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Okaloosa County BOCC — August 2, 2016 — CACI International IncCertOfIns- Board of County Commissioners — reading text
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©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 570000027216
LOC #:
ADDITIONAL REMARKS SCHEDULE Page _ of _
AGENCY NAMED INSURED
Aon Risk Services, Inc. of Washington, D.C. CACI International, Inc.
POLICY NUMBER
See Certificate Number: 570063145904
CARRIER NAIC CODE
See Certificate Number: 570063145904 EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
POLICY POLICY
INSR ADDL SUBR POLICY NUMBER EFFECTIVE EXPIRATION LIMITS
LTR TYPE OF INSURANCE INSD WVD DATE DATE
(MM/DD/YYYY) (MM/DD/YYYY)
WORKERS COMPENSATION
B N/A WC023102317 07/01/2016 07/01/2017
WC-AK,AZ,IL,KY,NC,NH,NJ,PA,UT,VA,VT
SIR applies per policy terms & conditions
C N/A WC023102318 07/01/2016 07/01/2017
Work Comp-FL
SIR applies per policy terms & conditions
C N/A WC023102319 07/01/2016 07/01/2017
Work Comp-MA
SIR applies per policy terms & conditions
B N/A WC023102320 07/01/2016 07/01/2017
Work Comp-WI
SIR applies per policy terms & conditions
C N/A WC023102321 07/01/2016 07/01/2017
Work Comp-CA
SIR applies per policy terms & conditions
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 570000027216
LOC #:
ADDITIONAL REMARKS SCHEDULE Page _ of _
AGENCY NAMED INSURED
Aon Risk Services, Inc. of Washington, D.C. CACI International, Inc.
POLICY NUMBER
See Certificate Number: 570063145904
CARRIER NAIC CODE
See Certificate Number: 570063145904 EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
Additional Description of Operations / Locations / Vehicles:
convey and shall not be construed to convey insuring rights on any party. Please note that insurance is only
evidenced for the policy period beginning July 1, 2016 and ending July 1, 2017.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD