Certificates of Insurance
A CORDTM CERTIFICATE OF LIABILITY INSURANCE T DATE lMM/DDIYY)
8/27/01
PRODUCER 561-368-2777 THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMATION
Acordia ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Boca Raton Division HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
3839 NW BOCA RATON BLVD.STE.200
Boca Raton, FL 33431 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Penn American Insurance CO
TPE VENTURES. INC. MGA Insurance Company
TPE STRUCTURES. INC. INSURER B:
P.O. BOX 2066 INSURER C:
IKEY WEST FL 33045 INSURER 0:
INSURER E:
COVERAGES
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. EXCLUSIO~S AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRI TYPE OF INSURANCE POLICY NUMBER ~<i~~Y~~~6gTt~~ P8k'-fEY,~J!~J.J$~ LIMITS
LTR I
A ~NERAL LIABILITY PAC6174763 12/09/00 12/09/01 EACH OCCURRENCE $ 1000000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 100000
I CLAIMS MADE W OCCUR M ED EXP (Any ome person' $ 5000
- PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 1000000
-
~'L AGGREn LIMIT APn PER: PRODUCTS - COMP/OP AGG $ 1000000
X POLICY ~~9T LOC
B ~TOMOBILE LIABILITY MPP138002 5/04/01 5/04/02 COMBINED SINGLE LIMIT
$ 1000000
ANY AUTO (Ea accident)
I--
I-- ALL OWNED AUTOS BODILY INJURY
~GeMEN' $
SCHEDULED AUTOS AP n \\, It( lPer person)
-
L HIRED AUTOS BY BODILY INJURY
$
L NON-OWNED AUTOS 'v '7 yOl (Per accident)
DATE 1-(
- .". ,..- ;7 PROPERTY DAMAGE $
v~t' lPer accident)
GARAGE LIABILITY n<".....', AUTO ONLY - EA ACCIDENT $
===i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
D- OCCUR 0 CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
NORKERS COMPENSATION AND r WC STATU- T TOTH-
TORY LIMITS ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDeNT
$
E,L, DISEASE - EA EMPLOYEE $
E,L DISEASE - POLICY LIMIT $
OTHER
MOIfROE COUNTY
DESCRIPTION OF OPERATIONSIlOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICA TE OF INSURANCE IS SHOWN AS ADDITIONAL INSURED WITH RESPECT
TO THE GENERAL LIABILITY AUG 31 2001
- W
RECmED BY: -
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER lETTER: CANCELLATION
MONROE COUNTY BOARD OF COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR, TO MAIL -1Q.. DAYS WRITTEN
COMMISIONERS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE U!FT. BUT FAILURE TO DD SO SHALL
5100 COLLEGE RD. #2 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
KEY WEST. FL 33040 REPRESENTATIVES. .AI"
AUTHORIZED ~~TIVE
I ~7 '.___ ~
,
ACORD 25-S (7/97)
55- 35
@ACORD CORPORATION 1988
Sep 04 Jt 0?:',5p
ENCLOSURE (4)
M.C.A. INST
~4709.2
"I c: n I" 0,,, C ", u "; ';:' ':i
~ONROECQUNJr
WIWIfIUCnON M~GEMENT
SEP-,~
, ,
/
3052954321
DME:
1996 fICRD ~
1VHP~RO [, COlJNTY, FLORIDA
Jhl'IUI~Slt For V\'aiver
of
I m.ll l'llfll~l!: Hequirements
It i) requesled that the in~1Jran!;t n:qLlircnH'llts, a ~pecjritd in the County's Schedule of Insurance Requirements, I>e
waived or mo( itied on (he following conlracl.
Contractor:
Contracl for:
Address of Co Hmctor:
Ph,)o\:':
Scope of \Vor~ :
Reason for Wi iver,
Policies WaiVi!
willllPply to:
Signature of (' :-ntr;.lclc;,r:
Risk Managen,er,[
Date
CUUflly t\,IIl1!i ",ifilor JPP\:~;
Dale:
~_~j.L(~e~~JI(
j~~;2_~::~Y
~-)'j!)f~ -)__]::;__1- 330 4 S- ,
2A5..~__~~t~.._.=Y_LLJ
.------~-Q,n,.c-L~.....ic__JCf's{uvud-\ - 0 f'\\./~
------ . ..-+t&L~J
y.----_._-~_..._.- ---~........_-_. -- .-~-~-----
-1-~1l___Cy-_--,-\~~._.:k____ h OVl - 0 ~ c(.. J Ctlli:L_
b.lf..uL__Y.C.h~1e..J. lhL C <<n ~ J
-,Jq~'~__JlQt____Q._~____~ Y V.eln Ie ley
:-~.~-=~--.~-"
~_~~Prov~
----- ... ~sLQL_
Ap~1;ovej:
Not Approved:
---. '--"~-"--'----'~'.'"-~'----_.~" --~ -..--- ---,"
~'
Board of Cour (y Cormn.ssiGi1'~r.s ii?peal:
Appiovel:.,__. ._.u_,,__
Meeting Dale:
Admll1islrl\llOn l1Slflj,:(I<:ln
1/ ,1' (!<J ,:~
Not Approved:
..,._'~._---~..~-_......_..- ~--_. ,- -__ _"______u__.___
\1102
," A-cORD", CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlCtYY)
08/23/2001
PRODUCER THIS CERTFICATE IS ISSUED AS A MATTER OF INFORMATION
WORKERS' COMPENSATION GROUP, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO BOX 410 ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW.
BOCA RATON FL 33429-0410 INSURERS AFFORDING CCM!RAGE
561-392-3300
II8UItED TPE STRUCTURES, INC. INSURER k AmCOMP PREFERRED INSURANCE CO.
PO BOX 2066 INSURER B:
KEY WEST FL 33045 INSURER C:
INSURER 0:
I INSURER E:
COVERAGES
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 CONDCTIONS OF SUCH
POLICIES. AGGREGATE LMTS SHOWN MAY HAVE BeEN REDUCED BY PAID CLAIMS.
I~~: POLICY EFFECTlYE POLICY EXPIRATION -
TYPE OF IN8UItANCE POUCY IIUIIIIER ~.
GENERAL LIA8IJTY EACH OCCURRENCE $
-
COMMERCIAl. GENERAL LWllllTY FIRE DAMAGE (Af'y one lint) $
I CLAIMS MADE o OCCUR MED EXP (Any otle ....-,) $
PERSONAl. & At::1V INJURY $
- GENERAl. AGGR~TE
$
GEN'L AGGREGATE LIMIT APPUE8 PER: PRODUCTS- ~ NlG $
nPOUCYn~ nLOC
~OIIOM.E UoUIJTY COMSlNED SlNG~ UMIT $
AN'( AUTO APPAQ~Ef{l r'I ~' --MENT (Ea -*lent)
I- 'lhUJ'
ALl OWNED AUTOS BOOIL Y INJURY
i-- BY - J~ $
SCHEDULED AUTOS ~ fll (Per ....-,)
I- DATE I '"' ' \ \
HIRED AUTOS BODlL Y INJURY
I- $
NON-OWNED AUTOS N/A .-L.. (Per lICCldenl)
I- WAIVER YES
- PROPERTY DAMAGE $
(Per lICCldenl)
=1UASanY AUTO ONlY - EA AccIDENT $
AN'( AUTO OlHER THAN EA N:.C $
AUTO ONlY: NlG $
EXCEII LIAIIIUTY EACH OCCURRejcE $
0- OCCUR 0 CLAIMS MADE NlGREGATE $
$
R DEDUCnBlE $
RETENTION $ $
WORKERS COMPENSATION AND X 1~5[.A.::ts11 10m-
EIIPLOYERI' UASanY WCV7006923 01-12-01 01-12-02 $100,000
E.L. EACH ACCIDeNT
A E.L. DISEASE - EAIEMPlOYEE $100,000
E.L, DISEASE - POUCY LIMIT $500.000
OTHIEIt
*FLORIDA EMPLOYEES ONLY* dROE COUNTY
cnON MANAGfMfNT
DESCRPTION OF OfII!RATIONM OCA~CL""'AIlOID M'1NDOIt...IT--=w. ~
AUG 31 2001
.., GJ-
IICEnED BY: ~
CERTIFICATE HOLDER I I ADDrTIONAL 1N8URED; IN8UItIElt LETTEIt: CANCELLATION
IHOULD NI'f OF THE MO\I& DEICRI8ED POl.ICIEIIIE ..oRE THE ElCJIIItATION
MONROE COUNTY BOARD OF COUNTY DATE THEREOF, THE IIIUIIG IN8UItIElt WLL ENOEAVOIt ,. UIL ~ DAYI WItITTEN
COMMISSIONERS C/O PURCHASING NOTICE TO THE CElmFlCATE HOLDEJt NAIlED TO ~ l.B'Tj IIUT FAlLUItE TO DO 10 IHALL
5100 COLLEGE ROAD #2 _POlE NO OIILIGATION OR LIAIIIUTY OF NI'f ICIND !rHE -...uiIl, IT, AGENTI OR
KEY WEST FL 33040 ItEPRElENTAllVEI. I J. ~ A .
AUTHOIUZED REPItEIENTATlVE /:z;. ~~7~
I
ACORD 21-8 (7/17)
f) ACORD CORPORATION 1881
ea/22/2ee1 18:23
385-292-4615
TPE
PAGE 83
1996 E4kiaa
INSURANCE AGENT'S STA.IBMENT
I have reviewed the above requirements with the bidder named below. The following deductibles
apply to the corresponding policy. '
POLICY
]Ie 17~o b1fJv?J
DEDUCTIBLES
~
Liability policies are _ Occurrence _ Cla:in1s Made
WORKERS' COMPENSATION GROUP
Pi division of GROUP ASSURANCE
PO BOX 410
BOCA RATON1..b~1U
561-392-3300
~~~~A
BIDDERS STATEMENT
I uudcrstand the insurance that will be TYumdatory if awarded the contract ~ will comply in full
with (Zuirem<:nb;o .:' ..
B~_
INSCKLST
Adminbln1ion Il\SU"Uomon
"709.3
II
08/22/01 10:35
TX/RX NO.2576
P.003
.