114 INSUflER D: INSUflER E: 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 CONTRACTOR OTHER DOCUMENT W ITH 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MWDDIYY DATE MWDD/Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES (Ea occurence) $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR R'!Ofl!C'; � �""1�' MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ {'.�._ -. - -- POLICY PRO JECT r7 LOC AUTOMOBILE LIABILITY`" ANY AUTOh -- p�. ---` —._.— COMBINED SINGLE LIMIT (Eaacddent) IS BODILY INJURY (Per person) $ ALL OW NED AUl'OS SCHEDULED AUTOS BODILY awdent) (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR []CLAIMS MADE `(�I AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ 1 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I TORYLIMITS I I ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERJEXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? EXCLUDED? Ups . describe antler E.L. DISEASE- POLICY LIMIT $ SCIAL PROVISIONS beloer OTHER A Professional Liab. AEE7204501 04/13/08 04/13/09 Ea. Claim $3,000,000 Claims -Made Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I (LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Monroe County Attn: Ann Riger 1100 Simonton St., Key/West FL 33040 G G 25 (2001/08) MONR-06 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAR 30 DAYS WRITTEN 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. DATE (MMIDD/YYYY) C ,ae n OP ID YK CERTIFICATE OF LIABILITY INSURANCE K2M DESl 08/04/08 !1N Talbot Insurance Partners 9930 Johnnycake Ridge Rd., #51B Mentor OH 44060 Phone:440-942-2152 Fax:440-942-2204 MBI / X2M Architecture, Inc. Scott C. Maloney, R.A. 2530. Superior Ave., #302 Cleveland OH 44114 ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AME ALTER THE COVERAGE AFFORDED BY THE OR INSURERS AFFORDING COVERAGE NAIC # INSURER A State Auto MatuatcSW ---CO _+ 25135_. . INSURER B. ~ INSURER C INSURER INSURER E COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR E ROCICYFtK.UU INUI� I PO qCrMITHSTANDING THE POLICIES OF INSURANCE OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND -CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -- ? - - - -_--' ' -'- -- - i POLICY EFFECTIVE POLICY EXPIRATION �A! j POLICY NUMBER DATE MMIDDIVV DATE MMIDDIYY NSR DD'C LIMITS LTR INSRtl OF EACH OCCURRENCE $1000000 GENERAL LIABILITY- COMMERCIAL GENERALTYPE LIABILITY .I BOP2202233 05 08/08/OB 08/08/09 DAMAGr=r(E o E� �REMIses (E occureM $ 300000 1 1 A CLAIMS MADE OCCUR MED EXP (Any one Person) I$1000000 $ 5000 �S1ne65 PERSONAL& ADV INJURY X B O�ner5 I — _ -i GENERAL AGGREGATE $ 2000000 _--- " _— - GENT AGGREGATE LIMIT APPLIES PER rpRODUCTS COMP/OP AGG _-�. -- $ 2000000 --- _- -- h, _—] PRO- I POLICY I JEGT LOC AUTOMOBILE A LIABILITY COMBINED SINGLE LIMB I $ 1000000 (Ea accident) 1 ANY Au ro - IALLOWNEDAUTOS BODILY INJURY I$ (Per Person) SCHEDULED Auros III BOP2202233 05 08/08/08 ! 08/08/09 1BoLYIent) BODILY RY $ HIRED Auros (Par ac Itlen[) X NON OWNED AUTOS __ -------- PROPERTY DAMAGE $ (Peraccitlent) + GA RAGELIABILITY AUTOON LV-EA ACCIDENT $ -- - j._. ANY AUTO �'. `' OTHER THAN EA ACC AUTO ONLY AGO $ - EACH OCCURRENCE $ EXCESS/UMBRELLA LIABILITY F CLAIMS MADE AGGREGATE $ :OCCUR l DEDUCTIBLE $ RETENTION $ �+ TORY LIMITS I ER WORKERS COMPENSATION AND EMPLOYERSLIABILITY BOP2202233 05 08 /G8/081 08/08/09 _ _L EL. EACH ACCIDENT I _ $1000000 — _ - AA IY PRD RI T; R/P4 TIE .F%611T;\'F - EL DISEASE EA EMPLOYES IDODDDD I IM1 EGIB EI..IUI: L4 y Ue cribeu tl r L DISEASE -POLICY LIMIT $ IOOOOOO SPECIAL PRC ISIO S b F -� OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder is named as Additional Insured. Monroe County Attn: Ann M. Riger The Historic Gato Cigar Factor 1100 Simonton St., Suite 2-216 Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 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. _ ACORD,� CERTIFICATE OF LIABILITY INSURANCE OP ID PC DATE CERTIFICATE PRODUCER MBIK2-1 04 21 09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Selves ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ggio, Teske � Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3401 Enterprise Pkwy. Ste. 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beachwood OH 44122 Phone: 216-839-2800 Fax: 216-839-2815 INSURERS AFFORDING COVERAGE INSURED NAIC INSURER A: Hudson Insurance Company 25054 INSURER B: 2530k2a Aro;hitecture, Inc, INSURERC: C530 SU�ndrOH 441r4 suite 302 INSURER D: INSURER E: 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 N TYPE OF INSURANCE POLICY NUMBER nwx _-E _-_____ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE f OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JECT F—I LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY 7 ANY AUTO EXCESS/UMBRELLA LIABILITY —1 OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If Y88, describe under SPECIAL PROVISIONS below OTHER A lPrOfessional Liab. I AEE7204502 Claims -Made LIMITS EACH OCCURRENCE $ PREMISES Ea occurence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ $ $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ $3,000,000 "`- mr 1 Rn or OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS re ate y43 000,000 Certificate Holder: Monroe County *30 Day Cancellation applies, except for 10-Day Notice for non-payment ofonr0 �. premium. ..,aUntt F CERTIFICATE HOLDER MONR-04 Monroe County Attn: Paulette Harper 1100 Simonton Street Key West FL 33040 04/13/091 04/13/10 Ea. Claim APR 009 CANCELLATION SHOULD ANY OF THE ABOVE DEWWWV 041I Vp `C E EXPIRATK) DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO A�AICA ..PAYS yyRlTrEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AWRD 25 (2001108) 1988 A ORNt?,. CERTIFICATE OF LIABILITY INSURANCE OP ID YR OATE(MWDD/YYYy) PRODUCER D$S1 08 26 09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Talbot Insurance Partners ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9930 Johnnycake Ridge Rd., #5B ALTER THE COVERAGER. TH13 CERTIFICATE F RDED BOY THE POLICIES ES BELOW. Mentor OH 44060 Phone: 440-942-2152 Fax: 440-942-2204 INSURERS AFFORDING COVERAGE INSURED NAIC M INSURER A: State Auto Nbtual Ins. Co. 25135 NEI K2M Architecture, Inc. INSURERS: Scot C. Maloney, R.A. INSURERC: 3121 Bridge Avenue Cleveland OH 44113 INSURER D: S COVERAGES INURER E: 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 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AND CONOITIONS OF SUCH LTR TYPE OF INSURANCE POLICY NUMBER Tr OENERAL LIABILITY LIMITS A COMMERCIAL GENERAL LIABILITY BOP2202233 06 EACH OCCURRENCE 08/08/09 08/08/10 CLAIMS MAOE OCCUR PREMISS En e $ 300000Q 2 Business OMnera MED EXP (Any one person;) $5000 PERSONAL 6 ADV INJURY $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 320 QQ000 POLICY JECT LOC PRODUCTS -COMP/OP AGG $2000OQO AUTOMOBILE LUML17Y ANY AUTO COMBINED SINGLE LIMIT :lOOOOOO Me accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY i A $ HIRED AUTOS SOP2202233 06 (Per person) 08/ /0 08/08/10 a NON -OWNED AUTOS BODILY INJURY : (Per accident) PROPERTY DAMAGE : (Peraoddent) cARAOE LusuTY < ANY AUTO AUTO ONLY - EA ACCIDENT S i OTHER THAN EA ACC $ EXCIE70BRELLA LIABLITY AUTO ONLY: AGG S OCCUR CLAIMS MADE EACH OCCURRENCE i AGGREGATE i DEDUCTIBLE $ RETENTION i $ WORKERS COMPENSATION AND : A EMPLOYERS' LIABILITY ANY PROPRIEBERIPXCLUDE/EXECUTIVE BOP2202233 06 TORY LIMITS ER 08/08/09 08/08/10 E.L. OFFICER/MEMBER EXCLUDED? EACH ACCIDENT $ 1000000 H yea, describe under SPECIAL PROVISIONS below E.L. DISEASE - EA EMPLOYEE 51000000 OTHER E.L. DISEASE -POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder is named as Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DMIIEBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County Board Of DATE THERW THE ISSUNG INSURER WILL ENDEAVOR TO MAIL 3O DAYS ww TEN County Comnisaioaers . NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO OO so SHALL The Historic Gato Cigar ractor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER 1100 Simonton St., Suite 1-213 ITS AGENTS OR R0RE3ENTATNES. Key meat FL 33040 AUTMORnD REwel ENTAME ACORD 25 (2001/08) Yvonne M. Kinne ®ACOR N 1988 ,.. DATE (MMIDDIYYYIf) • oRCERTIFICATE OF LIABILITY INSURAN OP IDssC MSIK2-1 11/20/09 PRODUCER Selvaggio, Teske &Associates THIS CERTIFICATE IS ISSUED AS A MANTER ONLY AND CONFERS NO RIGHTS UPO THE F INFORMATION HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3401 Enterprise Pkwy. Ste. 101 Beachwood OH 44122 Phone: 216-839-2800 Fax: 216-839-2815 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Hartford Casualty Ins • CO • 29424 INSURER B: Hudson Insurance Company 25054 INSURED INSURER C: mbl-k2m Architecture, Inc. INSURER D: Spectrum Design Services Inc. 3121 Bridge Avenue Cleveland OH 44113 INSURER E: 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. POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSR ADDL POLICY NUMBER DATE (MMIDDIYYYY) DATE (MMIDD/YYYY) LTR INSRD TYPE OF INSURANCE EACH OCCURRENCE $ 1,000,000 GENERAL LIABILITY 09/14/09 09/14/10 DAMAGE TO RENTED PREMISES (Ea occurence) $ 1000000 i � A X COMMERCIAL GENERAL LIABILITY 4 5 SBAI07 0 0 8 MED EXP (Any one person) $ 10,000 CLAIMS MADE � OCCUR 1,000,000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY X JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 45SBAI07008 09/14/09 09/14/10 (Ea accident) pj ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) _Q AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY �� 5 EA ACC $ i ANY AUTO OTHER THAN L AUTO ONLY: AGG $ 1 EACH OCCURRENCE $ 11000,000 EXCESS I UMBRELLA LIABILITY 45SRAI07008 09/14/09 09/14/10 ❑ AGGREGATE $ 1,000,000 OCCUR CLAIMS MADE A :x::] EXCLUDES $ PROFESS. $ DEDUCTIBLE FX_RETENTION $ 10 , 0 0 O WC STATU- OTH- WORKERS COMPENSATION TORY LIMITS X ER AND EMPLOYERS' LIABILITY Y / N 4 5SBAI07 0 08 0 9/ 14 / 0 9 09/14/10 E.L. EACH ACCIDENT $ 1000000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? OHIO STOP GAP E.L. DISEASE - EA EMPLOYEE $ 1000000 (Mandatory in NH) 1000000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER AEE7204502 04/13/09 04/13/10 Ea Claim $31000,000 B Professional Liab Aggregate $3,000,000 Claims -Made DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder and Additional Insured on all policies except Work Comp and Professional Liability, as required by contract. *30 Day Cancellation applies, except for 10-Day Notice for non-payment of premium CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MONR— 0 4 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Monroe County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Board of County Commissioners REPRESENTATIVES. 1100 Simonton street Monroe Cmnt� AUTHORIZED RE ENTATIVE Key West FL 33040ey Fw 0 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/01 ) The ACrVna41�0 are registered marks of ACORD RECE!VFD BY, Ct7Rl�® CERTIFICATE OF LIABILITY OPIDss DATE (MM1DD/YYYY) PRO1111 MBIK2-1 04/16/10 Iselvaggio, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Teske &As Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3 4 O1 Enterprise Pkwy. s to HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND . 101 ALTER THE COVERAGE AFFORDED BY THE POLICES BE Beachwood OH 44122 OR W. Phone: 216 - 8 3 9 - 2 8 0 0 Fax: 216 - 8 3 9 - 2 815 INSURERS AFFORDING COVERAGE ' '" 'GE NAIC # INSURER A: Hartford Casualty Ins. Co. 29424 mbi -k2m Architecture, Inc. INSURER B: Hudson Insurance Company 25054 Spectrum Design Services Inc. INSURERC: 3121 Bridge Avenue Cleveland OH 44113 INSURER D: COVERAGES INSURER E: 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. INSR DO'L ___7DATE LTR NSRO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION (MM1DD/YYYY) DATE (MMIDDIYYYY) LIMITS GENERAL LIABILITY A X COMMERCIAL EACH OCCURRENCE $ 1,000,000 GENERAL LIABILITY 4 5 S BAI07 0 0 8 0 9/ 14 / 0 9 09/14/10 DAMAGE TO RENTE---:::D CLAIMS MADE X OCCUR PREMISES (Ea occurence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENFRAL AGGREGATE s 2,000, 0 o o PRO- -7 POLICY FX1 JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABIUTY ANYAUTO 45SBAI07008 09/14/09 COMBINED SINGLE LIMIT 09/14/10 (Ea accident) $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS � BODILY INJURY (Per person) $ X HIRED AUTOS X I NON -OWNED AUTOS _ BODILY INJURY (Per accident) $ H/ PROPERTY DAMAGE GARAGE LIABILITY ANY AUTO (Per accident) $ $ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG $ E EXCESS I UMBRELLA LIABILITY A IX OCCUR EACH OCCURRENCE $ 1,000,000 CLr41MSMADE 45SBAI07008 09/14/09 09/14/10 AGGREGATE $ 1, 000, 0004 DEDUCTIBLE EXCLUDES $ PROFESS. $ i X RETENTION $ 10 , 0 0 0 1 WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y / N WC STATU- OTH- TORY LIMITS X ! A ANY PROPRIETOR/PARTNER/EXECUTIVE 4 5SBAI07 0 0 8 OFFICER/MEMBER EXCLUDEDD$ ER 09/14/09 0 9 / 14 /E.L.ACCIDENT 10 ELEACH ' (Mandatory in NH) OHIO STOP GAP . AC 10 0 0 0 0 0 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - EA EMPLOYEE $ 1000000 OTiI R E.L. DISEASE - POLICY LIMIT �~ + $ 1000000 B Professional Liab AEE7204503 04/13/10 04/13/11 Ea Claim $310001000 Claims -Made ;c DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Aggregate $ 3 , 0 0 0 , 0 0 Certificate Holder and Additional Insured on all policies except Work Comp and Professional Liabilit:y:Monroe County / Historic Gato Cigar Factory *30 Day Cancellation applies, except for 10-Da Notice for non-payment pp p y p yment of premium r C:tK IIFIGATE HOLDER v/1��Vt�tI�LI'111VI1 13 C4%%j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MONR — 0 6 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 D C Monroe County Board of County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 0 TT '} Commissioners, The Historic Gato Cigar FactoryIMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE: INSURER, ITS AGENTS OR 1100 Simonton St., # 1- 213 REPRESENTATIVES. Key West FL 33040 AUTHORIZED REPRE ENTATIVE 1CORD 25 (2009/01) 1988-2009 ACORD CORPORRTION. All rights reserved. The ACORD name and logo are registered marks of ACORD A4 CERTIFICATE OF LIABILITY INSURANCE D►TSIMMIDDIff " 9/13"2012 THIS CERTIFICATE M 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 IMPORTANT: If the certificate holder Is an ADD NAL I ) must endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain licies may require an endorsement A temant on this certificate does not cornier rights to the certificate holder In lieu of such endo s PnooucaR CofffACT Pal Cholawa 3TA, a Division of Oswald Companies S E P `� 'r NB PAX -815 3401 Enterprise Parkway, Suite 101 .MAIL NO 3eachwood OH 44122 MONROE CO INBURERISI APPORDIMO COVERAGE MAW a INSURED mbi-k2m Architecture, Inc. 3pectr Bridge �Design Services Ina3121 ue Cleveland0H 44113 MBIK2-1 F COVERAGES CERTIFICATE MIIYRFR• n4 oA40000 MMP MI^M onuses. 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. LN TYPE OF WOURANC! POLICY NUMBER EFF POLICY EXP XVYYM LIM" GENERAL LUIBILTTY Y Y 45SEW07WS IV14=2 14/2013 EACH OCCURRENCE $1 000 000 DAMAGE TO 901TRIT- MED EXP one i1 000 000 COMMERCIAL GENERAL LIABILITY CLAMS -MADE OCCUR Al Primary a AP DArE lid, $10 000 PERSONAL a AM MrJURY $1 000 000 oWbutM GENERAL AGGREGATE $000 OW W — GEML AGGREGATE LIMIT APPLIES PER: POLICY X PR4 LOC PRODUCTS - COMPIW AGG $2 000 000 f AUTOMOBILE LIABLITY Y 45SBA107008 1412012 4/2013 000 000 s ANY AUTO BODILY INJURY (Por Person) ALL ED BODILY INJURY O'er iO3UTOS NON OVSCHEDNiED HIRED AUTOS R PERTY EI occkforM S Al Pri mry UMBRELLA Me X OCCUR Y Y 45SBA107008 D11412012 V14=3 NCH OCCURRENCE $1.000,000 AGGREGATE $1000,000 EXCESS LIAR CLAIMS -MADE DEO IX I RETENTION 10 000 Exdudss ProleMional i WORKERS COMPENSATION EMPLOYERS' LIABILITY Y / N ANY PROPRIETORA'ARTNERID(ECUTIVE OFFICERAIEMBER EXCLUDED4 N❑ N / A Y 65SBAIO7008 911412012 14/2013 MSTATU- EACH ACCIDENT OH -STOP GAPAND $1000 000 DISEASE - EA EMPLO i1 000 000 (MyYocne In N DEeCRIPTION OF OPERATIONS bNow rE-LDISEASE - POLICY LMR $1 000 000 B Praleaknal LWWIIty Clalma Made Reim Date: W1/2001 N Y EE7204505 1312012 3/2013 h Clelrn $3.000.000 repefa $3,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHIC (Mheh ACORD 11M. AddMona Rsrserks sdwMe, N more spoce Is regW oM Additional Insured and Waiver of Subrogation as designated above is provided when required of the Named Insured by written contract or agreement. Monroe County Board of County Commissioners 1100 Simonton Street Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1088.2010 ACORn CI7RPORATI1nN All rinh}a roaarvarl ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD . li. l J® CERTIFICATE OF LIABILITY INSURANCEF411212'013 MMI DATE D/YYYY) 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 endorsements . PRODUCER Oswald Companies 3401 Enterprise Parkway, Suite 101 Beachwood OH 44122 NTA T NAE: M Patricia Cholewa PHFAX ONE - - A/C No):216-839-2815 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N e-- INSURER A:HartfOrd Casualty Ins, Co. 29424 INSURED rj INSURER B:Hudson Specialty Insurance Co. 25054 , mbi-k2m Architecture, Inc. CP �� Spectrum Design Services Inc. 3121 Bridge Avenue Cleveland OH 44113 INSURER C : INSURER D : INSURERE: INSURER F : 'C COVERAGES CERTIF)CA MBER: 293152640 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES PfF,,4NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY SIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR , ,RTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR UBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y 45SBA107008 /14/2012 /14/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEff___ PREMISES Ea occurrence $1,000,000 CLAIMS -MADE a OCCUR AP NA EMENT MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 X Al Primary & BDA X Non -Contributory GENERAL AGGREGATE $2,000,000 W GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY X PRO- X LOC JECTA AUTOMOBILE LIABILITY Y Y 45SBA107008 /14/2012 /14/2013 COMBINED SINCEETRMT— Ea accident) $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident)$ NON -OWNED HIRED AUTOS X AUTOS X $ Al Primary A X UMBRELLA LIAB X OCCUR Y 45SBA107008 /14/2012 /14/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION$10,000 Excludes Professional $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N / A Y 45SBA107008 /14/2012 /14/2013 WC STATU- X OTH- OH -STOP GAP E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000 N yes, describe under DESCRIPTION OF OPERATIONS tw1ow E.L. DISEASE - POLICY LIMIT $1,000,000 B Professional Liabil;t�' N Y _ AEE7204506 /13/2013 /13/2014 Each Claim $3,000,000 Claims Made Aggregate $3,000,000 Retro, Date: 9/1/2001 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Additional Insured and Waiver of Subrogation as designated above is provided when required of the Named Insured by written contract or agreement. Monroe County Board of County Commissioners 1100 Simonton Street Key West FL 33040 «. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 4 tHUMA Ca re Het Restae,res Rak ME"- - Benefits 9501 UNION CEMETERY ROAD LOVELAND, OH 45140 PHONE (513) 605-3522 FAX (513) 605-3523 MBI/K2M ARCHITECTURAL and HUMACare, Inc.- Consolidated Employee Management have entered into a co -employer / PEO relationship in which HUMACare Inc. assumes workers' compensation liability under the certificate attached. Questions regarding the certificate and/or the liability relationship should be directed to the Risk Management Department, 513-605-3522. Bureau of Workers' Ohio Compensation 30 s, OHSpring3 15 Columbus, OH 43215 Certificate of Premium Payment This certifies the employer listed below has paid into the Ohio State Insurance Fund as required by law. Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. For more information, call 1-800-OHIOBWC. This certificate must be conspicuously posted. Policy No. and Employer Period Specified Below 1349248 ohiobwacom HUMACARE 9501 UNION LOVELAND, "" 013 Thru 8/31l2013 MGT INC You can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation Required Posting Effective Oct. 13, 2004, Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work -related injury. The burden of proof is on the employee to prove the presence of alcohol or a controlled substance was not the proximate cause of the work -related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. OhioI Bureau of Compensation p Workers' You must post Unip"*oft mtkare of promhrn pw1awt ��JJ A�OR 16CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 9/17/2014 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 endorsements . PRODUCER The James B. Oswald Company 1100 Superior Avenue, Suite 1500 Cleveland OH 44114 NT CT NAME: PHONE (FAX,No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A INSURED MBIK2-1 B: L Specialty Insurance Co. 37 -INSURER INSURER C : K2M Design INSURER D : 1001 Whitehead St., Suite 101 Key West FL 33040-7522 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1228904447 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 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED PREMISES Ea occurrence) ccurrence $1,000,000 MED EXP (Any one person) $10,000 CLAIMS -MADE IT] OCCUR PERSONAL & ADV INJURY $1,000,000 X Al Primary & X Non -Contributory GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY X PRO- X LOC A AUTOMOBILE LIABILITY Y 45SBA107008 /14/2014 /14/2015 ED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS X AUTOS X $ Al Primary A X UMBRELLA LIAB X OCCUR Y Y 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION$10,000 Excludes Professional $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A Y 5SBA107008 /14/2014 /14/2015 O STIMIT X OTH- OH -STOP GAP E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT $1.000.000 If yes, describe under DESCRIPTION OF OPERATIONS below B Professional Liability Claims Made N Y PR9716562 /12/2014 /12/2015 Each Claim $3,000,000 Aggregate $3,000,000 Retro Date: 9/1/2001 Pollution & Envir. Liab. Included DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Additional Insured and Waiver of Subrogation as designated above is provided when required of the Named Inr",'%r tten contract or agreement. t Belle. Project: Mk-13142 Monroe ADA Segment 1 & 2 c �Cjies Monroe County Board of County Commissioners is an additional insured as noted above. B PRO GEMENT DA �.. WA CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County CommissioneZ :8 N� ?IiCC�04i11QE7WITH THE POLICY PROVISIONS. Attn: Ann Riger v UU�IUU�6 1100 Simonton Street, Room 2-216 y�J H AffESENTATIVE Key West FL 33040 i��l�� U tji ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD it, L�J 0 a E M C 0 C z a° W) N m C" m c� W9 w a N U*) barn O W U O B ff_ IF O �i ;i� A`��'�® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/17/2014 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 endorsements . PRODUCER The James B. Oswald Company 1100 Superior Avenue, Suite 1500 Cleveland OH 44114 NAME:Patricia Cholewa PHONE FAIL - - A/C No): EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC p INSURER A:HartfOrd Casualty Ins, Co. 29424 INSURED MBIK2-1 INSURER B :XL SpeciaU Insurance Co. 37 INSURER C : K2M Design 1001 Whitehead St., Suite 101 Key West FL 33040-7522 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1549223551 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 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 LTR TYPE OF INSURANCE ADDL IN R SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 MMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 4XA01Primary DAMAGE TORENTED PREMISES Eaoccurrence $1,000,000 MED EXP An one person $10,000 PERSONAL & ADV INJURY $1,000,000 & X Non -Contributory GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ X POLICY X PRO- JECT LOC A AUTOMOBILE LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS X AUTOS X $ Al Primary A X UMBRELLA LIAB X OCCUR YY 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION $10,000 Excludes Professional $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A Y 5SBA107008 /14/2014 /14/2015 WC LIMIT X OTH- ER OH -STOP GAP E.L. EACH ACCIDENT $1,000,000 (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 Professional Liability N Y PR9716562 /12/2014 /12/2015 Each Claim $3,000,000 Claims Made Aggregate $3,000,000 Retro Date: 9/1/2001 Pollution & Envir. Liab. Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Additional Insured and Waiver of Subrogation as designated abnuei&pLRyj . d when rAa-(JO Z14he Named Insured by written contractor agreement. 3WIi Marathon Airport Customs and Border. Mk-13008 NAIGEMENT ;uawdOIaA0 Sa IIOt WAI N/ A4unoD eO)uo lh aiilliL�fG11 �ti iiLet l 3- hG1►I"a III AGiILq G Monroe County Attn Ann M. Riger 1100 Simonton Street, Room 2-216 Key West FL 33040 SHOULD ANY OF THE•ABMAORBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDRE►RESENTAT77E -- '--- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD �2 N N sty N (nO « w m m UCD = O 0 m C p d O O7 ` m V Q L C a y�• o ;O: In = 4m+ At r Mi r Y O L o a li r. '�• N oc V H a�i m CL d o d o b. z 0 s N ® r m > � ■ p•l w mPC a O m O C E r 0 z U) rl 0 N CD N N O 5 a E. ■-1 O N .-/ O n O O w E a P6 0 % n N M Wao C N } �Do b4 m m a m' ti u c, i � t> c.� � ii •� � � m_ � Q m0 m an0 aE > � O Q .0 = m 'j2 wp Ly t !6 Gml . O. vO >Z Om m n m m S O r W U • ° > oq .E a • O OFm G = m p+ N E Q. p c m m a 0� °Q.ao- w m E E , In W O m c O � � O .Q O •L � . y,. ' 'O F'�CD Cr-_ Q c m a d tlJ .•— � .Q d) m,L L (q m W E O.6 O O r r m OD e ►Ae6Rb1 CERTIFICATE OF LIABILITY INSURANCEF9/17/2014 DATE(MM/DD/YYYY) 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 endorsements . PRODUCERNT The James B. Oswald Company 1100 Superior Avenue, Suite 1500 Cleveland OH 44114 CT NAME: Patricia Cholewa PHONE (FAX Extia216-839-9807 A/C. No . E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC p INSURER A INSURED MBIK2-1 INSURER B:XL Specialty Insurance INSURER C : K2M Design 1001 Whitehead St., Suite 101 Key West FL 33040-7522 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1315562623 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 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY Y Y 45SBA107008 /14/2014 /14/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 CLAIMS -MADE a OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 X Al Primary & X Non -Contributory GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY PRO- X LOC JECT $ A AUTOMOBILE LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 BIN D 5INGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X AUTOS NON -OWNED Peer accident) PERTY DAMAGE $ X $ Al Primary A X UMBRELLA LIAB X OCCUR YY 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DIED X I RETENTION $10,000 Excludes Professional $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I N / A y 45SBA107008 /14/2014 /14/2015 WC STATU- X OTH- DRY LIMANY OH -STOP GAP E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B Professional Liability N Y /12/2014 /12/2015 Each Claim $3,000,000 Claims Made r562 Aggregate $3,000,000 Retro Date: 9/1/2001 Pollution & Envir. Liab. Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) oee'Q�Op / Additional Insured and Waiver of Subrogation as designated above is provided when required of the Nared b ritten contract or agreement. Project: Mk-13082 Marathon Sewer Connections Monroe County Board of County Commissioners is an noted above. GQr ,- Aaddi'onal GEMENT o. DW AJ 1aKI If It Al t NULUtK GANGtLLAI1UN Monroe County Board of County Commissioners Attn:Ann M. Riger 1100 Simonton Street Room 2-216 Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLI(gZP4W19IQNS.7130 big go AUTHORIZED REPRESENTATIVE r Q ,4 �� 8 8 0 J 0 311 i Zoe u ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD i LsJ Ln 0 N co N N O a F a O N 0 h O C E a c r •a o m Qaa N W) bG O% w] C O d 'D Cmtwl CD a a. 6 r � m O W E W 0 = as m�rm� =Moo= t = «+"iigoW m� cWi t (D O Q m m r V V O G m E a o � x O 0 3 c-E� m m i �p M ia� Q O Q m o a °� fl 3 " 0 ID 30 o o coi m R E E O .� Tr � O m Q wi Yi .0 := CN V U O! ' D `L r m = m m (h 0 W m 2 O 78 G $ E 2 0 '$ w C) m «MY c W o m -oo`te c �Wamm3 W �E.e = o �r o � r r W ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM(Yl) 6/12/2015 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 endorsements . PRODUCERNT The James B. Oswald Company 1100 Superior Avenue, Suite 1500 Cleveland OH 44114 CT NAME: PHONE aC No EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:Hartford Casualty Ins. Co. 29424 INSURED MBIK2-1 INSURER B:XL Specialty Insurance Co. 37 INSURER C : K2M Design 1001 Whitehead St., Suite 101 Key West FL 33040-7522 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 119282432 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 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 LTR TYPE OF INSURANCE ADDL IN R SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence)$1,000,000 CLAIMS -MADE � OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 X Al Primary & X Non -Contributory GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- X LOC $ A AUTOMOBILE LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 COMBINED SINGLE Lill T Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS X $ Al Primary A X UMBRELLA LIAB X OCCUR Y Y 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DIED I X I RETENTION$10,000 Excludes Professional $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NCRY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ N I A y 45SBA107008 /14/2014 /14/2015 WC STATU- X OTH- LIM OH -STOP GAP E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B Professional Liability N Y DPR9724441 /12/2015 /12/2016 Each Claim $3,000,000 Claims Made Retro Date: 9/1/2001 Aggregate $3,000,000 Pollution & Envir. Liab. Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Additional Insured and Waiver of Subrogation as designated above is provided when required of the Named Insure written contract or agreement. Project: Mk-13082 Marathon Sewer Connections p PRO Monroe County Board of County Commissioners is an additional insured as noted above. R EMENT 4DA W / CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Ann M. Riger 1100 Simonton Street Room 2-216 AUTHORIZED REPRESENTATIVE Key West FL 33040 � � � .�� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ® CERTIFICATE OF LIABILITY INSURANCE G/D'TE(MM/DD/YYYY) 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 The James B. Oswald Company 1100 Superior Avenue, Suite 1500 Cleveland OH 44114 INSURED K2M Design 1001 Whitehead St., Suite 101 Key West FL 33040-7522 MBIK2-1 INSURER C : INSURER F : COVERAGES CERTIFICATE NUMBER: 1447290111 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 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PR M SESOEa occurrence) $1,000,000 CLAIMS 1XI -MADE OCCUR MED EXP (Any one person) $10,000 PERSONALS ADV INJURY $1,000,000 X Al Primary & X Non -Contributory GENERAL AGGREGATE $2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO-JECT X LOC $ A AUTOMOBILE LIABILITY Y Y 45SBA107008 /14/2014 /14/2015 Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ X NON -OWNED HIRED AUTOS q AUTOS PROPERTY DAMAGE Per accident $ X $ Al Primary A X UMBRELLA LIAB X OCCUR Y Y 45SBA107008 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10,000 Excludes Professional $ A WORKERS COMPENSATION y 45SBA107008 /14/2014 /14/2015 WC STATU- X OTH- Eg OH -STOP GAP AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN ] N / A E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, descr be under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B Professional Liability N Y DPR9724443 /12/2015 /12/2016 Each Claim $3,000,000 Claims Made Aggregate $3,000,000 Retro Date: 9/1/2001 Pollution & Envir. Liab. Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured and Waiver of Subrogation as designated above is provided when required of the Yam Ins d y written contract or agreement. Marathon Airport Customs and Border. Mk-13008 BY EMENT WAI A Monroe County Attn Ann M. Riger 1100 Simonton Street, Room 2-216 Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 444 , Z$f I,mit, ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD o IDIRA ` CERTIFICATE OF LIABILITY INSURANCE 6/112/2ArE 0 WDWYYYI A1� 5 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: N the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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( -A). CONTACT PRODUCER RAMS: 2aMcia_Cft01Bwa the James B. Oswald Company FAX �.No,Flnr2%439:2W7 . LAB ".i_- i 100 Superior Avenue. Suite 1500 E40A1L ;leveland OH 44114 APWh,%RChQJma@Rswaldc=panie;zGom _ WSURERM AFFORDING COVERAGE NAIC N' INSURED MBIK2-1 INSURER B' L_Spee(aity Ingur nae C0- _ t K2M Design «suRER c: 1001 Whitehead St. Suite 101 ,,,!,MR D : Key West FL 33040-7522 INSURER E : _ INSURER F : .ter waaocn.. RFVLSInN NUMBER, w V crvav— �..... �... .. _�._ _. _ ...,..v..w� 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 UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TVTYPE LTR . OF INSURANCE POLICY N1NaBER i rOUC' EW POLICY EXP LVAITS • GENERAL LIABILITY Y Y '45S8AI07000 �114QO14 51/4Im15 ; c CHOCCURRENCE 51.0W.000 07>Q't`TtTf&NYE0 PREMISES Es ac annca S1,000.000 _ X COMMEROAL GENERAL L"UTY I "EDEXP ony or* swd S10.000 CLAIMS -MADE X OCCUR PERSONAL 6 ADV INJURY S1.000.000 X Al Pt mwy 3 GENERALAGGREGATE $2,OW.000 X NnN-Cat Y PRODUCTS COMPOP AGG S2.000.000 �j Gm AGGREGATE DIRT APPLIES PER t f PAY 1" i m X LOC € E 1 5 A AUTOMOBILE LIABILITY Y Y 45SBA107000 4114f2014 W1412015 A ISt000000 SOMY INJURY (Par Pylon) L S ( ANY AUTO ,ALL Dt DULED AUTOS � XHHIRED AUTOS AI Psray 'X BODILY AY INAW (Pa8=i0m);'I S PROPERTY DAMAGE SS • iX I twON3.LA LIAR OCCUR Y Y 45SBA107005 911412014 9/1412015 OCCURRENCE $1,000 000 6 A��GGREGA--TEE : SIA00 000 HEXCESS UAB CLAIMSMADE N Exdudes ProMS51" 1 STATIY ;)( O N IS OH -STOP GAP OW X IRETEIt:tON510.000 i A WORROM COMPENSATION y 45SBA10700a 81142014 ,'11412015 AND EMPLOYERS' LIABILITYYIN ANY PROPRIETORNPARTNERlEXECt1rIVE N 1 NIA OFFIn ► q EXCLUDED? El EACH ACCIOENi S1,000.000 E L DISEASE - EA EMPLOYE S1,000.000 E.l. DISEASE - POLICY LIMT S1,000.000 yyeess pOE.SCRtPTION OPERATIONS Celm B Prdessional Liability N Y CClaims Made { Rehm Date: 9lt2001 DPR9724443 I fi1122015 6IIZ2016 Each Claim S3000.000 P�o((gl n S EMV4 Liao. Included 1 S3 000.000 DEWRW71ON OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Addlbml Raeatks SeMOW. IT mac IPaee K t.nalr•d► Additional Insured and Waiver of Subrogation as designated above is provided when required of the Named Insured by written contract or agreement. Project- Mk-13082 Marathon Sewer Connections APPRO pp Monroe County Board of County Commissioners is an additional insured as noted above W /A ._ b 7 ti h1N+,IIOJ`30d 1 7 'm -Nl1 Monroe County Board of County Commissioners Attn:Ann M. Riger 1100 Simonton Street Room 216 Key West FL I 33040 Nd L ! NfT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Q 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACURu DATE O&NDDIYYYY) �0R ® CERTIFICATE 4F LIABILITY INSURANCE 6/12/2015 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(IOS) must be endorsed. It 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 endorsements) PRODUCERPHONE NAME: YaLpGlaSirIVIG.YKG FAX The James B. Oswald Company A&,NQ e,al;21G_- 39-289'._- t 100 Superior Avenue, Suite 1500 E-MAIL P.holBwl&lYM=Pan , Ceveland OH 44114_ADD IiSURER;SIAFFORDING COVERAGE - r• _._.�...NAIcs INSURED MBIK2-1 INSURER 8 K2M Design INSURER C 1001 Whitehead St., Suite 101 INSURER D Kev West FL 33040-7522 1 W&URER E -- _ oCVHclrlyd An IYRFR COVERAGES ouo THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO 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 SHOVMt MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. .. _..-. POLICYEFF_.T POUI:YEXP .... INSR L1R ....TYPE OF INSURANCE ...,AOOG'6U6R POLICY NUMBER MMIDO/YYYY I LIMITS A GENERAL LIABILITY Y Y 45SBA107008 ,9/142014 W1412015 EACH OCCURRENCE $1,000.000 - -- i51Cb�A�ETbREr7TE6 51,000.000 X I_SghAMERCIAL GENERAL UABILirY ,. PREMIS_E_S;Ea occu"rcel ;_ _ 'MEDEXP(!,nlone erson) S10.000 CLAIMS -MAC X OCCUR PERSONAL 8 ADV IN.lURY + St»000 000 X Primary8 GENERAL AGGREGATE 12.000.000 X Non -Contributory - — ------ PRODUCTS COMPIOPAG_G_ S2.000.000 GENT_ AGGREGATE LIMIT APPLIES PER ---- -'- S PODGY ,X X . LOC 0114/2014 9114i2015 . S1.D00.000 A AUTOMOBILE LIABILITY Y 'Y ' 45SBA107008 SEa_aggdEViL t BODILY INJURY (Per Person) S ANY AUTO ? ALL OWNED . SCHEDULED BODILY INJURY (Per acadent) S ;AUTOS AUTOS PROPERTY DAMAGE S NON -OWNED �►er emdent� X HIREDAUTOS x. AUTOS {s X At Primary A X 'UMBRELLAUAB X OCCUR Y h! 45SBAIO7008 0/142014 b/14I2015 EACH OCCURRENCE S1,000,000 EXCESS Ull ., CLAIMS -MADE AGGREGATE ...~-51,00D.000 DED x RETENTKiN S 10.000 Excludes Professional S WORKERS COMPENSATION y 45SBA107008 9/142014 B114/2015 WC STATU• X OT . ER � _ STOP GAP A .,DORY ATU- . . EA ' ._ AND EMPLOYERS' LIABILITY YIN E L EACH ACCIDENT S1,000.000 ANY PROPRIETORIPARTNER/EXECUTIVE I N l A OFFICEWMEMBER EXCLUDED? E L DISEASE - EA EMPLOYEEI51,000,000 (Mandatory in NH) - -- _ ------ ._.---- it Yes, desalt under E L. DISEASE • POLICY LIMIT $1.000.000 DESCRIPTION OF OPERATIONS below B 'Professional Liability N Y DPR9724443 6/122015 6/12/2016 Each Claim $3,000,000 Aggregate LClaims Made Pollution Enwr a ncluded Retro Date 9/1/2001 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD IM, Addid0ml Remarks SchadWa,V more (pace Is npult I dditional Insured and Waiver of Subrogation as designated above is provided when required of the Name Insured by written contract or agreement. �E� Y R !"M D WA N/ _ CERTIFICATE HOLDER CANCELLATION N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y ,11Nl10J JUc1N0 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County COmmissibFlBtS ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street Key West FL 33040 ' -' AUTHOR1290 REPRESENTATIVE Nd L I Nnr Si Dsr, , ,,0, n,nnn_9nin ecnRn CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name aAQ9 Ire registered marks of ACORD AlcoRd CERTIFICATE OF LIABILITY INSURANCE °""012 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 lim cWtllcate holder Is an ADDITIONAL INSURED, the poNey(iss) 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 riplds to the ve ficam holder In lieu of such endorsemsntts FROOUCER nm James e. Oswald Company 1100 Superior Avenue, Stotts 1 SW ,levetand OH 44114 eavNao M8I1t;2-1 K2M Design 1001 Whitehead St., Suite 101 Key West FL 33040-7522 TE NUM13ER: PWa Otis; UCIES OP pJRANCE LISTED i1ow rlrLve peen �aavw ,.....� _ _. - __ -- _ CERT AT EM MAY NOTWITHSTANDING ISSUED OR MANY Y PERITAIN, THE INSURANCE AFERM OR FORDED $Y THE POLICIES DESCRIBEDOF ANY CONTRACT OR OTHER D�HER�EIN IS SUBJECT TO ALL THENT WITH RESPECT TO ICTERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rM O .F NSURANCE QlOt.'7116Wt.` Lem f amutmu mm Y Y 45SM07000 W1412014 0114=15 �RAC�HOCtI1tO 4sl,oso.000 ! �iiRE1YSE6NEaee1.. �51,000.000 X COLtMERCtAL GENERAL U A81UTY _ � a10 000 CLAIMS -MADE "x_ :OCCUR AIHOEXPW+yaM„apr�anl.,�, yam_ `PERSONALaADYNAMY st�oDD.00a AI Primary 3 . GENER+� Ate! ._ TE w _ ... , ,000.00D X NomCoatrlbulwY_ .____ �p�p�Tg_�gA1PtOPAGG�.000.000 __..-._..._. GEWL AGGREGATE LIMB APPLIES PER s X , X POLICYam AYTomosu UA NUTY Y Y 4SUM0700a 9J14/2014 1412016 _ _ _ _ ...- __. _ SOGILY INJURY MW PWWi S _.._ ANY AUTO ULEO ALL OWNED SCHEDULED a001LY eWRY Ot 1�s _ Q AUTOS ANON Plow $ s � -OWNED X` MIRED AUTOS X AUTOS X (Al Primaq X Y 45SBM07005 5/14/2014 91412015 LA,04pCCLE NdV _.._. �51,000000 X IJmaRaLLALIAe __ OCCUR IY ( _._ AGGREGATE - *f1.00D 000 ESa EiCLW CUUMSaNA�EI Ing .X I 510.000 CCMPaNaATION Y 45SBA107008 14f20t4 142013 N'` OH-STOPt3AP :.Eil {.._ ANO SuPLOYOW LGw1i YIN E.L. EACH ACCIOiNT __.. ANY PROPRIETORIPARTNERIEMCUrIVE f-N j NIA OiRCENIdL'kIelR E)LCLUOED7 J E L, DISEASE • FA DOWY" s1000 0 GPmk�Limb. Inairnal Llabilitlr N Y OPR9724447 b/12f201S $I12/2015 EgpacphsCpeh�GR �.000,M mompoGutlon 8 Emrir "ad RWo 0810' 011I2001 DucLvr IDN OF OPERATIONS / LOCATIONS I vENICLEe ~ACM 101. "SUWW Re ft seh@& M. If mew "m M nwkedl 4dditional Insured and Waiver of Subrogation as designated above is provided when required the Na red by written contract or Ns�greerrIe t MraEho<InAirport Customs and Border. Mk-13008 7 Nil O,i 30 d 1L° ANY OF THE ABODATEVE DBS�CRISED POLICIU BE CANCELLED BEFORE ACCGRDANCE wn TTHi PaICY F gym". I"ILt BE oB n1ERED IN Monroe County Atin Ann M. Row 1100 Simonton Street, Room 2-216 AUTHORIM Is PRIUMMATIYE Key West FL 33M I Z I Wd L I Nf f Swcgrf�. '.'/ a8uj0 � 03I I ®1989-2010 ACORD CORPORATION. AN rights reserved. ACORD 25 (2010105) The ACORD name and logo arrEtered marks of ACORD A'ob��® CERTIFICATE OF LIABILITY INSURANCE DAT2015 DIYYYY) 9/14/2015 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). CONTAC PRODUCER NAME:Patricia Cholewa The James B. Oswald Company _2 FAX No: 1100 Superior Avenue, Suite 1500 PHONEE-MAIL Cleveland OH 44114 ADDRESS: h I W w l m i m INSURERS AFFORDING COVERAGE NAIC # INSURERA:Hartford Casualtv Ins. Co. 29424 INSURED MBIK2-1 INSURER B K2M Design INSURERC 1001 Whitehead St., Suite 101 INSURERD Key West FL 33040-7522 IWCI IRFR F /+COTICl/`ATC WIIaaGCD• a 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 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 LTR TYPE OF INSURANCE Ll INSR IN R SUER WVD POLICY NUMBER POLICYEFF POLICY EXP LIMITS A GENERAL LIABILITY Y Y 45SBA107008 9/14/2015 9/14/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence)$1,000,000 Monroe X COMMERCIAL GENERAL LIABILITY �QCIIIflAS D CLAIMS -MADE OCCUR evelOPM Int MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 X Al Primary & �+�R 4 X Non -Contributory GENERAL AGGREGATE $2,000,000 53 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 YIME: i$ 7POLICY X PRO- X LOC RECENED BY: C AUTOMOBILE LIABILITY Y y 45UECBH0542 15 9/14/2016 GOMBINEOMTRM LIMIT Ea accident) $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED PeraccidenDAMAGE $ X )( HIRED AUTOS AUTOS $ X Al Primary A X UMBRELLA LIAB X OCCUR Y Y 45SBA107008 9/14/2015 9/14/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DIED X RETENTION $10,000 Excludes Professional $ A WORKERS COMPENSATION Y 45SBA107008 9/14/2015 9/14/2016 O S7ATU- x O R OH -STOP GAP E.L. EACH ACCIDENT $1,000,000 AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $1,000,000 OFFICER/MEMBER EXCLUDED? N❑ N I A (Mandatory in NH) E.L. DISEASE - POLICY LIMIT 1 $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below B Professional Liability N Y DPR9724443 6/12/2015 6/12/2016 Each Claim $3,000,000 $3,000,000 Claims Made Aggregate Pollution & Envir. Liab. Included Retro Date: 9/1/2001 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured and Waiver of Subrogation as designated above is provided when required of the Named nsured by written contract or agreement. o 'n 8 P EMENT rn A 0 C WAIVE S_ { I � o n ut CD It: MULUtK Monroe County Board of County Commissioners 1100 Simonton Street Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLI(t,`tES BE CELLED BEFORE THE EXPIRATION DATE THEREOF, NOTI WILL 3 - DELWERED IN ACCORDANCE WITH THE POLICY PROVISION C13 kD - AUTHORIZED REPRESENTATIVE 1W IDOO-LV IV — .W. w .........- -. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 8/27/201 5 Certificate of Coverage Bureau of Workers' Ohio Compensation 30 W. Spring St. Columbus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. This certificate is only valid if premiums and assessments, including install- ments, are paid by the applicable due date. To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292. This certificate must be conspicuously posted. Policy number and employer Period specified below 1493325 07/01/2015 through 06/30/2016 K2M DESIGN INC 9435 WATERSTONE BLVD. SUITE 250 CINCINNATI, OH 45249 w.ohio.gov Issuedsued byby: Adnu.sst>Jto /CEO You can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation Required Posting Effective Oct. 13, 2004, Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work -related injury. The burden of proof is on the employee to prove the presence of alcohol or a controlled substance was not the proximate cause of the work -related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. Bureau of Workers' Oh io Compensation You must post this language with the Certificate of Ohio Workers' Compensation DP-29 BWC-1629 (Rev. July 1, 2015) https://www. bwc.ohi o.gov/employer/services/C ertC ovRepri nts/secure/C erti fi cate. asp?txtC I D= 523465050 1/1 (MM/DD/YYYY) Af; "R" CERTIFICATE OF LIABILITY INSURANCE g/14/2015 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). coNrAcT PRODUCER NAME. I - FAX The James B. Oswald Company PHONE _ _ A/c No 1100 Superior Avenue, Suite 1500 C0100! rN E-MAIL m Cleveland OH 44114 toe N00P� s:P h I wI SO INSURERS AFFORDING COVERAGET INSURER A : f I INSURED MBIK2-1 S19 RERB:X I I In r n K2M Design J RERC:H r A i n In mni 1001 Whitehead St., Suite 101 INSURERD: Key West FL 33040-7522 �ME•-�,�, INSURER E � INSURER F rl rinCln41 kll IRADCO. L/UVr_KAUC.l VGI�III IVI�1r I�v�.vr.�. 7VJJVV 1VV 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. ILTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD 9/14/2015 POLICY EXP MM/DD LIMITS 9/14/2016 EACH OCCURRENCE $1,000,000 A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY Y Y 45SBA107008 DAMAGETO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 CLAIMS -MADE Fx ] OCCUR PERSONAL & ADV INJURY $1,000,000 X Al Primary & GENERAL AGGREGATE $2,000,000 X Non -Contributory PRODUCTS - COMP/OP AGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO X LOC COMBINED SINGLE$ C AUTOMOBILE LIABILITY Y Y 45UECBHO542 9/14/2015 9/14/2016 Ea accident$1,000,000 BODILY INJURY (Per person) $ — ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS 4AX BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Al Primary UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y Y 45SBA107008 9/14/2015 9/14/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 Excludes Professional WCsTATu- P GAP X oTH OH STO A NIA A Y 45SBA107008 9/14/2015 9/14/2016 DED X I RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECU I IVE OFFICER/MEMBER EXCLUDED? (Mandatory u1 NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT $1.000,000 B Professional Liability Claims Made Retro Date: 9/1/2001 N Y DPR9724443 6/12/2015 6/12/2016 Each Claim $3,000,000 Aggregate $3,000,000 Pollution & Envir. Liab. Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured and Waiver of Subrogation as designated above is provided when require of the Nam Insurer�by writtelo ntr ct or agreement. A GEI Nf - m Marathon Airport Customs and Border. Mk-13008 0 WAIV R S_ 'n� r� • I -r) o c-) u7 GERTWIGA It t1UL UrK Monroe County Attn Ann M. Riger 1100 Simonton Street, Room 2-216 Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED Po11CIES BE C4aELL2M BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL Etr,J DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ,.O AUTHORIZED REPRESENTATIVE �� r� rnon MA'rinkl All r ^hfc rac-ari ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 8/27/2015 Certificate of Coverage Bureau of Workers' Ohio Compensation 30 W. Spring St. Columbus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. This certificate is only valid if premiums and assessments, including install- ments, are paid by the applicable due date. To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292. This certificate must be conspicuously posted. Policy number and employer Period specified below 07/01/2015 through 1493325 06/30/2016 K2M DESIGN INC 9435 WATERSTONE BLVD. SUITE 250 CINCINNAT i, OH 45249 www.bwc.ohio.gov /� Issued by: Ad......ml—to /CEO You can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation Required Posting Effective Oct. 13, 2004, Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work -related injury. The burden of proof is on the employee to prove the presence of alcohol or a controlled substance was not the proximate cause of the work -related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. Bureau of Workers' You must post this language with the Certificate of Ohio Workers' Compensation Ohio Compensation DP-29 BWC-1629 (Rev. July 1, 2015) https://www.bwc.ohi o.gov/employer/services/C ertC ovR epri nts/secure/C ertifi cate. asp?txtC I D= 523465050 1 /1 DATE (MMIDDIYYYY) A ® CERTIFICATE OF LIABILITY INSURANCE 9/14/2015 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). CONTACT PRODUCER NAME: _. The James B. Oswald Company QC� PHOC.NE - - 7 FAX ac No 1100 Superior Avenue, Suite 1500 .pe'��e• 9' E-MAIL Cleveland OH 44114 F�F L�ti4 sQQ�� ADDRESS: h I w I m ni m �F\` `. Bye 01. INSURERS AFFORDING COVERAGE NAIC # O®`= INSURERA:Ha rd CasUaltyIns, 24 885 INsuRERE: INSURED MBIK2- `9x INSURER B: L Specialty Insurance7 K2M Design � -INSURER c:H r Accident Indemnity7 1001 Whitehead St., Suite 101 INSURERD: Key West FL 33040-7522 III IRA171- INSURER F : UUVCKAUt, VGRI IV 1v^ I V Y4.7G0GVVV 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. TYPE OF INSURANCE LLIABILITY MMERCIAL GENERAL LIABILITY CLAIMS -MADE r OCCUR AlPrimary & ADDL INSR Y SUBR WVD Y POLICY NUMBER 45SBA107008 POLICY EFF MWDD 9/14/2015 POLICY EXP MMIDD 9/14/2016 LIMITS EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL&ADVINJURY $1,000,000 GENERALAGGREGATE $2,000,000 n Contributory PRODUCTS -COMP/OP AGG $2,000,000 GGREGATE LIMIT APPLIES PER: X PRO- X LICY LOCCOMBINED FX SINGLE LIMI I $ OBILE LIABILITY Y 45UECBH0542 9/14/2015 9/14/2016 Ea accident 1 000 000 BODILY INJURY (Per person) $ Y AUTOL OWNED SCHEDULED TOS AUTOS ED AUTOS X AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGENON-OWNED Per accident $ $ Primary A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y 45SBA107008 9/14/2015 9/14/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 N / A N Y Y 45SBA107008 DPR9724443 9/14/2015 6/12/2015 9/14/2016 6/12/2016 Excludes Professional WC STATU- X oEg $ OH -STOP GAP DIED X I RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Professional Liability Claims Made Clai Ream Date: 9/1/2001 ro A E.L. EACH ACCIDENT $1,000,000 $1,000,000 _ E.L. DISEASE- EA EMPLOYE E.L. DISEASE - POLICY LIMIT $1,000,000 Each Claim $3,000,000 Aggregate $3,000,000 Pollution & Envir. Liab. Included B DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Additional Insured and Waiver of Subrogation as designated above is provided when required of the Name surE4by writtefi-4ontrM or agreement. o �+ Marathon Airport Customs and Border. Mk-13008 AP AGEM D f*1 rac NPYES_ t an :�o rTl CERTIFICATE HULULK Monroe County Attn Ann M. Riger 1100 Simonton Street, Room 2-216 Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLIES BE CAI LLE"EFORE THE EXPIRATION DATE THEREOF, NOTICE~- WILL BE�ELI%=ED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �noo nn�n nrnPn rnPPnPOTInN All rinhtc rPServed. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 8/27/2015 Certificate of Coverage OBureauhio I of Workers' Compensation 30 W. Spring St. Columbus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. This certificate is only valid if premiums and assessments, including install- ments, are paid by the applicable due date. To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292. This certificate must be conspicuously posted. Policy number and employer Period specified below 07/01/2015 through 1493325 06/30/2016 K2M DESIGN INC 9435 WATERSTONE BLVD. SUITE 250 CINCiNNAT i, OH 45249 www.bwc.ohio.gov 'A� V , Issued by: Adn,... ist—to /cEO You can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation Required Posting Effective Oct. 13, 2004, Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work -related injury. The burden of proof is on the employee to prove the presence of alcohol or a controlled substance was not the proximate cause of the work -related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. Bureau of Workers' 0�110 Compensation You must post this language with the Certificate of Ohio Workers' Compensation DP-29 BWC-1629 (Rev. July 1, 2015) https://www. bwc.ohi o. gov/employer/services/C ertC ovR epri nts/secure/C ertificate. asp?txtC I D= 523465050 1/1 DATE (MMIODMfYY) ACORV CERTIFICATE OF LIABILITY INSURANCE 9/14/2015 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(les) 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). 4rVn, na., PRODUCER NAME Pathcia.Lhoiewa FA1r The James B. Oswald Company ai1CA0i9�u•216- 9_-2807 (AM, . 1100 Superior Avenue, Suite 1500 E-MAIL r� Cleveland OH 44114 ADDRESS.PChQ[ewal_Q$Wa[dCOMPanteS CO uar ■ INSURED MBIK2-1 iNSuRERB:XI—SpecaityinsuranceCo. -7M -. K2M Design INSURER C : aL1f0rd AQCkteGL&Jnd=Dity 22357 1001 Whitehead St., Suite 101 INSIIRERD: Key West FL 33040-7522 INSURER E : INSURER F . RFVLSION NUMBER: GUVt:KAUta { C41'11r�VI�1F ,.w,ur... yL7GJLWV BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONS A001 SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSIR NIVO POLICY NUMBER (MMIDONYYYl, IM A GENERALUABIUTY Y Y 45SBA107008 911412015 i911412016 EACH OCCURRENCE S1.0DD.0D0_ X E LSESfEa u6ru�_ . '51.000.000 _ - — COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X— OCCUR MEO EXP �My ona parem $10 ODO pERgOI,IAL 6 Afr/ INJURY 51,000.000 X A! Primary 8 } GENERAL AGGREGATE 132000000 X Non Contributory PRODUCTS-COMP1011"AGG 1111121000.1111110 GEML AGGREGATE LIMIT APPLIES PER. 3POLICY �_ X i1 PRO- V LOG C AUTOMOBILE LIABILITY Y Y 4SUECBH0542 9/14/2015 9114/2016 WY(PIKPerim)X 7800, ANY AUTOALLOWNEO SCHEDULED NJIIRY(Per a°m S AUTOS AUTOS X OPERTY : FjPer scc Cen X HIRED AUTOS Autos $ X Al Primary A X UMBRELLA LIAB X Y 'Y 45SBA107008 9/14/2015 9/1412016 EACH OCCURRENCE $1,000,000 OCCUR AGGREGATE S7 000.000 EXCESS LIAO CLNMS4AADE _ 1DED XX RETENTIONS10.000 9/14/2015 9114/2016 Excludes Professional f WC STATU. ',X 'OTH t OH -STOP GAP A WORKERS COMPENSATION Y 45SBA107008 RY LIMtlT�_ --- AND EMPLOYERS' LIABILITY EL EACH ACCIDENT S1.000.D00 ANY PROPRIETORIPARTNEWEXECUrIVE Na NIA A f1,000A00 OFFICERWEMBEREXCLUDED7 (Mandatory in NH) EL DISEASE-EAEMPLOYE _ Ifyyaass descnbeunder DESCRIPTION OF OPERATIONS below ; E.L.DISEASE - POLICY LIMIT . f1.000.000 B Professional Liability N Y OPR9724443 611212015 W12l2016 Each Claim $3,000,0DO fAggution 53,000 Claims Made clod Pollution 6 Envir. Llab. Included Retro Date 9i1R001 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space la required) is when required of the Named Insured br-written co�kact F t Additional Insured and Waiver of Subrogation as designated above provided agreement. r c� Marathon Airport Customs and Border. Mk-13008 A GEMENI JDAv N {� __-.ter, • -�rw , - _ r_� .�. Monroe County Attn Ann M. Riger 1100 S-monton Street, Room 2 216 Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIESBE CANCEL 066RE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,n Arnon rnDOMRATlnN All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD