Okaloosa County BOCC — December 18, 2012 — Certificate of Liability Insurance — reading text

JAN-29-2018 TUE U4: 38 PM [HE HOLLOWAY AGENCY FAX No. BOU O82 JUII Pr. UU ACORD CERTIFICATE OF LIABILITY INSURANCE ee 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 CERTIFIGATE HOLDER. certificate holder in lieu of such endorsement(s), IMPORTANT: If the certificate halder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the tens and conditions of the pollcy, certaln policies may require an endorsament. A statement on this certificate does not confer rights to the CRESTVIEW, FL 32536 PRODUCER NAME, THE HOLLOWAY AGENCY tare 850-682-1900 [faG,noy 850-682-707 1 168 WEST WOODRUFF AVE ROBHEER: golffishsing@yahoo,com INSURER(8) AFFORDING COVERAGE NAIC # iwsureRa: ACCIDENT INSURANCE COMPANY INSURED MIKE MOULTON CONSTRUCTION, INC 891 S. FERDON BLVD INSURBRB: INSURER C; INSURER D: ; INSURER E: Crestview EE 32536 plane. COVERAGES CERTIFICATE NUMBER: 1 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 CERTIFIGATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUGH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, NBR TYPE OF INSURANCE INS Wwyp POLICY NUMBER ineaneen (MMOD YAYY) LIMITS alee x | | 1419128 08/11/2012}08/1 1/2019, facH occurence |g ____1000000 X_| COMMERCIAL GENERAL LIABILITY PREMISES (Ea Decurranca) | $ 100000 | CLAIMS-MADE occuR MED EXP (Any ona parson) _| $ 5000 PERSONAL & ADVINJURY | 8 1000000 = GENERAL AGGREGATE $ 2000000 GEN AGGREGATE LIMIT APPLIES PER: PRODUCTS - GOMPIOP AGG | $ 2000000 poucy| | SES LOC Ba: ae UABILITY ee oh pila £ ANY AUTO BODILY INJURY (Per person) | $ Tyas | [igie Se J HIRED AUTOS AUTOS | (Par accident $ $ | VBR EC ESTAR j222| OdcUr EACH OCCURRENCE s EXCESS UAR CLAIMS-MADE AGGREGATE $ ‘Toep | [rerenrions 8 ao T_T ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DIBEASE - EA EMPLOYER § Cee Seon OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, [f more space |y required) CRESTVIEW, FL 32536 i CERTIFICATE HOLDER CANCELLATION OKALOOSA COUNTY BOARD OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COUNTY COMMISSIONERS ACCORDANGE WITH THE POLICY PROVISIONS, 602-C N PEARL ST ramones es fll.) ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD nama and Jogo are registered marks of ACORD