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y'\CORD"NABOGIB-01CERTIFICATE OF LIABILITY INSURANCEJULIEDATE (MIWOD/YYYY)05/15/2018THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on^h[s csrtiflcate does not confer rights to the certificate holder In lieu of such endorsement(s).PRODUCEREarl Bacon Agency, Inc.Post Office Box 1^039Tallahassee, FL 32317?AC^"No.Extl: (850)878-2121FAX:-MA11as;@)S,?j,(850) 878.2128INSURER(S) AFFORDING COVERAGE!NsuRBAA:West American ^^^^^|44393_NAIC#INSUREDNabors, Giblin &Nickerson, P.A.P.O. Box 11008Tallahasses, FL 32302jNsuRERB;Ohio Casualty Insurance Company24074INSURER c:ZenIfh Insurance Company13269INSURER D ;INSURERE!INSURER F:.COVERAGESCERTIFICATE NUMB ER:REVISION NUMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED. BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.INSRJJB-AABcVfPE OF INSURANCExCOMMERCIAL GENERAL LIABILITfCLAIMS-MADE | X I OCCURSEN'L AGGREGAIE LIMIT APPUES PER;POUCY [| S'gPf | X ] LOGOTHER:AUTOMOBILE LIABILIT]'xXANY AUTO.AUTOS ONLYWO°SONLY>JMBRELLA UAB3XCESS LIAB^gULED<OCCURCLAIMS-MADI3ED ( X | RETENTION? 10,00'IORKERS COMPENSATIONND EMPLOYERS' UABIUFrNY PROPRIETOR/PARTNER/EXECUTIVE'FIQER/MeMBEB EXCLUDED? .landatory In NH)!es. dsscribe underiCRIPTION OF OPERATIONS belowIDINSx//;UEN\iPOLICY NUMBER5KW58291554AW58291554S058291554B30151630DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may b<[EFT"Con'tract#10-M70'"'"""""""' -"--- -"——-..""—-..".-.""""-""—,.;olller County Is an additional Insured with respects to the general Liability per writtenPOLICY EFF(MM/DGfYYYYI01/28/201801/28/201801/28/201831/28f2018POLICY EXFIMM/OO/m"!01/28/201!01/28/201 £1M/28/201S31/28/2019LIMITSEACH OCCURRENCEDAMAGE TO RENTEDPREMISES (Ea occun-enca).MED EXP (Any one paraon)PERSONAL & ADV INJURYGENERAL AGGREGATEPRODUCTS - COMP/OP AGOEMPLOYEE BEN ASCOMBINED SINGLE LIMITfEa'accident)BODILY INJURY (Per person)_BODILY INJURY (Per accident)roPERTY.pAMAGE'eracciden!;ACH OCCURRENCEWSREQATEaggregatePER I I OTH-STATUTE I I EES.L. EACH ACCIDENTS.L. DISEASE-EA EMPLOYEEl:.L. DISEASE-POLICY LIMITtttached ? more space fs raqulred];ontract., 1,000,0011,000,001s - ~ 1-5,OOIi.,_2,000,001„ • 2,000,00(_2,000,00(, 1,000,00(ts(__tt 5,ooo,o6ct_g_5,000,000; 1,000,OOC_.1,000,0001,000,000CERTIFICATE HOLDER_CANCELLATIONSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVE^ %^^L. ^ACORD 25(2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
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