Certificates of Insurance
" --
~~ Th~ Reciprocal
~ AllIance
Risk Retention Group
Issue Date: 08/13/01
PROFESSIONAL LIABILITY OCCURRENCE
INSURANCE POLICY FOR
PROFESSIONAL COUNSELORS AND HUMAN
DEVELOPMENT PRACTITIONERS
Policy Number: CLl1578401
Administered by:
ACA Insurance Trust. Inc.
5999 Stevenson Avenue
Alexandria, VA 22304-3300
Toll Free: 1.800-347.6647 x284
...-.-~~.
ACAIKsvW/CE
TRUST
i.,,: ( , '.f..4-~'" I , d
...-.....,...
ITEM DECLARATIONS
INDIVIDUAL POLICY
--------------------------------------------------------
1. NAMED INSURED: Herbert A. Marlowe, Jr.
2. ADDRESS:
P.O. Box 998
Newberry, FL 32669
3. POLICY PERIOD:
From: 08/25/01 To: 08/25/02
12:01 A.M. Standard Time at Location of Designated Premises
4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges:
COVERAGE
A. PROFESSIONAL LIABILITY $
PREMIUM
382.00
B. GENERAL LIABILITY $
0.00
M"['ll;'OVED BY RISK MANAGEMENT
BYOi . ~J~ ~*-j:~,
OHE {2.../'2 of 0 I
W^"fr~: NIA \r......../ YES
TOTAL PREMIUM: $
382.00
5. LIMITS OF LIABILITY:
$1, 000 , 000 each Incident or each Occurrence $1', 000 , 000 in the Aggregate
6. THE NAMED INSURED IS:
Sole Proprietor (incl. Individual)
Corporation
Partnership
X Other (refer to Item 7 below)
7. BUSINESS OF THE NAMED INSURED:
(Rating Category)
Self-Employed
Counselor/Human Development Professional
8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and
agreements contained in the following form(s) or endorsement(s): CPL.0004.0199 CPL.0005.0199 CPL.0006.0199
NOTICE
THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE
INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE
FOR YOUR RISK RETENTION GROUP.
CPL-0005-0 199-00
..
.'
CERTIFICATE OF INSURANCE
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 LISTED BELOW,
FLORIDA FARM BUREAU INSURANCE COMPANIES COMPANIES AFFORDING COVERAGES:
P.O. BOX 147030 Company
Lette r A:
-
GAINESVillE, FLORIDA 32614-7030 Florida Farm Bureau General Ins. Co.
Company
NAME AND ADDRESS OF INSURED: Letter B:
-
HERBERT A MARLOWE JR Florida Farm Bureau Casualty Ins. Co.
PO BOX 998
NEWBERRY, FL 32669-0998
The policies of insurance listed below have been issued to the insured named above and are in force at this time, 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,
CO.
LTR
POLICY EFFECTIVE
DATE (MM/DD/YV)
POLICY EXPIRATION
DATE (MM/DD/YV)
ALL LIMITS IN THOUSANDS
TYPE OF INSURANCE
POLICY NUMBER
A
GENERAL LIABILITY:
IXJ COMMERCIAL GENERAL
~ LIABILITY (OCCURRENCE
FORM)
DOWNER'S & CONTRACTOR'S
PROTECTIVE
SGL 0514545 02 08/01/2001 08/01/2002
GENERAL AGGREGATE
PRODUCTS-COMPLETED
OPERATIONS AGGREGATE
PERSONAL & ADVERTISING
INJURY
EACH OCCURRENCE
D FARMER'S PERSONAL
LIABILITY
FIRE DAMAGE (Anyone fire)
MEDICAL EXPENSE
(Anyone person)
AUTOMOBILE LIABILITY:
$
~~E~N0~IT $
D ANY AUTO
D ALL OWNED AUTOS
D SCHEDULED AUTOS
D HIRED AUTOS
D NON-OWNED AUTOS
EXCESS LIABILITY:
$
BODILY
INJURY (Per
Accident)
PROPERTY
DAMAGE
$
D UMBRELLA FORM
D OTHER THAN UMBRELLA
FORM
EMPLOYERS LIABILITY:
D FARM EMPLOYER'S
LIABILITY
D FARM EMPLOYEE'S MEDICAL
OTHER:
EACH
OCCURRENCE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES:
SEE FORM CG2010
$ 2,000
$ 2,000
$ 1,000
$ 1,000
$ 50
$ 5
$
$
(Each Occurrence)
$
(Each Employee)
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to
mail 10 days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind
upon the company,
County Code 01- 2 Date Issued 06/12/2002
NAME AND ADDRESS OF CERTIFICATE HOLDER:
ATTN: COLEEN GARDNER
MONROE BOARD OF COUNTY COMMISSIONERS
2798 OVERSEAS HWY STE 400
MARATHON, FL 33050-4277
Serviced by
ALACHUA
GARY A HALL
AUTHORIZED REPRESENTATIVE
County Farm Bureau
W57 93-7-692 (Rev, 5/93)
POUCYNUMBER: SGL 0514545 02
COMMERCIAL GENERAL LIABILITY
CG 20 10 1093
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL UABILlTY COVERAGE PART
SCHEDULE
Name of Person or Organization: ATTN: COLE EN GARDNER
MONROE BOARD OF COUNTY COMMISSIONERS
(If no entry appears above, information required to complete this endorsement will be shown in the Declara-
tions as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in
the Schedule, but only with respect to liability arising out of your ongoing operations performed for that in-
sured.
CG20101093
Copyright, Insurance Services Qffice, Inc., 1992
o
Ma~ 03 02 02:32p
H.a~ 03 02 11:34a
Growth Mgt
RCA INSURANCE TRUST
(305)289-2854
7038235267
p.2
p.2
DMe lS$uctJ
l\IEi\IORA:\Dl ;\101; INSl TRANCE 05/03/02
Producer This memorandum is iSSll ed as a matter of
ACA Insurance Trust, Inc. in(ot"mation only and confers no rights upon the
5999 Stevenson Avenue bolder. This memorandum does not amend, extend
Alexandria, V A 223043 or alter the co\'crages afforded by the Certificate
listed below.
Company Affording Covernge
Iosured The Reciprocal Alliance
Herbert A Marlowe, Jr Risk Retention Group
PO Box 998 Covered Person(s)
Newbury, 1"'L 3Z669 Herbert A Marlowe, Jr
Self Rmployed Counselor
This is to certify That the Certilicate listed below has 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 memorandum may be issued or may pertain, the insuraDce afforded by the Certificate described berein is subject to
all the terms, exclusions and conditions of sllch Certificate. The limits shown may have been reduced by paid claims.
Type of Insurance Certificate Number Effective Date Expiration Date Limits
Professional Liability
Occurrence each incident $1,000,000
CLl1578401 08/25(01 08/25/02
each $1,000,000
aggregate
General Uability and
Additional Insured (see each incident $
below for the N/A N/A N/A
covered locations) each $
aggregate
Non-Owned Automobile
N/A N/A N/A N/A N/A
General Liabilit)' Locations:
CERTll'ICA TE HOLDER: Should tbe above described Certificate be cancened
Growth Management Division before tbe expiration date thereof, the issning
company will endeavor to mail ~ days written
2798 Overseas Highway, Ste 400 notice to the Memorandum Holder named to the
Marathon, FL 93050 left, but failure to mail such notice shall impose no
obligation or liability of any kind upon tbe company
its agents or representatives.
