Okaloosa County BOCC — January 7, 2014 — Insurance Certificate

ACD® CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS F 2114/2013 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 CONTACT NAME: Certificates Department SIhIe Insurance Group, Inc. (A/C, No, Eet);407-569-5490 , NO) 407-389-3580 P.O. Box 160398 EMAIL Altamonte Springs FL 32716 ADDRESS:CertIfICateS@SIhIe.COm INSURER(S) AFFORDING COVERAGE NAIC a / INSURER A Valley Forge Insurance Co 20508 INSURED EATAP- INSURER B Continental Insurance Co. 35289 EA Tapping Services, LLC INSURER C Transportation Ins Company 20494 615 Superior Commerce Blvd., Suite 103 INSURER 0: Apopka FL 32703 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1288203647 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 ADDL'SUBR POLICY 0FF POLICY EXP LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER IMMIOD/YYYYI IMM/DDIYYYYI LIMITS A GENERAL LIABILITY 5083113525 2/1/2013 211/2014 EACH OCCURRENCE Si 000 000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) S300.000 CLAIMS-MADE X OCCUR MED EXP (Any one person) 55.000 X Contractual Liab PERSONAL &ADV INJURY S 1.000.000 GENERAL AGGREGATE $2000000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS . COMP/OP AGO $2000000 POLICY X LOC S B AUTOMOBILE LIABILITY 2/1/2013 2/1/2014 COMBINED SINGLE LIMIT 5083113539 (Ea aCCideni) $1.000.000 X ANY AUTO BODILY INJURY (Per person) S ALL ORAtED SCHEDULED BODILY INJURY (Per accloenhl S AUTOS AUTOS NON.OVVNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS (Per accideri) PIP S10,000 C X UMBRELLA LIAB X OCCUR 5083113508 2/1/2013 2/112014 EACH OCCURRENCE $5.000000 EXCESS LIAB -- CLAIMS-MADE AGGREGATE 55,000.000 OED X RETENTION S1O.000 . S A WORKERS COMPENSATION WC583113511 2/112013 2/1/2014 X /ACSTATU. 0TH AND EMPLOYERS' LIABILITY TORY LIMITS ER YIN ANY PROPRIETOR/PARTNERIEXECUTIVE EL EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E L DISEASE . EA EMPLOYEE 51000000 II es. desa'rbe under DSCRIPTION OF OPERATIONS below E L DISEASE . POLICY LIMIT S1000000 A Contractors Equipment 5083113525 21112013 2/1/2014 Leased & Rented $50,000 Leased & Rented Limit Per Item $25000 Ded $1000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Okaloosa County Board of County Commissioners is included as additional insured for General Liability where required by written contract Waiver of Subrogation applies where required by written contract to the General Liability and Workers Compensation policies in favor of Okaloosa County Board or County Commissioners. DTIIrAT uru rt CANCFI I ATI(Thi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Okaloosa County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Jack Allen, Purchasing Svc Mgr. 1804 Lewis Turner Boulevard AUTHORIZED REPRESENTATIVE Fort Walton Beach FL 32547 (9 19-200 ALUKU (UKtUF(A I IUN. All rtgnts reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD