Certificates of Insurance
AC.ORD~ CERTIFICA1- OF LIABILITY INSUR.. ~C~ 10 DS I DATE (MMlDDNY)
. OADR-l 05/02/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Envisio Insurance Group, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
7217 Benjamin Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa FL 33634-3037 INSURERS AFFORDING COVERAGE
Phone:8l3-880-8889 Fax:8l3-243-l683
INSURED INSURER A: Legion Insurance Company
INSURER B:
~~:~ ~~~~ti~J>>WlWf p ~ 3 ReV D INSURER C:
2140 Sunnydale Blvd, Suite C INSURER 0:
Clearwater FL 33765
I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWITHSTANDING
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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
~Q!J~Y. Ef.!:~GTIYE POL!~X.~~PIRATION
DATE ,MMlDDIVV\ DATE ,MMlDDNYl
LIMITS
ANY AUTO
APOROVED BY RISK MANAGEMEN
RY C~ I L.)o .- 0 f~ 1~')cf'I"-
f)ATE I' 3 \6 L
7 I /
WAI\lFR: N!^ l/ YES
EACH OCCURRENCE $
FIRE DAMAGE (Anyone flre) $
MED EXP (Anyone person) $
PERSOILA.L !l. ADV !NJURY $
GENERAL AGGREGATE $
PRODUCTS-COMPK>PAGG $
COMBINED SINGLE LIMIT $
(Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $
AGGREGATE $
$
$
$
GENERAL LIABILITY
-
COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE 0 OCCUR
f--
f--
GEN'L AGGREGATE LIMIT APPLIES PER:
h nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY
I--
-
-
SCHEDULED AUTOS
-
HIRED AUTOS
NON-OWNED AUTOS
ALL OWNED AUTOS
-
-
GARAGE LIABILITY
rl ANY AUTO
EXCESS LIABILITY
~ OCCUR D CLAIMS MADE
I DEDUCTIBLE
11 RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC41554260
05/31/01
05/31/02
x I TORYLlMrrsl IU~~-
E.l. EACH ACCIDENT $ 100000
E.L. DISEASE. EA EMPLOYEE $ 1000 0 0
E.l. DISEASE - POLICY LIMIT $ 50 0000
A
OTHER
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DESCRIPTION OF OPERATI06lSlLocr-TIONSNEHICLES/EXCLUSIONS~DDE~ BY ENDORSEMENT/SPECIAL PROVISIONS
JAN - 2 "
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CERTIFICATE HOLDER
I N I ADDITIONAL INSURED; INSURER LETTER:
MBOCC-l
CANCELLATION
Monroe County Board of County
Commissioners
5100 College Road
Stock Island, Key West FL 33040
I
ACORD 25-5 (7/97)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
-
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTHIV ~ ^
l~j O[yl
@ACORDCORPORATION 1988
CERTIFICATE OF INSURANCE
SUCI;t INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE
TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN NO
EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE
DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW.
This certifies that: Q STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, or
D STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
has coverage in force for the following Named Insured as shown below:
Named Insured R 0 a d Run n e r Mar kin 9 sIn c .
Address of Named Insured ? 1 4 n S II n n y rl8 1 P. R 1 v rl .
Cle8rw8ter, FL 33765
POLICY NUMBER 770 2643 A24.5 H
EFFECTIVE DATE 7/24/01
OF POLICY
DESCRIPTION OF 1993 GMC Flatbej
VEHICLE
LIABILITY COVERAGE dYES DNo DYES DNo DYES DNo DYES D NO
LIMITS OF LIABILITY
a. Bodily Injury
Each Person
Each Accident
b. Property Damage
Each Accident
c. Bodily Injury & Property 1MM
Damage Single Unit
Each Accident
PHYSICAL DAMAGE DYES DNO DYES DNO DYES DNO DYES D NO
COVERAGES
a. Comprehensive $ 250 Deductible $ Deductible $ Deductible $ Deductible
DYES DNO DYES DNo DYES DNO DYES DNO
b. Collision $ 250 Deductible $ Deductible $ Deductible $ Deductible
EMPLOYER'S DNO
NON-OWNERSHIP DYES DYES DNO DYES DNO DYES D NO
COVERAGE
HIRED CAR COVERAGE DYES DNO DYES DNO DYES DNO DYES DNO
Signature of Authorized Representative
Name and Address of Certificate Holder
I Monroe County
Commissioners
5100 College
Stock Island,
Board of County
Rd.
Key West Fl
33040
I
L
Agent
59-1226 1?/18/n1
Title Agent's Code Number Date
Name and Address of Agent
I Thomas H Miller
616 W Brandon Blvd.
Brandon, FL 33511
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