Okaloosa County BOCC — July 7, 2015 — SIXEL COI

DATE (MM/DD/YYYY) ACORD’ CERTIFICATE OF LIABILITY INSURANCE 12/26/2014]+ THIS CERTIFICATEIS 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 1SSUING 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 SUBROGATIONIS 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). PRODUGER gg:;ACT WELLS FARGO INS INC/PHS MSC Woto, 2 (866) 467-8730 [wens: (888) 443-6112 715776 P:(866) 467-8730 F:(888) 443-6112| s PO BOX 29611 INSURER(S) AFFORDING COVERAGE NAICH CHARLOTTE NC 28229 INSURERA: Hartford Casualty Ins Co INSURED INSURERB: Multiple Companies INSURER C: STIXEL CONSULTING GROUP INSURER D : 497 OAKWAY RD STE 220 INSURER E: EUGENE OR 97401 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 a " ADDL SUBR| POLICY EFF POLICY EXP TR TYPE OF INSURANCE ‘msr| wyp POLICY NUMBER (MM/DD/TTYY) ABUDDATED LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE <1, 000,000 g X DAMAGE TC RENTED | CLAIMS-MADE | # | OCCUR PREMISES (Fa ocourence) P30 0, 000 A | X| General ILiab X 41 SBA PJ1177 01/02/2015} 01/02/2016 | MEDEXP (Any one person) 510, 000 PERSONAL & ADVINJURY 51, 000, 000 | GEN'L AGGREGATE LIMIT APPLIES PER: . GENERALAGGREGATE [s2 000, 000 PRO- PoLlch:] JECT Loc PRODUCTS - COMP/OP AGG |52 ’ 000 , 000 OTHER: 5 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accldent) 1,000,000 ANY AUTO BODILY INJURY (Per person) |s [ | ALLOWNED SCHEDULED “ A | | autos AUTOS 41 SBA PJ1177 01/02/2015( 01/02/2016 | BODILY INJURY (Per accident) |s NON-OWNED PROPERTY DAMAGE _)i- HIRED AUTOS| X AUTOS {Per accident) s X | UMBRELLALIAB | X [ OCCUR EACH OCCURRENCE 52,000,000 il | = | A EXGESS LIAB CLAIMS-MADE 41 SBA BJ1177 01/02/2015| 01/02/2016 |AGGREGATE 52,000,000 DE[I X |REI'ENTIDN$107 000 5 WORKERS COMPENSATION X PER I OTH- AND EMPLOYERS" LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEYIN £.L. EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? wa ’ r B |{Mandatory in NH) D 41 WEC BV3336 01/02/2015] 01/02/2016 |EL.DISEASE-EAEMPLOYEE 5]_, 000,000 If yes, describe under - $ DESCRIPTION OF OPERATIONS below EL DISEASE -PoLicy imT 11, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHIOIESORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION 44 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 01-02-15A57:56 RCVD BEFORE THE EXPIRATION DATE THEREOF, NOTIGE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. OkalOO sa COthy AUTHORIZED REPRESENTATIVE . 602-C N PEARL ST /V7 CRESTVIEW, FL 32536 (}J4-2n3-Ap ; * A‘U[é"“\‘/ ©1988-2014 ACORD CORPORATION. All rights reservet ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD