Okaloosa County BOCC — March 18, 2014 — R&E Farms COI

R&EFA-1 OP ID: JB I4WRL CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I DATE (MMIDDfYYYY) 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 SanBuck, Inc. PHONE FAX P.O. Box 311650 (AC, No. Ext): (NC, No): Enterprise, AL 36331-1650 E-MAIL John Milton Buck INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ROCKHILL INS. Co INSURED R & E Farms, LLC INSURER B: Canal Insurance Co William Rivenbark INSURER C. ROCKHILL INS CO 625 Burnt St Black, AL 36314 INSURER D: INSURER E: I 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 ABBL)US1. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD!YYYY) (MM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 $ DAMAGE TO A X COMMERCIAL GENERAL LIABILITY ENVP005290-01 08116/2013 08/16/2014 PREMISES EIn) $ 100,001 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5,00( PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 1,000,00( GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,00( - POLICY fl JFcr fl LOC - - JJE1INGLE LIMIT $ AUTOMOBILE LIABILITY 1,000,000 (Ea acci $ B ANY AUTO P1A07520301 11/10/2013 11/1012014 BODILY INJURY (Per person) $ I ALL OWNED AUTOS AUTOS SCHEDULED NON-OWNED BODILY INJURY (Per accident) PROPERTY DAMAGE S - HIRED AUTOS AUTOS (PER ACCIDENT) $ - UMBRELLA LIAB EXCESS LIAB [_J OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ - DED I I RETENTION $ - - $ - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- TORY LIMITS I 0TH- ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, descrIbe under - DESCRIPTION OF OPERATIONS below - - E.L. DISEASE - POLICY LIMIT $ C Pollution Liabilit ENVP005290-01 08/16/2013 08/16/2014 Site Coy 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) AWTF dewatered sludge hauling/disposal CERTIFICATE HOLDER CANCELLATION OKALOOI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Okaloosa County Board of County Commissioners AUTHORIZED REPRESENTATIVE 602 C North Pearl Street Crestview, FL 32536 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (201 0/05) /) Tfile ACORZiame and logo are registered marks of ACORD 03-1214A09:25 RCVD