Okaloosa County BOCC — May 17, 2016 — Harcros COI 05112016

PS260028002 0510053317 DATE (MM/DDIYYYY) ) ACORD’ CERTIFICATE OF LIABILITY INSURANCE 070/3015 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 CAHO0HG64724 1-913-982-3650 fig:‘é{m IMA, Inc. (NE Kansas Division) PHONE FAX ) (AIG, No, Ext): (AIC, Noj: 51 Corporate Woods ADDRESS: 9393 W. 110th Street, Suite 600 ___INSURER(S) AFFORDING COVERAGE _ _ NAIC# Overland Park, KS 66210 INSURER A: AIG SPECIALTY INS CO 26883 INSURED INSURER B: ZURTCH AMER INS CO 5 i 16535 Harcros Chemicals, Inc. {NSURER C : 5200 Speaker Road IHEURERD: INSURER E : o Kansas City, KS 66106-1048 INSURER F : COVERAGES CERTIFICATE NUMBER: 45186257 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ) 'ADOL SUBR POLICY ETR TYPE OF INSURANCE INSD_WVD POLICY NUMBER !MMmDN%f{Fv) 153}6%’7?‘&, LIMITS A X COMMERCIAL GENERAL LIABILITY EG11525470 10/01/15 10/01/16 EACH OCCURRENCE s 1,000,000 CcLamsMADE X OCCUR PRENGES e et nce) S 300,000 X Bedily Injury & Prop MED EXP (Any one person) s 25, DO& g i X Dmg Liab Ded: $500,000 PERSONAL & ADV INJURY § 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY S * Lo _PRODUCTS - COMP/OPAGG § 2,000,000 OTHER: s B AUTOMOBILE LIABILITY BAP930129214 10/01/15 10/01/16 {:Eo:;csémgeg)smel.e LIMIT s 1,000,000 X ANY AUTO BODILY INJURY (Per person) § ALL OWNED SCHEDULED AUTOS ;\‘gmg ; 'BODILY INJURY (Per accident) $ N-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Por accident). $ X Liab Ded: 3 a UMBRELLALIAB X 0ccUR EGU12334755 10/01/15 10/01/16 EAGH OCCURRENCE _§ 25,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE s 25,000,000 DED RETENTION S $ WORKERS COMPENSATION x PER OTH- B N ERPCOVERSTLIABILITY i WC930129314 10/01/15 10/01/16 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT 5 1,000,000 OFFICERMEMBER EXCLUDED? E NIA A et s - {Mandatory in NH) E.L. DISEASE - EA EMPLOYEE § 1,000,000 If yes, describa under QTR DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMT _§ 1,000,000 A Pollution Legal Liability EG11525470 10/01/15 10/01/16 Per Claim 1,000,000 A Additional Pollution Legal EG11525470 10/01/15 10/01/16 Additional Limit 1,000,000 Liability (Per Occurence) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, A I Remarks Schedule, may be it more space is required) RE: LIQUID CHLORINE CONTRACT #C03-0991-WS2-133; OKALOOSA COUNTY IS INCLUDED AS ADDITIONAL INSURED ON THE GENERAL LIABILITY POLICY IF REQUIRED BY WRITTEN CONTRACT OR AGREEMENT SUBJECT TO THE POLICY TERMS AND CONDITIONS. C-20N CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE OKALOOSA COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 602C NORTH PEARL STREET AUTHORIZED REPRESENTATIVE CRESTVIEW, FL 32536 QQW usa i © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registe