Okaloosa County BOCC — March 18, 2014 — Cuts by Angela 3-12-14 — reading text

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. linge DOL SUBR CY EXP rink TYPE OF INSURANCE INS WD POLICY NUMBER CADDY) (UMBIVYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 4,000,006, in | DAMAGE TO RENTED A | | commerciAt GENERAL LIABRITY > 4 31 04109344. 10/10/2013 | 10/40/2014 DAMAGE t (Ea ocomrencey | # 100,008 | CLAIMS-MADE OCCUR MED EXP {Any ane person) | $ 5,000 |__| PERSONAL & ADVINJURY | $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | § 2,000,000 POLICY FRO- Loc Emp Ben. $ 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY FOMBINED § § ANY AUTO BODILY INJURY (Perperan} | & ALL OWNED SCHEDULED BODILY INJURY (Per accident) | $ J NON-OWNED PROPERTY DAMAGE 3 HIRED AUTOS AUTOS (PER ACCIDENT) $ X | umpretaciaw = | X | occur EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE UMB00114364 10/10/2013 | 10/10/2014 | accrecate $ 1,000,006; pep |X | RETENTIONS 40000 5 WORKERS COMPENSATION We STATU- OTH- AND EMPLOYERS" LIABILITY X Ey, LIMITS ER B | ANY PROPRIETORIPARTNER/EXECUTIVE WC13A66690 06/16/2013 | 06/16/2014 | &L. EACH ACCIDENT $ 1,006,000, OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH} E.L. DISEASE - EA EMPLOYEE] $ 1,000,000 If yes, describe under 4 0.080) DESCRIPTION OF OPERATIONS below ELL. DISEASE - POLICY LIMIT | § ,000, DEBCRIPTION OF OPERATIONG { LOCATIONS ¢ VEHICLES (Attach ACORD tt, Additianat Remarke Schedule, mare space is required} County Commissioners 602-C North Pearl Street Crestview, FL 32536 CERTIFICATE HOLDER CANCELLATION OKALB01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gkaloosa County Board of CORD T c AUTHORIZED REPRESENTATIVE Lang Rare ACORD 25 (2919/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ii | . CUTS-01 OP ID: PJ ACCOR — CERTIFICATE OF LIABILITY INSURANCE eee maa ” 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. : 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 fiew of such endarsementt(s). nan Sut pers aS Ps rTP ashe san ape ehh Sr SCS CW St St As EPAPER PSPs IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to PRODUCER CONTACT F - NAME: ort Walton Beach Client Waldorff Ins & Bonding - FWB PHONE 45 Eglin Parkway NE, Ste 202 (Ale Wo, Exo: 850-581-4925 [ (AIG, Noy. 850-581-4920 Fort Walton Beach, FL 32548 ROORESS: Fort Walton Beach Client = : INSURER(S} AFFORDING COVERAGE NAIC # insurer a: Southern -Owners ins. Go. 10190 INSURED Cuts By Anglea INSURER B : Angela Holley DBA : ” 1701 Hwy 85, North BISURERC: Eglin AFB, FL 32542 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: : REVISION NUMBER: THIS 1S 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 POLIGIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP INR TYPE OF INSURANCE INSE POLICY NUMBER ADDI) (AMODIVYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,069 A 1X | commercial GENERAL LIABILITY x 78750945 03/44/2074 | 03/14/2015 | DAMACETORENTED ls 300,000 | CLAIMS-MADE OCCUR MED EXP (Any one person) | $ 16,000 —_ PERSONAL & ADVINJURY | $ 1,000,000 —_ GENERAL AGGREGATE $ 4,060,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG | $ 4,000,000 | POLICY | | 58%: | loc $ AUTOMOBILE LIABILITY i ae Livi |, ANY AUTO BODILY INJURY (Perperson) | $ [| ALL OWNED SCHEDULED 7 AUTOS AUTOS NED aeOPE alin accident) | $ | OPER] HIRED AUTOS AUTOS (PER ACCIDENT) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED | | RETENTION $ WORKERS COMPENSATION we STATU- [or AND EMPLOYERS’ LIABILITY vs TORY LIMITS: ER ANY PROPRIETOR/PARTNERIEXECUTIVE EL. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA {Mandatory in NH} EL DISEASE - EAEMPLOYEE| $ if yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT | $ ee 1701 Highway 85 North, Eglin AFB, FL 32342-1498. fel dded as additional insured as respects General Liabil DESCRIPTION OF OPERATIONS J LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate holder is ity. CERTIFICATE HOLDER CANCELLATION OKALBO1 Okaloosa County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Contracts & Lease cOordinator 602-C North Pearl Street \Crestview, FL 32536 AUTHORIZED REPRESENTATIVE Lue lilleff ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD