Okaloosa County BOCC — 2013 meeting #1141 (date undetermined) — DeVaux Certificate of Insurance — reading text

DEVA-01 OP ID: EM —_,; oO CERTIFICATE OF LIABILITY INSURANCE ue, 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 Phone: 850-581-4925] james” Waldorff Ins & Bonding - FWB . PHONE FAX 45 Eglin Parkway NE, Ste 202 ax: 850-581-4930) (aic, No, Ext): (AIC, No): Fort Walton Beach, FL 32548 ‘ed x Cae ag: Danny Hare at, ; Se) INSURER(S) AFFORDING COVERAGE NAIC # insurER A: ASSOCiation Insurance Company INSURED Devaux @coxnt INSURER B: SOUthern -Owners Ins. Co. 10190 evaux@cox.net ; 348 Marie Circle INSURER c : OWners Insurance Company 32700 Fort Walton Beach, FL 32548 INSURER D : INSURER E: 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL|SUBRI POLICY EFF_| POLICY EXP LTR TYPE OF INSURANCE INSR | WvD POLICY NUMBER (MMI/DDIYYYY) | (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 el DAMAGE TO RENTED B | X | comMERCIAL GENERAL LIABILITY 78464180 04/22/2013 | 04/22/2014 | premises (Ea occurrence) | $ 50,000 | CLAIMS-MADE OCCUR MED EXP (Any one person) | $ 5,000) |__| PERSONAL & ADVINJURY | $ 1,000,000) |__| GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 1,000,000 POLICY fee: LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000; Cc ANY AUTO 14946418000 04/22/2013 | 04/22/2014 | BODILY INJURY (Per person) | $ hoe xX ree BODILY INJURY (Per accident) | $ NON-OWNED PROPERTY DAMAGE 3 HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED | | RETENTION $ $ WORKERS COMPENSATION x | WC STATU- [OTH AND EMPLOYERS’ LIABILITY YIN TORY LIMITS ER A | ANY PROPRIETOR/PARTNER/EXECUTIVE IWCV010823901 07/25/2012 | 07/25/2013 | £1. EACH ACCIDENT $ 100,000) OFFICER/MEMBER EXCLUDED? [| N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE] $ 100,000) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 500,000) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Okaloosa Co BOCC-Install Storm Shutter/Window Door Protection @ Various School $122500 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. Okaloosa County Board of County Commissioners AUTHORIZED REPRESENTATIVE 602-C North Pearl Street Crestview, FL 32536 Lhaony Rhee © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD