Certificates of Insurance
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy
and does not amend, extend, or alter the coverage afforded by the policies listed below.
Named Insured(s):
TAFF LEASING, L.P., BY STAFF ACQUISITION, INC., THE
ENERAL PARTNER, AND THE AFFILIATED LIMITED
ARTNERSHIPS OF WHICH STAFF ACQUISITION, INC. IS THE
ENERAL PARTNER AND STAFF LEASING, INC IS THE LIMITED
ARTNER.
00 301 BOULEVARD WEST, SUITE 202
RADENTON, FL 34205
C'NA
RISK MANACEMENT
Coverages:
Insurer Affording Coverage
Continental Casualty Company
The policy(ies) of insurance listed below have been issued to the insured named above for the policy period indicated. The insurance
afforded by the policy(ies) described herein is subject to all the terms, exclusions and conditions of such policy(ies).
Type of Insurance
Certificate Exp. Date
o CONTINUOUS
o EXTENDED
* IX! POLICY TERM
Policy Number
Limits
Workers'
Compensation
1-1-2001
WC 189165165
WC 189165182
Employers Liability
Bodily Injury By Accident
$1,000,000 Each Accident
Bodily Injury By Disease
$1,000,000
Policy Limit
Bodily Injury By QiS&...,,, MONR
$1,000,000 ; ^ OE~on
, I (l~. r
Other:
DATE
" ~-----
, SEP 1 5 2000
I TIME:
L RECEIVED BY:
Effective Date: 01- JAN - 2 000
INITIAL
Employees Leased To:
11360.Tom Ryan Inc
Ryan Construction Services
L' Y...
OlliE --3~ ~OD
W~:"Tl?,' .. .-- yrS
",: ,/.:_,
The above referenced workers' compensation policy provides statutory benefits only to employees of the Named Insured(s) on the policy, not to employees
of any other employer.
*If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the
certificate expiration date. However, you will not be notified annually of the continuation of coverage,
Notice of Cancellation: (Not applicable unless a number of days are entered below)
Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policy(ies) until at least 30
days notice of such cancellation has been mailed to:
DhT"E -
, cD
9:J-. .... .
---~-~ aJ.~~
-
Certificate Holder
INlTIA 1.
MONROE COUNTY BORAD OF COMMISSIONERS
5100 COLLEGE ROAD
Key West, FL 33040-4399
Martin Oosterbaan
Authorized Representative
30-AUG-2000
St. Louis, MO (877)427-5567
Office Phone
Date Issued
'1,.,' .Jillllllll....
Attttlllt@ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYY)
09106/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
USI Rorida - Lakeland HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
p, O. Drawer 1398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
402 S. Kentucky Ave., 4th A. COMPANIES AFFORDING COVERAGE
Lakeland FL 33802-1398 COMPANY
A Zurich Ins r "
INSURED IVIUl'h -:\,I~ \: ~.J ;' ":::ME,,'d
COMPANY CONSTRUC""
Ryan Construction Service B .. ,~ , I
POBox 555 COMPANY I SEP 1 1 2000
Big Pine Key FL 33043 C
COMPANY TIME: "nD\H- i
D RECEIVED BY:
COVERAGES '---""
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.
co TYPE OF INSURANCE POliCY NUMBER POUCY EFFECTIVE POUCY EXPIRATION UMrrS
Lm DATE (MM/DDIYY) , DATE (MM/DDIYY)
GENERAL LIABILITY I I I GENERAL AGGREGATE $
- -- -- --
COMMERCIAL GENERAL LIABILITY PRODUCTS. COMP/OP AGG $
I CLAIMS MADE o OCCUR PERSONAL & ADV INJURY $
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $
-
FIRE DAMAGE (Anyone fire) $
.- ,. ,n MED EXP (Anyone person) $
AUTOMOBILE LIABILITY rn. k.hL 'IG;)
- COMBINED SINGLE LIMIT $
ANY AUTO
- DATE__ "-~Lf~'I:3-=C ~--
ALL OWNED AUTOS ::> BODILY INJURY
- $
SCHEDULED AUTOS INITIAL (Per person)
-
HIRED AUTOS 9999 BODILY INJURY
- $
NON.OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
. ~ ,....., ''''1\" '.. ,.... ...,. ..., :.;' i'
GARAGE LIABILITY . ,O~\\- AUTO ONLY. EA ACCIDENT $
- f{) . I)~--
ANY AUTO I I OTHER THAN AUTO ONLY:
- -- --
-
q~ (3-f5l?.. EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY / _I_l- EACH OCCURRENCE $
=1 UMBRELLA FORM ---- -
AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I WC. .S.T.ATU. I IOETr.
EMPLOYERS' LIABILITY TnRY lIMrT~ ER
EL EACH ACCIDENT $
THE PROPRIETOR! RINCL EL DISEASE . POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE . EA EMPLOYEE $
OTHER
A Bui Iders Risk BR99551252 08/30/00 08/30/01 323,800
~ESCRIPTION OF OPERATIONS/LOr( TIONSNEHICLES/SPECIAL ITEMS
E: US 1, Key West, L
CERTIFICATE HOLDER CANCEUATlON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Monroe Cou~ Board of County Commissioners EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
500 Whitehe St ----1Q. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Key West FL 33040 BUT FAILURE TO MAIL SUCH NOTICE SU'" "'M~~ NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE ~S AGENTS OR'1'l'fPRE~VES.
AUTHORIZED REPRESENTATlVE.. .~~J,,\1tJ
P~~"t....'l'1.I\ '1 i l
ACORD 25-S (1/95) @ ACORD CORPORATION 1988
A4I~4I.lr It@ CERTIFICATE OF LIABILITY .INSURANCE DATE (MMlDDNY)
08/22/00
PRODUCER THIS CERTlACATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTlACATE
USI FlorIda - LakeIand HOLDER. THIS CERTlACATE DOES NOT AMEND, EXTEND OR
P. O. Drawer 1398 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
402 S. Kentucky Ave., 4th A. COMPANIES AFFORDING COVERAGE
Lakeland FL 33802-1398 COMPANY
A Ohio Casualty Ins Co MO~BnE COUNTY ,-.,~
" .
INSURED COMPANY .~ .v ",'~""'"
Tom Ryan, Inc. B United National ~~D 1 1 ?nnn
and 'tan Construcllon ServIces COMPANY ""~~
P.O. x 555 C ZUrich !TIMJ:'
Big Pine Key FL 33043
COMPANY RECEIVED BY: .J (l/ (..
D /
COVERAGES
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.
---- ~
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POlICY EXPIRATION UMrrs
LTR DATE (MM/DDNY) DATE (MMiODiYY)
B GENERAL LIABilITY 86GOOO1465 01/22/00 01/22/01 GENERAL AGGREGATE $ 1,000,000
--
X COMMERCIAL GENERAL LIABILITY PRODUCTS. COMP/OP AGG $ 1 , 000,000
~ CLAIMS MADE 00 OCCUR PERSONAL & ADV INJURY $ 1 ,000,000
-
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
-
FIRE DAMAGE (Anyone fire) $ 50,000
MED EXP (Anyone person) $ 1,000
A AUTOMOBILE LIABILITY BAW52221956 01/22/00 01/22/01 1,000,000
'-- COMBINED SINGLE LIMIT $
'-- ANY AUTO
ALL OWNED AUTOS BODILY INJURY
rx (Per person) $
SCHEDULED AUTOS
"x HIRED AUTOS BODILY INJURY
~ $
NON.OWNED AUTOS Ci- r3-C D (per accident)
- $1,000 COMP/COLL DEDUCT
-
D^TE_ .10 PROPERTY DAMAGE $
~RAGE LIABILITY INITIAL AUTO ONLY. EA ACCIDENT $
ANY AUTO '~::A'[(\(1f~~' OTHER THAN AUTO ONLY: ")'~';",, ;
-
EACH ACCIDENT $
- AGGREGATE $
EXCESS LIABILITY V \ , ,. I\. /lL.--"" EACH OCCURRENCE $
',""-1"" " D
R",UMBRElLA FORM q- g-D .... - AGGREGATE $
OTHER THAN UMBRELLA FORM C'.~E ---- - __ $
WORKERS COMPENSATION AND I': . "[ ':,.-- - WC STATl. I I01Jf' I. > 'c;Yi..~
EMPLOYERS' LIABilITY \1" '\'~": I'~r ' -"-- n"v LIMITS .;;
_/_/- _/_/- EL EACH ACCIDENT $
THE PROPRIETOR! R'NCL El DISEASE . POLICY LIMIT $
PARTNERs/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE . EA EMPLOYEE $
OTHER
A In land Mar ine B\I052221956 01/22/00 01/22/01 Scheduled
A Auto Phys Damage BAW52221956 01/22/00 01/22/01 Scheduled
C Bui Iders Risk BR 97001300 10/18/99 1 0/18/00 168 , 500
8ESCRIPTION OF OhERATIONSIlQCATIONSNFHICLES/SPECIAL ITEMS listed addit ional
ertificate older, Its emp oyees and directors are as
insured as respects general liability and auto liability.
Insured location: East Martello Towers, Key West, FL
fax 305-872-3769
CERTlACATE HOLDER CANCEU:A11ON " ;,' ,. .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Monroe County Board of County Commissioners EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
-.:!Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE ~tOTl9.li~ALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND U E COMPANY, ITS A~EPRESENTATlVES.
AUlHORIZED R~~SENTATIVE '\ . I !
.......~ ;T~\-\""v~,J
ACORD 25-S (1195) @ ACORD OORPdRATlOO'1988
The Inland Marine Declarations and INLAND MARINE OECLARA nONS
endorsements, if any. issued to form a part
thereof, completes the Commercial
Insuranc;e Policy numbered as follows: SR 995 5125 2
[XIIew Policy
o Renewal of
In return for the payment of the premium, and subject to all the terms of this
policy, we agree with you t de the insurance as stated in this policy.
THIS IS A COINSURANCE RACT. Please read your policy.
Construction Services
Tom Ryan.
POBox 555
Big Pine I(~y,
. ZURICH
OF AMERICA
10038
2.
A)
r Information (complete A-D)
B) Telephone #: (863)686-1161
C) Maryland Producer #: 02086460
D) Field Office Name: US I-Florida
E) Field Office Code: 44
3. Polley Period - From EffectIve Date Of: 8/30/00
To (check one): 0 Continuous Reporting iI One Year From Effective Date
12:01 a.m. Standard Time at your mailing address above.
4. Form of Business: 0 Individual 0 Partnership ~ Corporation 0 Joint Venture
5. Limits of Insurance (select either One-Shot or Reporting Form option below)
o Reporting Form (continuous policy) IXI One-Shot (non-reporting form/single structure policy) HBIS-1
o 1-8 Family Dwelling Xl Commercial Structure
Property Location US Hto{y 1
Key West, FL
Anyone structure
Property temporarily at
any other premises
Property in transit
All covered property
at all locations (same
as A unless otherwise
noted) $
Rate $ .36
Premium $ 1165.68
Tax (applicable in KYonly) $
Total Fully Earned Policy Premium $
($250 minimum premium applicable)
A)
B)
o Annual Rate
o Monthly Rate (HBIS - 4)
A)
B)
o Other
$ 323,800
C)
D)
$
$
10,000
25,000
C)
D)
Anyone structure
Property temporarily at
any other premises
Property in transit
All covered property
at all locations
$1,000,000
E)
F)
G)
H)
$
$
10,000
25,000
$5,000,000
E)
F)
G)
H)
Per Report
Per Report
Per Report
Per Report
6. Deductible (minimum $250 unless otherwise indicated): 0 $500 0 $1,000 0 $2,500 :ltJ $5,000 Other
7. Forms Applicable To All Coverage Parts:
~ 40471 Builders Risk Coverage Form
~ 47681 Comm. Inland Marine Coverage Part
~ CM0001 Comm. Inland Marine Conditions
~ IL0017 Common Policy Conditions (IL0146 in WA)
o 9H0003 Florida Builders Risk Declarations
o HBIS-4 Monthly Rate Endorsement
o HBIS-35 Windstorm or Hail Exclusion
XJ HBIS-37 Existing Building(s) or Structures(s) Cov.
Rate
Premium
Tax (applicable in KYonly)
Total Fully Earned Policy Premium
Countersigned:
8b30JOO
ate
FM170001 REV. 1/97
o HBIS-42 Florida Fraud Statement
:tJ HBIS-43 Windstorm Percentage Deductible
o HBIS-44 New York Fraud Statement
Other Forms: (list other applicable state and/or HBIS
forms; all required state forms applicable)
Non-Renorting Endorsement
By:
----------...
~ ~
Authorized Representative
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy
and does not amend, extend, or alter the coverage afforded by the policies listed below.
Named Insured(s):
TAFF LEASING, L.P., BY STAFF ACQUISITION, INC., THE
ENERAL PARTNER, AND THE AFFILIATED LIMITED
ARTNERSHIPS OF WHICH STAFF ACQUISITION, INC. IS THE
ENERAL PARTNER AND STAFF LEASING, INC IS THE ON OE COUNTY
ARTNER. CON"TRll" 10"1 '~A~IAGE"
00 301 BOULEVARD WEST, SUITE 202 ;) t, 1\ '..... \ ,IVI
RADENTON, FL 34205
C'NA
SK MANACEMENT
Coverages:
Insurer Affording Coverage
Continental Casualty Company
TIME:
The policy(ies) of insurance listed below have been issue 0 e Insure na e a ove for the policy period indicated. The insurance
afforded by the policy(ies) described herein is subject to all the terms, exclusions and conditions of such policy(ies},
Type of Insurance
Certificate Exp. Date
o CONTINUOUS
o EXTENDED
* IX! POLICY TERM
Policy Number
Limits
Workers'
Compensation
1-1-2001
WC 189165165
WC 189165182
Employers Liability
Bodily Injury By Accident
$1,000,000 Each Accident
Bodily Injury By Disease
$1,000,000
Policy Limit
Bodily Injury By Disease
$1,000,000
Each Person
Other:
Employees Leased To:
11360.Tom Ryan Inc
Ryan Construction Services
Effective Date: Ol-JAN-2000
The above referenced workers' compensation policy provides statutory benefits only to employees of the Named 1nsured(s) on the policy, not to employees
of any other employer.
*If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the
certificate expiration date. However, you will not be notified annually of the continuation of coverage.
Notice of Cancellation: (Not applicable unless a number of days are entered below)
Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policy(ies) until at least 30
days notice of such cancellation has been mailed to:
Certificate Holder
~ o.c/J-,,~
-
MONROE COUNTY BOARD OF COMMISSIONERS
5100 COLLEGE ROAD
Kev West, FL 33040-4399
Martin Oosterbaan
Authorized Representative
06-SEP-2000
51. Louis, MO (877)427-5567
Office Phone
Date Issued
AGENT
OE COUNlY HO E BUILDERS INSURANCE PROGRAM
'j...T!n~1 !\l~Mt;nEMENT Post Office Box 10197
Jacksonville, FL 32247-0197
US I-Florida
P 0 Drawer 1398
Lakeland, FL 33802
SEP 11 2000
I
ITIME:
L~ECtIVED BY: _.
CERTIFICATE OF INSURANCE
This Certificate is provided as evidence of insurance under Polici' # RRqq'i'i 11'i1
of the Company named herein.
MORTGAGEE
INSURED
Name and Address
Monroe County Board of Co. Commissioners
500 Whitehead Street
Key West, FL 33040
Name and Address
Tom Ryan, Inc. dba Ryan Construction Svcs
POBox 555
Big Pine Key, FL 33043
Amount of Coverage Per Bldg
(Completed Value) $ 323,800
Description and Location of Property to be Insured:
Re roofin of the Fort on
Premium
$ 1165.58
E:Hective Date (Date
Construction Began) 8 30 00
Term
12 Months
This is to certify that the above is insured under a Builder's Risk policy issued by a Maryland Casualty Company, covering property
identified above from the inception date shown, subject to all terms and conditions contained in the policy.
Insurance as provided under the aforementioned policy is subject to all terms. conditions and limitations thereof and shall in no
event extend beyond date of termination of the insured's interest in the articles described her .
Dated
A
Authorized Agent
WARNING
This Certificate is issued to protect the mortgagee only. Under the terms of the insured's policy, insured agrees to report
all starts and pay the appropriate premium to the Home Builders Insurance Program, P.O. Box 10197, Jacksonville, FL
32247-0197. Insured must report all starts shown on this certificate prior to the end of the next month. If insured does
not report within this time period, the insured will not be covered.
Insured should check with his HSIP agent to make sure he understands his reporting requirements.
MARYLAND CASUAL TV COMPANIES