Okaloosa County BOCC — June 17, 2014 — Certificate of Insurance — reading text

= . ( , CERTIFICATE OF LIABILITY INSURANCE OP ID: JMC DATE (MMIDDIYYYY) 06/10/2014 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 endorsement(s). PRODUCER RSH Phone: 800-338-1391] CONTACT 701 Market St., Ste. 1100 Fax: 888-621-3173] [a/c No, Ext): (AG, No): St. Louis, MO 63101 EMAL CUSTOMER Ip #: CONS-07 INSURER(S) AFFORDING GOVERAGE NAIC # INSURED Constantine Engineering, Inc. INsuRER A: CNA Insurance Company 20443 ESG, Inc. , . INSURER B: 1988 Lewis Turner Boulevard INSURER C:: Fort Walton Beach, FL 32547 INSURER D: INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 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 ADDLTSUBR POLICY EFF | POLICY EXP LTR TYPE OF INSURANCE INSR | WYD POLICY NUMBER {MM/DDIVYYY} | (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ | CLAIMS-MADE [| OCCUR MED EXP (Any one person) $ PERSONAL & ADVINJURY | $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ | POLICY | FRO | | LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a (Ea accident) |__| ANY AUTO BODILY INJURY (Perperson) | $ |__| ALL OWNED AUTOS BODILY INJURY (Per accident) | $ |__| SCHEDULED AUTOS PROPERTY DAMAGE 5 HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION _$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY VIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? [| NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE] $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT | $ A. |Professional Liab. F-EH254041975 12/04/2013 | 12/04/2014 ‘Per Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION OKALOOC OKALOOSA COUNTY 602-C NORTH PEARL STREET CRESTVIEW, FL 32536 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 D4 On~& ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: JMC ACORD CERTIFICATE OF LIABILITY INSURANCE “06/10/2014 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 endorsement(s). PRODUCER Phone: 800-338-1391] saueee! 701 Market St., Ste. 1100 Fax: 888-621-3173} [a)c' No, Ext): (AIG, No}: St. Louis, MO 63104 MM gs: CUSTOMER Ip #: CONS-07 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Constantine Engineering Inc. INSURER A: Hartford Insurance Company 22357 ESG, Inc. INSURER B: 1988 Lewis Turner Boulevard INSURER C Fort Walton Beach, FL 32547 * INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. i ADDLISUBR LIGVE POLICY EXP NSR TYPE OF INSURANCE INSR | WvD POLICY NUMBER (AMIDDIVYYY) | (MMIDDIVYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A lx] 4104/2014 | DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY 84SBWVK2142 11/01/2013 01/2014 | BREMISES (Ea occurrence) _| $ 1,000,000 | CLAIMS-MADE OCCUR MED EXP (Any one person) _| $ 10,000 X |XCU SEVERABILITY OF INTEREST PERSONAL & ADVINJURY | $ 1,000,000 CONTRACTUAL PROFESSIONAL LIAB EXCL GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE usr APPLIES PER: PRODUCTS - COMPIOP AGG | $ 2,000,000 POLICY X | PR FeO OC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A TX 84UEGRF7329 4410112043 | 44/01/2014 }@2 oe ° nero LA | ANY AUTO BODILY INJURY (Per person) | $ |__| ALL OWNED AUTOS BODILY INJURY (Per accident)| $ |__| SCHEDULED AUTOS PROPERTY DAMAGE X | HIRED AUTOS (Per accident) $ X | NON-OWNED AUTOS $ $ X | UMBRELLA LIAB X | occur EACH OCCURRENCE $ 5,000,000 EXCESS LIAB 7 5,000,000 A CLAIMS-MADE 84SBWVK2142 4410112013 | 11/01/2014 AGGREGATE $ ,000, DEDUCTIBLE $ X | RETENTION $ 10,000 $ WORKERS COMPENSATION X WC STATU- OTH AND EMPLOYERS' LIABILITY VIN TORY LIMITS ER A _| ANY PROPRIETOR/PARTNER/EXECUTIVE 84WBGKA8107 11/01/2013 | 11/01/2014 | EL. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? [| N/A (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 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS WORK PERFORMED BY THE wad INSURED. A WAIVER OF SUBROGATION IS INCLUDED IN FAVOR OF THE NAMED URED. CERTIFICATE HOLDER CANCELLATION OKALOOC 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 BH One © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD