Okaloosa County BOCC — May 15, 2013 — Joe Swales Liability Ins — reading text

Printed By Bill a DATE (MM/DDIYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 3/27/2013 PRODUCER . . Harris Insurance Services, Inc. Fort Walton Beach, FL 32548 123 Miracle Strip Parkway S. E. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone - (850)244-2111 Fax - (850)243-5265 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Tapco c/o Penn America Swales, Joe — 1005 27Th St - INSURER D: Niceville, FL 32578 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. ADD Epa ee | SRO TYPE OF INSURANCE POLICY NUMBER Pe eT MmUDENT LIMITS GENERAL LABILITY : EACH OCCURRENCE $ 300.000 PAC6983586 4/5/2012 4/5/2013 SAMAGETO RENTED : x COMMERCIAL GENERAL LIABILITY PREMISES (Ba occurence $ 4 00,000 Aly ] CLAIMS MADE OCCUR MED EXP (Any one person) |S 5,000 PERSONAL & ADVINJURY |S Excluded GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGS $ Exciuded POLICY PROJECT Loc AUTOMOBILE LIABILITY |COMBINED SINGLE LIMIT ANY AUTO {Ea accident) $ ALL OWNED AUTOS BODILY INJURY — {Ea person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY {Per accident) $ NON-OWNED AUTOS: PROPERTY DAMAGE | (Per accident} $ GARAGE LIABILITY AUTO ONLY-EAACCIDENT |§ ANY AUTO OTHER THAN EA ACC | $ —} Al : UTO ONLY: nee 15 EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 3 occur im CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION § WORKER'S COMPENSATION AND Towcuirs _| ole EMPLOYERS’ LIABILITY E.L DISEASE -EA ACCIDENT 3 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EC DISEASE - EA EMPLOYEE Ifyes, describe under $ SPECIAL PROVISIONS below ELL DISEASE- POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER AND ADDITIONAL INSURED CANCELLATION Okaloosa County Water & Sewer Dept 1804 Lewis Tumer Bivd, Ste 300 Ft Walton Bch, FL 32547 Phone: Fax 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 OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Bill Rehi ACORD 25 (2001/08)