Authorized Representative
~ ~ ~ /~~~
~ ~
/YiA
/Yi~ . ~
r~tIVJ~ ~
;(If ~ ffl9-~~"-'
o 7/3
FLORIDA FARM BUREAU INSURANCE COMPANIES
POST OFFICE BOX 147030
. GAINESVILLE, FLORIDA 32614.7030
09/06/2002
Policy Cancellation Notice
1..1111.11.11....1.1.11...1.1..1
MONROE BOARD OF COUNTY COMMISS
ATTN: COLEEN GARDNER
2798 OVERSEAS HWY STE 400
MARATHON FL 33050
{ro'J - ~-@- ~ fwfF"---;
iill~ 2 m02 I JJ!
I I 1'1 .
L.______ ~ ~
, GROWTH MANAGEM T DI ISI~~!
Insured: Herbert A Marlowe Jr
PO Box 998
Newberry FL 32669-0998
Policy Number: SGL 0514545
Dear Additional Insured,
The above captioned policy is being cancelled for underwriting
reasons.
In accordance with the terms of the policy, we will continue to
protect your interest until 12:01 A.M., standard time, 10/28/2002.
If you have any questions, please contact the agent:
Gary A,Hall
4432 NW 23Rd Ave Ste 3
Gainesville FL 32606
Phone 352 332-7009
U39
/
Cc..'~
== -Arol LthUL~
FLORIDA FARM BUREAU INSURANCE COMPANIES
POST OFFICE BOX 147030 GAINESVILLE, FLORIDA 32614-7030
10/22/2002
REINSTATEMENT NOTICE
SGL0514545
MONROE BOARD OF COUNTY COMMISS
ATTN: COLEEN GARDNER
2798 OVERSEAS HWY STE 400
MARATHON FL 33050
Re: Insurance Policy #: SGL 0514545
HERBERT A MARLOWE JR
PO BOX 998
NEWBERRY FL 32669-0998
Member #: Q000753086
Account #: 0267825066-00
Policy Period: From: 08/01/2002 To: 08/01/2003
(12:01 AM Standard Time)
Florida Farm Bureau General Insurance Company
Dear Additional Insured:
The above policy has been reinstated with no lapse in coverage.
For questions concerning this notice, please contact the
Florida Farm Bureau agent:
GARY A HALL
4432 NW 23RD AVE STE 3
GAINESVILLE FL 32606
Phone 352 332-7009
01-{) 24801
f r ;'1 ~-f~ ~fl \~
qJ(i-
! UU I OCT 3 1 200
I i
t.GRO~H MANAGEM ISION
CD: '~~CCC
~ ice ~aVr lL
~ fli
till I
,
CERTIFICATE OF INSURANCE
A,., ..Iyfica..
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 LISTED BELOW,
FLORIDA FARM BUREAU INSURANCE COMPANIES COMPANIES AFFORDING COVERAGES:
P.O. BOX 147030 Company
Letter A:
-
GAINESVillE, FLORIDA 32614-7030 Florida Farm Bureau General Ins. Co.
Company
NAME AND ADDRESS OF INSURED: Letter B:
-
HERBERT A MARLOWE JR Florida Farm Bureau Casualty Ins. Co.
PO BOX 998
NEWBERRY, FL 32669-0998
The policies of insurance listed below have been issued to the insured named above and are in force at this time. 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.
CO.
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DDNY)
POLICY EXPIRATION
DATE (MM/DDNY)
ALL LIMITS IN THOUSANDS
fVl COMMERCIAL GENERAL
tXJ LIABILITY (OCCURRENCE
FORM)
DOWNER'S & CONTRACTOR'S
PROTECTIVE
SGL 0514545 03 08/01/2002 08/01/2003
$ 2,000
$ 2,000
$ 1,000
$ 1,000
$ 50
$ 5
A
O FARMER'S PERSONAL
LIABILITY
o ANY AUTO
o ALL OWNED AUTOS
o SCHEDULED AUTOS
o HIRED AUTOS
o NON-OWNED AUTOS
EXCESS LIABILITY:
o UMBRELLA FORM
O OTHER THAN UMBRELLA
FORM
EMPLOYERS LIABILITY:
O FARM EMPLOYER'S
LIABILITY
o FARM EMPLOYEE'S MEDICAL
HER:
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES:
SEE ATTACHED FORM CG2010
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to
mail 10 days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind
upon the company.
County Code 0 1 - 0 Date Issued 0 1 /2 0 / 2 0 0 3
NAME AND ADDRESS OF CERTIFICATE HOLDER:
MONROE BOARD OF COUNTY COMMISSIONERS
1100 SIMANTON STREET
KEY WEST, FL 33040-1100
Serviced by
ALACHUA
County Farm Bureau
GARY A HALL
AUTHORIZED REPRESENTATIVE
c.c:~
W61
93-7-692 (Rev. 5/93)
POLICY NUMBER:SGL 0514545 03
COMMERCIAL GENERAL LIABILITY
CG 20 10 10 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
MONROE BOARD OF COUNTY COMMISSIONERS
(If no entry appears above, information required to complete this endorsement will be shown in the Declara-
tions as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in
the Schedule, but only with respect to liability arising out of your ongoing operations performed for that in-
sured.
CG 20 10 10 93
Copyright, Insurance Services ..9ffice, Inc., 1992
D
CERTIFICATE OF INSURANCE
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 LISTED BELOW.
COMPANIES AFFORDING COVERAGES:
FLORIDA FARM BUREAU INSURANCE COMPANIES
P.O. BOX 147030
GAINESVILLE, FLORIDA 32614-7030
Company
Letter A:
Florida Farm Bureau General Ins. Co.
NAME AND ADDRESS OF INSURED:
HERBERT A. MARLOWE, JR.
PO BOX 998
NEWBERRY,FL 32669
Company
Letter B:
Florida Farm Bureau Casualty Ins. Co.
policies insurance Ii below have been issued to the Insured named above and are in force at this time. Notwi ng any requirement, term or conditiOn 01 any contract or
other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies desCribed heI8in is subject to all the terms. exclusions and
conditions 01 such po"cies.
CO,
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE DATE
(MWDD/YY)
POlICY EXPIRATION
DATE (MMlDD/YY)
ALL LIMITS IN THOUSANDS
Employers Uabllity:
o F ann Employer's Liability
o Fann Employee's Madical
GeneIaI Aggregate $ 2,000
Products-wmpleted $ 2,000
operations aggregate
08/01/2002 08/01/2003 PeI10naI & Advertising Injury $ 1,000
Each OccumlllC8 $ 1,000
Are Damage (Any one fire) $ 50
Medical Expense (Any one person) $ 5
Combined $
Single Unit
Bodily InjUry $
(Per Person)
Bodily Injury $
(Per Accident)
Property $
Damage
Each Aggregate
OcCUrrence
A
General Ueblllty:
lir Commercial General Liability
(Occurrence Form)
DOwner's & Contractor's
Protective
o Farmer's Personal liability
SGL 0514545
Automobile Liability:
o Any auto
o All owned autos
o Scheduled autos
o Hired autos
o Non-owned autos
Excess Uabllity:
o Umbrella Form
o Other than Umbrella fonn
$
$
$
(Each OocurrBnoe)
$
(Each EmpIoyoB)
Other:
$
DESCRIPTION OF OPERATIONSILOCATIONSNEHIClES:
ADDITIONAL INSURED: MONROE COUNTY BOARD OF COMMISSIONERS
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof. the Issuing company will endeavor to
mail ~ days written notice to the below named certificate holder, but failure to mall such notice shall impose no obHgation or liability of any kind
upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER: COUNTY CODE 1 DATE ISSUED 11 / 12 / 'p2
MONROE COUNTY BOARD OF COMMISSIONERS
1100 SIMONTON STREET
KEY WEST, FL 33040
Serviced by
ALACHUA
County Farm Bureau
GARY HALL
AUTHORIZED REPRESENTATIVE
93-7-692 (Rev 10100)