Certificates of Insurance
m: L.ESl:E GlOVER At: ROGER 8OUCH~D INS fo: 1':'5 LAND CLEARING
FII)(#: (727)449-.267 Dllte: 1':;/11/0'. 09:58 AM Page 1 ot 1
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AC.OBD. CERTIFICATE OF LIABILITY INSURANCE Ofl'l~ LQ\ OATI I_D/'I''I)
SOUTH- 10/1"/01
_Ill 1 Till CI.TI~TI ,,_D AI A IIATTI. OF INPOIIlIlATlOH
aoUCHAJU) ON I. Y AND CONfI'" NO IlIOHTI U..oN THI CIItTl'ICATI
10l STARCREST DaIVE HOLDI'" TIa ca.T1I11CATI DOU NOT AMIND, IXTOl) O.
l' 0 ISOZ 60iO ~TIIIl TMI COIIIUM A'fOIlDID 1'1 THII'OLlCII. IILOW.
CLEARWATER fL 33158-1010 I INtUItIItS AFFOIl~ COVINGI
Phone: '21-...,-6481 Fax; 12,-.t'-126?
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"'1UIlI~ ~~..!!:~ ANDICAII CAS~!~._E9__
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IN~ j~eH ~
BOU'fHDST nltSilrktMfIRC;: ~_.. --
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05 IG.K .r.a D1\ In: U2 _ INSURfR 0
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, II<StJlUR e
COYIUQII
1'1iE PO\.ICIE8 01' INSUIIlANCE LISno BELOW ,,"VI! BEEN ISSU!Cl TO THE if'lSUf\~0 NIlMED "toIlE FOIll TME: po:.tCV peRIOD INOIC_TEO, NOTWlT~T.A.~DING
AAY flE:QUIREM!IIlT. TIU<MOR CONOITI~OF Nlt CONTRACT OR OT,.,ER O'XUMENT WITH RESPECT TO WHICH THiS CERTIFiCAT'HoCAY IE !S$UEC OR
MAY PlRTAI~ THI t~$U!lIANCI""I'ORDlO BY T!'II POLICIIS OUCRIIID HI!RII"l '$ SUI.lICT -0 AU. THI TIRIlS, IXCLUSICNS "NO CO""OtTIONS 01' Sl.IC",
POLICIIS. AGGREGA'TI LIt.1ITS .$HOIllN MAv HAVE IIl!l!r~ REOUCEO 11'( PAt 0 CLAIMS.
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POuCY - MOT r: .r,,., I !
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APPROVED BY RISK MANAGE'. E'NT
BY Cl . LJ ~ ~:t;-lN'
DATE '7'\ I Z2) 01 !
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WA!VFR: N/A 1../ VES
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1.2/31/00
12/31/01
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f. cA(.h<c'''OEI!T ~ 1000000
~C1se;,et.eH~p'OYe; : '-100'000-0-
IH 1lI'<EA3t .0>0\..(- u..r Ts :1000000
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IlI_TIOIt c.- _'_.OC"'T_"'iGL~XC\.U..OItI_IY INCO"'''III'NT''P'C~ _VI'IClN'
COVI:IWiII APPLIIS TO OMLY '!'KOS! DtPLOYIES LIMED TO BUT ROt SUBCONTRACl'ORS
OF: ME' : CLIIRT; PJ' S I.AN'D CLEAIURG , UCAVATIJlG I'D: n'-2136 ,
511-'.0-..81 .cov.srr. '7/12/00*
.1
CIIlTlPICATI HOLDI.
R ,~IO_...-o, MlAlIft .BU'"
CANCILLATION
TB YOMIIOE comrn BOAItD or
COIMISBlOQU (LICENtll1G DBP1'1
CIlOIS WllI'G ROOM . 002
5100 eouz_ JU)
stOCJC JSlNID n. 33040
THBWONR 'HOULO""'Y ~ THI..OVi OIlCIlI"Il'O.ICII... CMcnL'IlIl~~ TIflI_MTlON
OAT' TMI_', 1" IIIUINr.IN.U..IIWU.. ..1l.A\I01\ TO MAL ..3L OAYI W1IIITTlN
NOTICI TO 'I<I CIIITI"CATI ~LClIII_ TO ,I<, L"., IU. "u.uIl rt. ~O.o 'IoW.L
,_" NO O"IUTIC~ OII,'_IT~ Cl' ANt l\lNO L'I'OM TMI .....','.' "'_n 01.
.........T
.u,..
C ACORD COIt~ltATIClN 1_
IoCOItD 2W (7187)
...... AtD.....@ .....................;I.lml.II;lil......~.~......I.."'.1.I..J.ill"'.~.;...........R'l'..... ....................1.~.6.6.5.. .
ISSUE DATE (MMIDD/YY)
CORDIA-WPB DIVISION
01 S. FLAGLER DR. #600
EST PALM BEACH FL 33401
10 23 01
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.
COMPANIES AFFORDING COVERAGE
PRODUCER
J'S LANDCLEARING &
XCAVATION SVC,INC
o BOX 540517
REENACRES, FL 33454
COMPANY A OWNERS INSURANCE CO
LETTER
COMPANY B RLI INSURANCE CO/GRESHAM & CO
LETTER
COMPANY C OLD DOMINION
LETTER
COMPANY D
LETTER
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.
POLICY EFFECTIVE POLICY EXPIRATIO
TYPE OF INSURANCE POLICY NUMBER LIMITS
DATE (MMIDD/YY) DATE (MMIDD/YY)
2057187201 03/09/01 03/09/02 GENERAL AGGREGATE $ 1 000 00
OMMERCIAL GENERAL L1ABILlT PRODUCTS-COMP/OP AGG. $ 1 000 00
LAIMS MADE[i]OCCUR. PERSONAL & ADV, INJURY $ 1 000 00
OWNER'S & CONTRACTOR'S PROTo EACH OCCURRENCE $ 1 000 00
FIRE DAMAGE (Anyone fire) $ 100 00
ME D.EXP. (Anyone person) $ 10 00
AUTOMOBILE LIABILITY BINDER53015 11/01/01 11/01/02 COMBINED SINGLE
ANY AUTO LIMIT $ 1 000 00
ALL OWNED AUTOS BODIL Y INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODIL Y INJURY
NON-OWNED AUTOS (Per accident) $
GARAGE LIABILITY
PROPERTY DAMAGE
ERUOO03690\RLI 05/04/01 05/04/02 EACH OCCURRENCE
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
APPROVED BY RISK MAN GEMENT
Bya. ~~d~
t STATUTORY LIMITS
~:"'(1' - EACH ACCIDENT
<:-CC~--C DISEASE -POLICY LIMIT
(!. C : ().J ISEASE-EACH EMPLOYEE $
OTHER THAN UMBRELLA FORM
OTHER
DATE
WMVFR:
s
DESCRIPTION OF OPERATlONSJ LOCATlONSIVE HICLES/SPECIAL ITEMS
IS NAMED AS ADDITIONAL INSURED WITH RESPECTS TO GENERAL
THE MONROE COUNTY BOARD
OF CNTY COMM.ITS EMPLOY.
&OFFICIALS, 5100 COLLEGE
ROAD CROSS WING RM #002
STOCK ISLAND FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL.lO- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, IT AGENTS OR REPRESENTATIVES.
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15450 ....
ISSUE DATE (MMIDD/YY)
CORDIA-WPB DIVISION
01 S. FLAGLER DR. #600
EST PALM BEACH FL 33401
10 19 01
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.
COMPANIES AFFORDING COVERAGE
PRODUCER
COMPANY A OWNERS INSURANCE CO
LETTER
J'S LANDCLEARING &
XCAVATION SVC,INC
o BOX 540517
REENACRES, FL 33454
COMPANY B PROGRESSIVE COMPANIES
LETTER
COMPANY C RLI/CRC
LETTER
COMPANY D
LETTER
TH IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOlWrrHSTANDING ANY REQUIREMENT TERM OR CONDrrlON 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 CONDrrlONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EXPIRATIO
TYPE OF INSURANCE POLICY NUMBER LIMITS
DATE (MM/DD/YV) DATE (MMIDD/YY)
2057187201 03/09/01 03/09/02 GENERAL AGGREGATE $ 1 000 00
OMMERCIAL GENERAL LIABILlT PRODUCTS-COMP/OP AGG. $ 1 000 00
LAIMS MADE[UOCCUR. PERSONAL & ADV. INJURY $ 1 000 00
OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 1 000 00
FIRE DAMAGE (Anyone fire) $ 100 00
ME D.EXP. (Anyone person> $ 10 00
AUTOMOBILE LIABILITY CA044118111 11/01/00 11/01/01 COMBINED SINGLE
ANY AUTO APPROVED BY RISK MANAGEMEN LIMIT $ 1 000 00
ALL OWNED AUTOS Y Ct . Lj BODIL Y INJURY
SCHEDULED AUTOS X"---- (Per person) $
HIRED AUTOS BODIL Y INJURY
NON-OWNED AUTOS ATE ( (Per accident) $
GARAGE LIABILITY
VAlVER: N/A PROPERTY DAMAGE
BINDER50984 05/02/01 05/02/02 EACH OCCURRENCE
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
EACH ACCIDENT $
AND
DISEASE-POLICY LIMIT $
EMPLOYERS' LIABILITY
DISEASE-EACH EMPLOYEE $
OTHEBLANKET RENTAL 2057227701 03/09/01 03/09/02 $100,000/$1000 DED
CONTR. EQUIP ALL RISK FORM
DESCRIPTION OF OPERATIONS/LOCATlONSIVEHIClES/SPECIAL ITEMS
ERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH RESPECTS TO GENERAL
lABILITY.
AX 561-740-9981
THE MONROE COUNTY BOARD
OF CNTY COMM.ITS EMPLOY.
&OFFICIALS, 5100 COLLEGE
ROAD CROSS WING RM #002
STOCK ISLAND FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL .lD.- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOl..DER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, rrs AGENTS OR REPRESENTATIVES.
ACORD~ CERTIFICATE OF LIABILITY INSURANCl;orJ'~~~ L9 DATE (MMlDDIYY)
10/22/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BOUCHARD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 STARCREST DRIVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBOX 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CLEARWATER FL 33758-6090 INSURERS AFFORDING COVERAGE
Phone: 727-447-6481 Fax:727-449-1267
INSURED INSURER A: AMERICAN CASUALTY CO
INSURER B:
SOUTHEAST PERSONNEL LEASING INSURER C:
(CLIENT: SEE REF BELOW)
905 MLK JR DR STE 110 I INSURER D:
TARPON SPRINGS FL 34689
I INSURER E:
i./-
I
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 CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRI TYPE OF INSURANCE POLICY NUMBER b~i~rM~&590}YE P~,}+~~~~6~m?N LIMITS
LTR
nERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
- GENERAL AGGREGATE 1$
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY .~.- ~~~ COMBINED SINGLE LIMIT
- S
ANY AUTO '"k (Ea accident)
- ~~
ALL OWNED AUTOS APPROVED BY RISK MANAGEMENT ~'-f~ BODILY INJURY
- $
SCHEDULED AUTOS '-- -..." (Per person)
- BY G\. LJo. 1- -~ ~~ I--
- HIRED AUTOS !'-6cJ..r- BODILY INJURY
OATE 1 0 I :3;- { 0 r (Per accident) $
NON-OWNED AUTOS
-
- 1 T PROPERTY DAMAGE $
/' (Per accident)
R" ""'~ "'.. '" PI, IV/A ill, AUTO ONLY- EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
I AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE S
I RETENTION $ 5
WORKERS COMPENSATION AND I TORY LIMITS 1 10JIH-
ER
A EMPLOYERS' LIABILITY WC 166791601 12/31/00 12/31/01 51000000
E.L. EACH ACCIDENT
E:L. DISEASE - EA EMPLOYEE $ 1000000
I E:L. DISEASE - POLICY LIMIT 51000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
COVERAGE APPLIES TO ONLY THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS
OF: REF: CLIENT: PJ'S LAND CLEARING & EXCAVATING FAX: 937-2138 &
561-740 - 9981 *COV.EP'F. 7/12/00*
CERTIFICATE HOLDER I N 1 ADDITIONAL INSURED: INSURER LETTER: CANCELLATION
THEMONR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOtol
THE MONROE COUNTY BOARD OF DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL JL DAYS WRITTEN
COMMISSIONERS (LICENSING DEPT) NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
CROSS WING ROOM # 002
5100 COLLEGE RD IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
STOCK ISLAND FL 33040 REPRESENLATIVES.
I AUTHOR\!y~
ACORD 25-S (7/97)
@ACORD CORPORATION 1988
10/19/2001 15:40
5617409981
PJ S LANDCLEARING
.~I
--
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P.J.'. land Cle8ring & EJa.vatlng. Inc.
. - A~
--
Green8cr8ls. Fl 33454-0517
(581) 740-9838
Trimming of Mangrov. Treea in Sahater Ponde east End of
Airport -
."~'Ll .....
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P_J.'s land Clearing &~, Inc. curendy earn.. $1.000.000 .
Geller.. U8biIity and $2,000,000 UmbreIa CowIrege
l
NidII'"
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EJace. Umbrela Coveraa8
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PAGE 02
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~ or tIlOCItW .. die fDllawilll CQIIIrII:&.
. ~. P.J.'s Land Clearing & Excavating, Inc.
<:.oanct tor. tangrove TrimminQ- Kev W-.t Intern<ltinn<ll 4irpQrt
~ofCuMl.... PO Bny 1:\40"'17
Greenacres, FL 33454-0517
'(561) 740-9938
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MONROE COtJNl'Y, fLORIDA
Req1MBtl'aI'w....
01
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Scopo of WoIk:
Trimming of Mangrove Trees in Saltwater Ponds East End of
Airport
..... ror Waive
P.J.'s Land Clearing & Excavating, Inc. currently carries $1,000.000
General Liability and $2,000,000 Umbrella Coverage
Palidll Waiftr
wiIIlfPlY to:
Excess Umbrella Coveraae
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P J.'s Land Clearing & Excavating, Inc.
P.O. Box 540517
Greenacres, FL 33454
(561) 740-9938
(561) 740-9981 Fax
1 )jsland I ((ub_c !Ism II h .lld
Risk Management
Monroe County
Atten: Wayne Robertson
5100 College Road
Key West, FI. 33040
Dear Mr. Robertson,
Enclosed please find the original Certificate Of Insurance for our general liability. This
reflects the corrected renewal date for our Automobile Liability. If you should have any
'questions please feel free to contact the office at any time.
Thank you,
~SLwwL
Jill Sherwood
Office Manager