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Certificates of Insurance STATE FARM INSURANCE COMPANIES® A >/ K ty 1'crw( .... DATE OF NOTICE: MAK 16 2007 7401 Cypress Gardena Boulevard I Winter Haven FL 33888 -- -- - - - -. , -_ --- - -- CODE: O y 'p )5 5t h , .3 A241 19 147A EU' V -, D ei 1 MONROE COUNTY BOARD OF �� N TE: PLEASE NOTIFY STATE FARM AT THE COUNTY COMMISSIONERS MAR 2 0 %001 i A DRESS LISTED AT THE TOP LEFT CORNER 1100 SIMONTON ST RM 1 -213 0 THIS PAGE REGARDING ANY CHANGE OF KEY WEST FL 33040 -3110 __,____ _____.i A DRESS INFORMATION. 1 1.. COUNTY { R!5 I I IIIlrnIIr Irl1I , :A9 a3A130321 :3WIl 100 ?0ZTill 4 1N3INd013A30 S3111110Vd A[Nf1OO 3OdNOVI ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 1163 F603 - NAMED INSURED: POLICY NO: 83 8673 D26 - 59H COVERAGE: ' I S PEDRO FALCON ELECTRICAL YR /MAKE/MODEL: 1994 FREIGHT TRUCK BI AND PD LIABILITY i t{; :.ti CONTRACTORS INC VIN /CAMPER: 1 FV6JFAB5RL587063 $1 MIL x .4 f 31160 AVENUE 0 AGENT NAME: WILLIAM MARTI $2000 DED COMP. VEIN 'o BIG PINE KEY FL 33043 -4516 AGENT PHONE: (954)987 -0121 $2000 DED. COLL. c ENDORSEMENT NO: 6028E.5 POLICY EFFECTIVE MAR 12 2007 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0838673 -59G. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. • • \Of _ l n OUTING D 8 :5A-e- /frac 0 _________ 1 �w 0 • ac` FRT ACORD_ CERTIFICATE OF LIABILITY INSURANCE OPID PEDRO-2 10 24 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER BUTLER, BUCKLEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MIAMI FL 33126 Phone: 305-262-0086 INSURED INSURERS AFFORDING COVERAGE NAIC# PEDRO FALCON ELECTRICAL CONTRACTORS, INC. 31160 AVE C BIG PINE KEY FL 33043-4516 INSURER k INSURER B: INSURER c: INSURER 0: INSURER E- Ori~ AMERICAN INTERNATIONAL GRP AlG F.C.C.r. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING .. . ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~~ ~~~ I PD~~~~MMIDD~- P~kTE'/MMlDDrP,~N ... . - TYPE OF INSURANCE POLICY NUMBER LIMITS ~NERAL LIABILITY EACH OCCURRENCE $1,000,000 B X ~lC.. 3MMERCIAL GENERAL LIABILITY CPPOOO7150 03/13/07 03/13/08 ~_ISES (Ea o~~~~nce) $100,000 m_ - H CLAIMS MADE [il OCCUR MED EXP (Anyone person) $ 5,000 1-- ..... PERSONAL & ADV INJURY $ 1,000.,000 . GENERAL AGGREGATE $2,000,000 -- "'-'-- rr AGG~EnE,~~~ APPlS PER: PRODUCTS - COM PlOP AGG $2,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Eaaccident) , ANY AUTO f-- hi \ ( -. - 1- ALL OWNED AUTOS , ~Q BODILY INJURY $ SCHEDULED AUTOS (Per person) f-- HIRED AUTOS BODilY INJURY u_ 10'-<,: G'OJ $ NON-OWNED AUTOS {Per accident) f-- --- I f-- PROPERTY DAMAGE $ (Per accident) RAGE L1AalL'TY AUTO ONLY - EA ACCIDENT $ -, ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGO $ ~ESSJUMBRELLA liABILITY EACH OCCURRENCE $ 4,000,000 B X OCCUR D CLAIMS MADE UMBOO05173 03/13/07 03/13/08 AGGREGATE $ 4,000,000 $ H DEDUCTIBLE $ RETENTION $ I $ WORKERS COMPENSATION AND ITORY;:t'lC,i~s I IUER- A EMPLOYERS' LIABiLITY WC1760051 01/01/07 01/01/08 $ 500000 ANY PROPRIETORlF':l.Rn,<:t:JEXECUTIVE E.l. ~Ar.H ACCIDENT ---- OFFICER/MEMBER EXCllj;jED? E.l. Dlbt:ASE - EA EMPLOYEE $ 500000 ~~E(;I~tS~~~V~~?~~S below EL DiSEASE - POLICY LIMIT $ 500000 OTHER 03/13/081 A EQUIP FLOATER CPPOOO71531 03/13/07 I LIMITS $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS PROJECT: BIG PINE KEY FIRE STATION #13 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS NAMED AS AN ADDITIONAL INSURED. Cc ;:::; i,-, Q,.y, c. e.- CERTIFICATE HOLDER CANCELLATION MONCTPW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN MONROE COUNTY PUBLIC WORKS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ATTN: ANN RIGER 1100 SIMONTON ST. , STE. 2-216 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR KEY WEST FL 33040 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) @ ACORD CORPORATION 1988 eX, 12/11A1 Au< tA'e- I7k ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10]'9 DATE (MM/DDIYYYY) PEDRO-2 04/25/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BUTLER, BUCKLEY, DEETS INC. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6161 BLUE LAGOON DR. , STE 420 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, MIAMI FL 33126 Phone: 305-262-0086 INSURERS AFFORDING COVERAGE " NAIC# INSURED FCCI Insurance Cq;;., ...;! ITIE:~ - - " INSURER A: , INSURER B: th".kJ ,1(_;,;/. A. (~ :D PEDRO FALCON ELECTRICAL INSURER c- J,I:'~ ,,_, M^1. CONTRACTORS, INC. 31160 AVE C INSURER 0: no 1\ "'" 'UUp BIG PINE KEY FL 33043-4516 I INSURER E: ^, COVERAGES ,'-;".-- JTJt' 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . 'LTR ~SR: TYPE OF INSURANCE POLICY NUMBER I PD~';!~~~MIDDJYY1- P8k~1YI~:~~J!gN LIMITS ~NERAL UABllITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CPOOO71532 03/13/08 03/13/09 PREMISES (E~~~~~nce\ $100,000 I CLAIMS MADE [!] OCCUR MED EX? (Anyone person) $ 5,000 f-- PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 c- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 hi ,n:RO' n, POLICY JECT LOC ~TOMOBILE UABllITY COMBINED SINGLE LIMIT $ ANY AUTO (Eaaccident) - [)D\. 00,,. .~ ALL OWNED AUTOS. BODILY INJURY - $ SCHEDULED AUTOS (Per person) - HIRED AUTOS ---- ....- -..-- - If--~ ~ BODILY INJURY $ NON-OWNED AUTOS {Per accident) - ~i PROPERTY DAMAGE $ .... . .' -.--"-'- (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: .AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 4,000,000 A !J OCCUR D CLAIMS MADE UMBOO05173 2 03/13/08 03/13/09 AGGREGATE $ 4,000,000 $ ~ ~EDUCTIBLE $ X RETENTION $10 000 $ WORKERS COMPENSATION AND I TORY LIMITS I I U ~~. EMPLOYERS' LLABILlTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under $ SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECLAL PROVISIONS TEN (*10) DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT. BIG PINE KEY FIRE STATION #13 MONROE CO. BD OF CO. COMM. IS LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION MONROE3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MONROE COUNTY FACILITIES DATE THEREOF, THE ISSUING INSURER W1LL ENDEAVOR TO MAIL *30 DAYS WRITTEN DEVELOPMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ANN RIGER 1100 SIMONTON ST ROOM 2-216 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR KEY WEST FL 33040 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (20)l:'1/08) G~..~ @ ACORD CORPORATION 1988 ACOR~M CERTIFICATE OF LIABILITY INSURANCE PRODUCER Phone: 305-423-2204 Fa;.::: 786-662-67'76 Allied North America Insurance Brokerage 550 Biltmore Way, PH2 Coral Gables FL 33134 ~ INSURERS AFFORDING COVERAGE INSURED Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C Big pine Key FL 33043-4516 ! INs~!3~B.i\:National Union Fire Ins i INSURER B: r';NSURER c: INSURER D: INSURER E: I .---...............................................................-...t COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA,.'VIED ABOVE POR THE POLICY PERIOD INDIC.lI...TED. NOTWITHSTANDING .ANY RE:QUIREf.~ENT t TERM OR CONDITION OF k'IT CONTRACT OR OTHER DOCUMENT WITH RESPECT TO viHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO P..LL THE TERMS, EXCLUSIONS k'JD CO~"1)ITrONS o Eo' SUCH POLICIES. AGGREGATB Llt-1ITS SHOWN' fvtAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR "'7'DfjT(f'- ----..--..--....-.! POLlCY NUMBER "--"--"-T POL.ICY EFFECTIVE POLiCY ExpiRATloN.r--.........-.....-...........----.-.-.-- LIMITS 1 GENERAL LIABILITY n COMMERCIAL GENERAL LIABILITY r-~I.~.~.~] CLAIMS MACE I ! OCCUR l ! H--.....-.... : l ~ 1 GEN'L AGGREGATE LIMIT APPLIES PER: Ii POLICY ....-....... PE:O- ............1 LOC AUTOMOBILE lIABIL.ITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS I ~._-_.._.._......................................_... 1 PERSONAL & ADV INJURY 1 GENERAL AGGREGATE r-..-..-..........-.........."...-...--.. .. j PRODUCTS N COMP/OP AG~_ COMBINED SINGLE LIMIT (Ea accident) 1 1$ GARAGE LIABILITY ANY AUTO BODlLYINJURY (Per person) $ 800tL Y INJURY (Per accident) s PROPERTY DAMAGE (Per accident) s 1 EXCESS/UMBREL.LA L.i!ABtlITY P OCCUR r--J CLAIMS MACE t--l 1 1 DEDUCTIBLE r---'i j i RETENTION $ A WORKERS COMPENSATION ,~ND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERlEXECUilVE OFFICERJl\,1EMBER EXCLUDE!)? ~p~~:t~~6vfS~~NS below ! OTHER AUTO ONLY - EA ACCIDENT i $ ! OTHER THAN EA ACe $ I AUTO ONLY: AGG $ ~ EAC~ OCCURRENC_~__~.. ..!....._.___._._____..._.. j AGGREGATE $ $ ,~._..__...._._._._...___....N_..____.__.._ $ IWC5446016 11/2/2009 111/2/2010 I ! ! ! OTHN ER DESCRIPTION OF OPERATIONS ILC)CATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS flrViE. RECE.~;fDRY' CERTIFICATE HOLDER Monroe County Board of County Commissioners 1100 Simonton Street, Room 2-216 Key West FL 33040 CANCELLATION SHOULD k'lY OF THE ABOVE DESCRIBED POLICIES BE CA:.~CELLED BEFORE THE EXPIRATION DATE THEREOF I THE ISSUING INSURER WILL ENDEAVOR TO MAII.~ 30 DAYS WRI'rTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT I BUT Ef'AII.lURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILI'rY OF A..~y KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ./.fll"':"-;:? //:: .~..." ~ .' q .~ ~~:3J ;-~V ~ Aa. -- v~ 0 ;~z: L ACORD 25 (2001/08)