Okaloosa County BOCC — March 3, 2015 — Certificate of Liability Insurance - Nabors, Giblin & Nickerson, P.A. (2 documents) — reading text

//‘fi . NABOR-1 QP ID: GS ACCRD CERTIFICATE OF LIABILITY INSURANCE B ! THIS CERTIFICATE 1S 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 Earl Bacon Agency, Inc Phone: 850-878-2121 CONTACT NAME: 3131 Lonnbladh Road Fax: 850-878-2128 §‘1,§N”,fo Exty: (AIE, Noy: P.O. Box 12039 ; X Tallahassee, FL 32317 ADDRESS: John R. Nyien, Jr. INSURER(S) AFFORDING COVERAGE NAIC # nsurer a : Zenith Insurance Co 13269 INSURED N?l;(ors, Gibllir‘;& insurer 8 : American States Insurance Co 19704 ickerson, P.A. ) P.O. Box 11008 INSURER C - Tallahassee, FL 32302 INSURER D : INSURERE : 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADDL|SUBR| POLICY EFF POLICY EXP TYPE OF INSURANCE INSR | WvD POLICY NUMBER (MN/DDIYYYY] | (MV/DD/IYYYY} LimTs | GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000, B | X | COMMERCIAL GENERAL LIABILITY 01C132656936 01/28/2016 | 01/28/2016 | PAVRE S (o reence) | § 1,000,000 | CLAIMS-MADE OCCUR MED EXP (Any one persan) | § 10,000 L PERSONAL & ADV INJURY | § 1,000,000] | ] GENERAL AGGREGATE 5 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG | § 2,000,000 poucy| | 58% Loc $ | AUTOMOBILE LIABILITY ety SLELIMIT | 1,000,000 B | |anyauTO 01C13265936 01/28/2015 | 01/28/2016 | BODILY INJURY (Per person) | § N fi[l:ll'i' g\éVNED - 28¥53ULED BODILY INJURY {Per accident}| $ | X | HRep AuTos | X | AOToaNED PROPERTY DAAGE P $ | X | UMBRELLALIAB | X | occur EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE 01SU41768160 01/2812015 | 01/2812016 | acorecATE s 5,000,000 DED | X | RETENTION S 10,000 $ WORKERS GOMPENSATION X | WG STATU- OTI- AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER A | ANY PROPRIETOR/PARTNER/EXECUTIVE 2830151627 01/28/2015 | 01/28/2016 | £ EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA g (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE| 8 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) CERTIFICATE HOLDER CANCELLATION Okaloosa County, Florida OKCOFO2 1804 Lewis Turner Blvd Ste 400 Fort Walton Beach, FL 32547 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (ALl G ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. s NABOR-1 OP ID: GS ACORD" CERTIFICATE OF LIABILITY INSURANCE otitai0ts 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 Earl Bacon Agency, Inc 3131 Lonnbladh Road P.O. Box 12039 Tallahassee, FL 32317 CONTACT Phone: 850-878-2121 NAME: Fax: 850-878-2128 PHONE (AJ/C, No, Ext): FAX (AIC, No): E-MAIL ADDRESS: John R. Nylen, Jr. INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zehith Insurance Co 13269 INSURED ma‘i‘:"'s: Gib';i“ & iNsuRer B : American States Insurance Co 19704 ickerson, P.A. ) - : P.O. Box 11008 wsurer ¢ : TheTravelers Indemnity Company 25658 Tallahassee, FL 32302 INSURER D : INSURERE : INSURERF : 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLISUBR IE1§§ TYPE OF INSURANCE INSR1WVD POLICY NUMBER (rm;fl%}(fi;i') (n%l?n%%\/{v%)\(&) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ~ ] DAMAGE TO RENTED B | X | COMMERGIAL GENERAL LIABILITY 01C13265936 01/28/2015 | 01/28/2016 | prepvises (Ea oceurrence) $ 1,000,000 | CLAIMS-MADE OCCUR MED EXP (Any one person) | $ 10,000, PERSONAL & ADVINJURY | § 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 2,000,000 POLICY JPECO‘E LoC $ AUTOMOBILE LIABILITY ?Eg“ggé?é'gfit)s'NGLE LMT 1,000,000 c ANY AUTO BA446L476109SEL 01/28/2009 | 01/28/2010 | BODILY INJURY (Per person) | 3 fiblzl'g‘évNED - fifi?ggULED BODILY INJURY (Per accident) | $ X X | NoN-OwnED PROPERTY DAMAGE s HIRED AUTOS AUTOS (Per accident) $ X |umsretiaviag | X | ooour EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE 01SU41768160 01/28/2015 | 01/28/2016 | AGGREGATE $ 5,000,000 DED | X | RETENTION § 10,000 $ WORKERS COMPENSATION X | WC STATU- OTH- AND EMPLOYERS' LIABILITY VIN TORY LIMITS ER A Aog;:/lgEg/m5TB%§/E;\(%{3%§§;<ECUT|VE D NIA 2830151627 01/28/2015 | 01/28/2016 | £ EACH ACCIDENT $ 1,000,000 ffl\lland:tury':’n NHC)’ i E.L. DISEASE - EA EMPLOYEE| $ 1,000,000 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) CERTIFICATE HOLDER CANGELLATION Okaloosa County, Florida 1804 Lewis Turner Blvd Ste 400 Fort Walton Beach, FL 32547 OKCOFO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ACCORDANCE WITH THE POLICY PROVISIONS. IN AUTHORIZED REPRESENTATIVE /A2l 7L} ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. Allrights reserved.