Okaloosa County BOCC — April 1, 2014 — Insurance Certificates

Cor’ ° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 03/18/14 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(les) 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 ReNEAet Gilmore Insurance & Bonding, Inc. fale F ex: (850) 244-3387 [FRE voy. _ (850) 244-2610 P.O. Box 249 EMAIL, S: info@insurancefast.com _ Mary Esther, FL 32569 INSURER(S) AFFORDING COVERAGE NAIC # Phone _(850) 244-3387, Fax (850) 244-2610 INSURER A: _Auto-Owners Ins, Co, 18988 INSURED INSURER B : Jimmy Henderson II Construction Company Inc INSURER C: 714-B Bob Sikes Blvd. INSURER D : Fort Walton Beach, FL 32547 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 GONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OFFICERIMEMBER EXCLUDED? (Mandatory in NH) IFyes, describe under, DESCRIPTION OF OPERATIONS below INSR ADDLISUBR| | POLICY EFF | POLICY EXP. LTR TYPE OF INSURANCE INSR|WVD POLICY NUMBER (MN/BDIYYYY) | (MMDDIYYYY) Limits GENERAL LIABILITY EACH OCCURRENCE s_1,000,000.00 GE TO RENTED [¥] COMMERCIAL GENERAL. LIABILITY ee (Eaoccurence) | $ 300,000.00 x (J © ctas-maoe [v] occur 78618787-13 toot | 1012014 MED EXP (Anyone person) | 5 10,000.00 i= PERSONAL & ADVINJURY | $ 1,000,000.00 oO GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG| $_2,000,000.00 poucr CES C1 woe COMBINED SINGLE LIMIT : AUTOMOBILE LIABILITY COMBINED ; $ 1 any auro BODILY INJURY (Per person) | $ AtkQwneD =] SCHEDULED BODILY INJURY (Per accident) $ NON-OWNED DAMAGE (1 wirenautos §=((] autos (ecbeeant $s O ia 8 (] umereauiaB [| cccur EACH OCCURRENCE $ [_] excess Lia CO cuams.mape AGGREGATE s [] veo [1 retennons $ WORKERS COMPENSATION WE STATU- OTH. AND EMPLOYERS’ LIABILITY YIN C) roRY Uintrs ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ ELL. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT| $ ea DESCRIPTION OF OQPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is listed as additional insured with respects ta the General Liability. CERTIFICATE HOLDER CANCELLATION Okalaosa County 602 C North Pearl St. Crestview, FL 32536- (650) 689-5998 ACORD 25 (2010/08) QF 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 CACHE © 1988-2010 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD JIMMY-7 OP ID: KJ ACORD _ CERTIFICATE OF LIABILITY INSURANCE “osrtar2014. REPRESENTATIVE OR PRODUCER, AND THE C ERTIFICATE HOLDER. 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 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION !S 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 Fisher Brown Div, Pensacola 1701 West Garden Street Pensacola, FL 32502 Phone: 850-432-7474| x Fax: 850-438-4678 canracr Kim Brady ee a exy, 850-432-7474 [ERX two}: 850-438-4678 EMAL. korady@fbbins.com Ed Wonders INSURER(S) AFFORDING COVERAGE NAIC # isurer a Association Insurance Company INSURED Jimmy Henderson II INSURER B : Construction Co., Inc. Kara Lunsford INSURER C : 714 B Bob Sikes Bivd INSURER D : Fort Walton Beach, FL 32547 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 DDL SUBR OLIG LICY EXP LTR TYPE OF INSURANCE sR lwvp POLICY NUMBER HVBBRAAY) [COBIAN LIMITS GENERAL LIABILITY EACH OCCURRENCE s r DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) _| $ | CLAIMS-MADE OCCUR MED EXP (Any one person) | $ PERSONAL & AOVINJURY |S GENERAL AGGREGATE $ GEN'L AGGREGATE = APPLIES PER: PRODUCTS - COMPIOP AGG | $ POLICY | BR FRO. Loc § COMBINED SINGLE LIMIT | AUTOMOBILE LIABILITY Seen A ANY AUTO BODILY INJURY (Per person) | $ ALL OWNED SCHEDULED _ |e pia BODILY INJURY (Per accident) | $ NON-OWNED PROPERTY DAMAGE 3 HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE § veo | [retentions $ WORKERS COMPENSATION WE STATU- OTH AND EMPLOYERS" LIABILITY YIN x [roav itis ER A | ANY PROPRIETOR/PARTNER/EXECUTIVE IWCV014533101 03/14/2014 | 03/14/2015 | €... EACH ACCIDENT § 1,000,000; OFFICER/MEMBER EXCLUDED? NTA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE] § 1,000,000 Ityes, describe under DESCRIPTION OF OPERATIONS below ELL. DISEASE - POLICY LIMIT | $ 1,000,000) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Ramarks Schadule, if more space Is required) CERTIFICATE HOLDER CANCELLATION Okaloosa County 602-C North Pearl St. 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 Th ble ACORD 25 (2010/05) fos [4 é/and logo are r i ACORD nai CA [OQ © 1988-2010 ACORD CORPORATION. All rights reserved. istered marks of ACORD