Okaloosa County BOCC — March 4, 2014 — American Suncraft Ins.

- - 1 0 DATE(MMJDD ACO RD CERTIFICATE OF LIABILITY INSURANCE 1/ 0I2Q14 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 pollcy(Ios) 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 Debra Brum Brower Insurance Agency FAX 409 E. Monument Ave. buite 400 t E-MAIL Dayton OH 45402 AsoRE so. dbrummettbrQweflJ1Surance.cOm INSIJRELAYFORD1N0 COVERAGE NAIC U INSURER :Tpms Spealty lnsuence Co 25496 INSURED AMERS8C INSURERS :Westfield Group ______________________ ?_4112 American Suncraft Construction INSIJRERC: 10836 Schiller Rd INSURER 0: Medway OH 45341 INSURER E:_ INSURER F: COVERAGES CERTIFICATE NUMBER: qR1 1719 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLiCY EFF TYPE OF INSURANCE MSP p POLICY NUMBER (MWDO/YYYY) I UNITS______________ B GENERAL LIABILITY Y Y TRA0758627 /112014 11112015 EACH OCCURRENCE $1000000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PIIEMISES (Es oCoaTanCe) $500,000 1 CLAIMS-MADE OCCUR MEDEXP(Myoeperson $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,00,000 O,00D GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 B POLICY [1JPFRei P1 LOG COMMINBU SINGLE UNIT $ AUTO$IOBILEUABIUTY Y TP.A0756627 1/112014 /1/2015 (Edent} s1,000.000 X ANYAUIO BODILY INJURY (Per person) $ - ALL OI.M.JEDfl1 SCHEDULED BODILY INJURY (Per acdent) $ - AUTOS L I AUTOS NON-OWNED PROPERTY DAMAOE $ - HIRED AUTO S AUTOS jEMccdenh) Hired Car PD $125000 A UMBRELLA LIAB X OCCUR '' N 31164C141AL1 /1/2014 11/2015 EACH OCCURRENCE $9,000,000 X EXCESS LIAB I Cl-AIMS-MADE AGGREGATE $ - PED I I RETENTIQN $ WORKERS COMPENSATION I WC STATU- I lplH. $ B - N TRA0756627 111/2014 11/2015 Employers Liab. AND EMPLOYERS' LIABILITY YIN I TORY LIMITS I I ER ANY PROPRIETOR,PARTNERIEXECUTIVE [j] El EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EILOY $ luau desalne under - DSÔRIPTION OF OPERATIONS beI - E.L. DISEASE - POLICY LIMIT $ B Leaaed!Rented Equipment TRA0756027 111t2014 /1/2015 hR Equip. LImit: 225.000 Deductible: 1,060 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdditIonal Remulc5 Schedule, if more apace Is required) Project: Repair and Paint Countryview and Bluewater Tanks 2014 Polyengineering and Okaloosa County Board of County Commissioners are areinclUded as Additional Insured with respects to the above General Liability as required by written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. Okaloosa County, Florida 302 N. Wilson St. AUTHORIZED REPRESENTATIVE Crestview FL 32536 L LA:i;: I I (S)lWrn-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD  POWER NO. 3401942 07 General Power V Westfield Insurance Co. of Attorney Westfield National Insurance Co. Ohio Farmers Insurance Co. CERTIFIED COPY Westfield Center, Ohio Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a Company and collectively as Companies, duly organized and existing under the laws of the State of Ohio, and having its principal office In Westfield Center, Medina County, Ohio, do by these presents make, constitute and appoint THOMAS D. CASSADY, LOUIS R. FISHER, THOMAS W. CHATHAM, PAULETTE M. AERNI, FRANK J. LECH, PAUL J. SCHUELER, JR., RICHARD A. DAVIS, ANNE TIERNEY, LINDA L. HOGLE, JOINTLY OR SEVERALLY of CINCINNATI and State of OH its true and lawful Attorney(s(-In-Fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretyshIp - - - - - - - - -- - - - - - - - - -- - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE, OR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney (s)-in-Fact may do In the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: Be It Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary. 'Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Each adopted at a meeting held on February 8, 2000). In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 21st day of JANUARY AD., 2008 - Corporate WESTFIELD INSURANCE COMPANY Seals !,...... Affixed f,/ Jo...' ?*\ WESTFIELD NATIONAL INSURANCE COMPANY OHIO FARMERS INSURANCE COMPANY t(SEAL)) ( SEAL . "S ,' •• VP State of Ohio County of Medina ss.: Richard L. Kinnaird, Jr., Senior Executive On this 21st day of JANUARY AD., 2008 , before me personally came Richard L. Kinnaird, Jr. to me known, Who, being by me duly sworn, did depose and say, that he resides in Medina, Ohio; that he 15 Senior Executive of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described In and which executed the above instrument: that he knows the seals of said Companies: that the seals affixed to said instrument are such corporate seals: that they were so affixed by order of the Boards of Directors of said Companies: and that he signed his name thereto by like order. State of Ohio I William J. Kahelin, A rney at Law, Notary Public My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code) County of Medina ss.: C OF I, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect: and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this .111. 5 'day of Fi,hri,a r/ 701 ..I - C. -:''' ' /0." •.. tE\? SE AL)I r ( SEAL %.. 1848 /_)44 Frank A. Carri no'creta Scr:ury BPOAC2 (combined) (06.02)