Okaloosa County BOCC — February 18, 2014 — Certificate of Liability Insurance

aay ACORD' Neue” CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5-1-2013 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain policies ma certificate holder in lieu of such endorsement (s), policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to y require an endorsement. A statement on this certificate does not confer rights to the PRODUCER (877) 945-7378 CONTACT Willis of Minnesota, Inc. PHONE FAX 26 Century Bivd (AIC No. Ext 877-945-7378 (AIG No); 888-467-2378 PO Box 305191 E-MAIL Nashville TN 37230-5191 ACCRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire ins. Co INSURED CCI Systems, Inc. 105 Kent Street Iron Mountain MI 49801 INSURER B: The Travelers Indemnity Company INSURER C: Travelers Property Casualty Co of America INSURER D: The Travelers Indemnity Company of CT INSURER E. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 SE 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP: LIMITS LTR _ INSR wo. (MMYDDIYY) (MiDDAYY) A GENERAL LIABLITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY x 630 6581P228 SIN3 5I1/14 CRE TO RENTED) $ 300,000 - ' MED EXP (Any one person) $ 4 0,000 5 area PERSONAL & ADV INJURY $ 1 ,000,000 GEN'L AGGREGATE LIMIT APPLIES GENERAL AGGREGATE $ 2,000,000 PER: PRODUCTS-COMPIOP AGG $ 2,000,000 O POLICY HIPROJECT BLOC 'B | AUTOMOBILE LIABILITY eee Tes 1 § 1,000,000 fl ANY AUTO 4 810 4173N531 5/1113 5/14 BODILY INJURY (Per person) $ 0 AUTOS ep tog Ee BODILY INJURY (Per accident) $ BQ HIRED AUTOS fa NON-OWNED feereccdenty noe § ia] a] $ c f UMBRELLA LIAB & OCCUR EACH OCCURRENCE $ 5,000,000 O EXCESS LIAB OCLAIMS-MADE | X CUP 6581P228 5/1/13 5N4 AGGREGATE $ 5,000,000 ODED O RETENTION S $ D | WORKERS COMPENSATION AND X| oars | ee | EMPLOYERS LIABILITY UB 4173N531 SAH3 5414 EL EACH $ 1,000,000 ANY PROPRIETOR/PARNERIEXECUTIVE YIN ACCIDENT , ’ oreeemeneee eueneoe wa ELOSENSEER [7,000,000 if yes, describe under [»] EL. DISEASE— $ 1,000,000 DESCRIPTION OF ; ’ , OPERATIONS below POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Okaloosa County Florida work. The Workers’ compensation policy includes Longshore and Harbor Workers’ Compensation Ace coverage for Florida. Itis hereby agreed that Okaloosa County Florida; his engineer, Polyengineering, Inc.; Engineer Consultants; all officers, directors, partners, employees, agent and consultants and subcontractor of each are included as Additional Insureds under the General Liability, Automobile Liability and Umbrella Liability policies as respects work performed by the Named Insured as required by written contract, agreement or permit and executed prior to loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Okaloosa County Florida Aitn: Board of County Commissioners 302 N. Wilson St #203 Crestview, FL 32536 AUTHORIZED REPRESENTATIVE ae ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The Acord name and logo are registered marks of ACORD