Okaloosa County BOCC — May 17, 2016 — GREENSOUTH CERT. OF INS. — reading text

GREEN-2 OP ID: WN DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/05/2016 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 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 NAME: SanBuck, Inc. PHONE FAX P.O. Box 311650 (A/C, No, Ext): (A/C, No): Enterprise, AL 36331-1650 E-MAIL ADDRESS: John Milton Buck INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Rockhill Insurance INSURED Greensouth Solutions, LLC INSURER B : Berkley Southeast 10804 Cole Dunn INSURER C : The Sheffield Fund 30851 Smyrna Road Florala, AL 36442 INSURER D : NY Marine & Gen. Ins. Co. INSURER E : Hallmark Specialty Ins. Co. 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY ENVP004634-03 08/20/2015 08/20/2016 PREMISES (Ea occurrence) $ 50,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 5,000 A X Contractors Pollu ENVP004634-03 08/20/2015 08/20/2016 PERSONAL & ADV INJURY $ 5,000,000 A X Transportation Po ENVP004634-03 08/20/2015 08/20/2016 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 5,000,000 PRO- POLICY JECT LOC Pollution $ 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 B ANY AUTO CAA 4284250 09/21/2015 09/21/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (PER ACCIDENT) $ X Brd Form P $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 E X EXCESS LIAB CLAIMS-MADE 77HX153242- AUTO ONLY 09/21/2015 09/21/2016 AGGREGATE $ 1,000,000 DED RETENTION $ 0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY X TORY LIMITS ER Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE 600-2016-19705-02 01/01/2016 12/31/2016 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A D (Mandatory in NH) WC201500010360 (FLORIDA) 12/16/2015 12/31/2016 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A E&O (Professional) ENVP004634-03 08/20/2015 08/20/2016 Agg 1,000,000 Each occ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION OKALOO1 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 (2010/05) The ACORD name and logo are registered marks of ACORD