Okaloosa County BOCC — October 18, 2016 — Certificate of Liability Ins 070516 - 070517

DATE (MMDD/YYYY) AN o ACORD CERTIFICATE OF LIABILITY INSURANCE 09128/16 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the polilcy, 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 SULLIVAN INS OF NW FLORIDA, INC o 25 Walter Martin Rd Ste 102 _ (850)862-63000001 [ % ot (850)862-5359 ,,A,ngn%sa: nancy.sullivanins@hotmail.com Ft Walton Beach, FL 32548 INSURER(S) AFFORDING COVERAGE nacs | I wisurer A: _Nautilus Insurance Company INSURED INSURER B : Allen Howell & Glen Bishop INSURERC : INSURER D : 10056 Cnty Rd 3280 INSURERE : - Brucs, FL 32455 INSURERF : 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. i TYPE OF INSURANCE (e W POLICY NUMBER | OBV Lws X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 . " DAMAGE TO RENTED | cLamsamne [X] occur | PREMISES (Enocourence) |8 100,000 | et} - MED EXP (Any one person) | § 5,000 Al | Y NN691530 07/05/16 | 07/05/17 | PERSONAL &ADVINJURY | § 1,000,000 | GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 2,000,000 X] poucy || 58% [ e PRODUCTS - COMP/OP AGG | $ 2,000,000 —r COMBINED T - MBINED SINGLE | AUTOMOBILE LIABILITY | (B aocdent $ ANY AUTO BODILY INJURY {Per persan) | § ] | owneD SCHEDULED - D Y SoHED BODILY INJURY (Per accident) | $ | HIRED NON-OWNED PROPERTY DAMAGE s || AUTOS ONLY AUTOS ONLY | (Per accidont) $ | | UMBRELLALIAB OCCUR EACH OCCURRENCE s i EXCESS LIAB CLAIMS-MADE AGGREGATE $ oED | | ReTENTIONS s WORKERS COMPENSATION [ PER [ 13" AND EMPLOYERS' LIABILITY vi : ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA {Mandatory in NH) EL DISEASE - EAEMPLOYEE § If yes, describe und DESERIPTION OF GPERATIONS below EL DISEASE - POLICY LIMIT | § DESCRIPTION OF OPERATIONS / LOCATIONS { VEHICLES (ACORD 101, Additional Schedule, may be f more space Is required) CERTIFICATE HOLDER CANCELLATION Okaloosa County Board of Commissioners 1250 N Eglin Pkwy Shalimar, FL 32579 aallen@co.okaloosa.fl.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Moy £ £ ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD