Okaloosa County BOCC — January 3, 2017 — Updated COI

DATE (MM/DD/YYYY) g I . A‘CORD CERTIFICATE OF LIABILITY INSURANCE 12/27116 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: I 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: . Alice Pousson Sume Insurance Sroup, Inc. PHONE " 850-332-5458 EXT, 1900 P oy: 850-607-2060 Pensacola FL 32502 | Kk <s. apousson@sihle.com INSURER(S) AFFORDING COVERAGE NAIC # wsurer A :BITCO Insurance Companies*™ INSURED LORD&SO0-03 ivsurer B :North River insurance Gompany Lord & Son Construction, Inc. INSURER € : PO Box 1808 . Fort Walton Beach FL 32549 INSURER D : INSURERE : INSURER F : COVERAGES CERTIFICATE NUMBER: 8365554879 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, EXGLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDL[SUBR BOLICY EEE_| POLICY EXP LTR TYPE OF INSURANCE INSD EV\?\?D POLICY NUMBER (MMllil)D[YYYY) (Mamnlvvm LIMITS A | x | COMMERGIAL GENERAL LIABILITY CLP 365824 1112017 1/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) | $100,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY | $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT Loc PRODUCTS - COMP/OP AGG | $2,000,000 OTHER: $ A | AUTOMOBILE LIABILITY CAP3641871 1112017 112018 | GOMBIEDSINGLELIMIT 1 4 000,000 X | ANY AUTO BODILY INJURY (Per person) | § AL OWNED Egfiggxifi; BODILY INJURY (Per acoident) | $ ~ | - PROPERTY DAMAGE HREDAUTOS | | AUTOS (Per accident) $ PiP $10,000 B [ X | UMBRELLA LIAB OCGUR 5811077523 1172017 1/1/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED | X l RETENTION $0 A |WORKERS COMPENSATION WC3631865 1112017 PER QTk- AND EMPLOYERS' LIABILITY vIN ttrzo1s | x [ERRrre || OF ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? D NiA {Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $500,000 A | Contractors Equipment N | N |CLP 631781 1/1/2017 111/2018 |Leased and Rented 300,000 [ Per itam MAX 150,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Checked Baggage Screening Project, Northwest Florida Regional Airport Leven D. Lord - License # CGC008942 Certificate holder is included as additional insured with regards to the General Liability and Automobile Liability and Umbrella coverage when required by written contract. 30 Day Notice of Cancellation applies for the certificate holder with respects to General Liability and Automobile Liability coverage when required by written contract. 10 Days for non-payment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Okaloosa County ACCORDANCE WITH THE POLICY PROVISIONS. 602-C North Pearl Street Crestview FL 32536 AUTHORIZED REPRESENTATIVE [ © 1988-2