Okaloosa County BOCC — April 1, 2014 — COI — reading text

DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/1/2015 3/24/2014 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). CONTACT PRODUCER LOCKTON COMPANIES, LLC NAME: 5847 SAN FELIPE, SUITE 320 PHONE (A/C, No, Ext): FAX (A/C, No): HOUSTON TX 77057 E-MAIL 866-260-3538 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ACE American Insurance Company 22667 INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED, INSURER B : Indemnity Insurance Co of North America 43575 1300299 RELATED & SUBSIDIARY COMPANIES INCLUDING: INSURER C : ACE Property & Casualty Insurance Co 20699 SPRINGHILL REGIONAL LANDFILL 4945 HIGHWAY 273 INSURER D : CAMPBELLTON FL 32426 INSURER E : INSURER F : COVERAGES FLCAMPBE CERTIFICATE NUMBER: 12847635 REVISION NUMBER: XXXXXXX 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 A GENERAL LIABILITY Y Y HDO G2732924A 1/1/2014 1/1/2015 EACH OCCURRENCE 5,000,000 $ DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) 5,000,000 $ CLAIMS-MADE X OCCUR MED EXP (Any one person) $ XXXXXXX X XCU INCLUDED PERSONAL & ADV INJURY $ 5,000,000 X ISO FORM CG 00011207 GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 6,000,000 PRO- POLICY X JECT X LOC $ COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY Y Y MMT H08816025 1/1/2014 1/1/2015 (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ XXXXXXX X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXXXXX X MCS-90 $ XXXXXXX C X UMBRELLA LIAB X OCCUR Y Y XOO G27054961 1/1/2014 1/1/2015 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000 DED RETENTION $ $ XXXXXXX WORKERS COMPENSATION WC STATU- OTH- B AND EMPLOYERS' LIABILITY Y/N Y WLR C47876345 (AOS) 1/1/2014 1/1/2015 X TORY LIMITS ER A WLR C47876357 (AZ,CA&MA) 1/1/2014 1/1/2015 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 3,000,000 A OFFICER/MEMBER EXCLUDED? N N/A SCF C47876369 (WI) 1/1/2014 1/1/2015 $ 3,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 3,000,000 A EXCESS AUTO Y Y XSA H08816013 1/1/2014 1/1/2015 COMBINED SINGLE LIMIT LIABILITY $9,000,000 (EACH ACCIDENT) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (EXCEPT FOR WORKERS’ COMP/EL) WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. 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. 12847635 AUTHORIZED REPRESENTATIVE COUNTY OF OKALOOSA, FLORIDA 302 N. WILSON ST. - SUITE 302 CRESTVIEW FL 32536 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD