Okaloosa County BOCC — October 5, 2013 — FA Certificate of Insurance - Okaloosa — reading text

DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/6/2013 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: Helen Stuart Roach Howard Smith & Barton PHONE FAX 8750 N. Central Expressway (A/C, No, Ext): (972) 744-2704 (A/C, No): (972) 744-2804 Suite 500 E-MAIL ADDRESS: hstuart@rhsb.com Dallas TX 75243 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Great Northern Ins Co 20303 INSURED (214) 953-4000 INSURER B : Federal Ins Co 20281 First Southwest Company First Southwest Asset Management, Inc. INSURER C : Texas Mutual Ins Co 22945 325 N. St. Paul INSURER D : Travelers Prop Cas America 36161 Suite 800 Dallas TX 75201 INSURER E : Fireman's Fund Insurance Co 21873 INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 24609 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 $ 1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY 35787714 12/15/2012 12/15/2013 PREMISES (Ea occurrence) $ 1,000,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Included PRO- POLICY JECT X LOC Location Agg Limit $ 10,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO 74968567 12/15/2012 12/15/2013 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ BE X UMBRELLA LIAB X OCCUR 79785393 12/15/2012 12/15/2013 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE SHX00031999006 12/15/2012 12/15/2013 AGGREGATE $ 10,000,000 DED RETENTION $ Excess Umbrella $ 10,000,000 WORKERS COMPENSATION WC STATU- OTH- CD TSF0001199604 - TX 4/1/2013 4/1/2014 X TORY LIMITS ER AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE HJUB3491N91613 - OS 4/1/2013 4/1/2014 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) General and auto liability policies include a blanket automatic additional insured endorsement/provision that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. General and auto liability policies contains a special endorsement/provision with “primary additional insured” wording. General and auto liability, and workers compensation policies include a blanket automatic waiver of subrogation endorsement/provision that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it. RE: Okaloosa County Financial Advisory Services, Contract No. C04-1098-BCC5-68. CERTIFICATE HOLDER CANCELLATION 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 Attn: John Christopher AUTHORIZED REPRESENTATIVE 602C 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 Page 1 of 1