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Okaloosa County BOCC — August 24, 2013 — Severn Trent Contract Extension — reading text
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Machine-extracted text — 64-Severn Trent Contract Extension.pdf
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TC2K-UB-8042%519-19/1/2013 |7/1/2014 [x | WMoSTae.| Ole
AND EMPLOYERS’ LIABILITY YIN
C_ | ANY PROPRIETOR/PARTNER/EXECUTIVE * TRK-UB-8042X520-13 17/1/2013 |7/1/2014 | EL. EACHACCIDENT $ 1,000,000
(Mandstory in NH) EXCLUDED? E.L. DISEASE-EAEMPLOYEE |$ 1,000,000
OL BReSION OF OPERATIONS below E.L. DISEASE-POLICYLimIT |$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space is required)
* Covered States are MA, AZ & WI
Re: Okaloosa County Utility Bill Printing Services Contract, Bid #WS 27-09, per notice award dated
November 20, 2009.
Okaloosa County is included as Additional Insured with regards to General and Automobile Policies
where required per written contract and where allowed by law.
CERTIFICATE HOLDER
CANCELLATION
Okaloosa County
602-C North Pearl Street
Crestview, FL 32536
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,
ACCORDANCE WITH THE POLICY PROVISIONS.
NOTICE WILL BE DELIVERED IN
AUTHORIZED REPRESENTATIVE
An SL wed bm EI
ACORD 25 (2010/05)
Coll:4141731 Tp1:1665816 Cert:20023565
The ACORD name and logo are registered marks of ACORD
© 1988-2010 ACORD CORPORATION. All rights reserved.
AGENCY CUSTOMER ID: 427656
LOC#:
ACORD
Ce ADDITIONAL REMARKS SCHEDULE Page_2.of 2
AGENCY NAMED INSURED
Severn Trent Environmental Services, Inc.
Willis of Pennsylvania, Inc. 4837 Swift Road, Suite 100
POLICY NUMBER Sarasota, FL 34231
See First Page
CARRIER NAIC CODE
See First Page EFFECTIVEDATE: See First Page
ADDITIONAL REMARKS .
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
If contract required less limit than what’s shown in the certificate, the lower limit will be
applicable.
ACORD 101 (2008/01) Coll:4141731 Tpl1:1665816 Cert:20023565 ©2008ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD