03/18/2009 Agremeent
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
April 2, 2009
TO:
Maria Slavik
Risk Administrator
Pamela G. Hanc~.
FROM:
At the March 18, 2009, Board of County Commissioner's meeting, the Board granted
approval and authorized execution of the insurance proposal from Lexington Insurance Company
to restore the ramp at the KWIA back to the pre-loss condition.
Enclosed are two duplicate originals of the above-mentioned for your handling. Should
you have any questions please do not hesitate to contact this office.
cc: County Attorney
Finance
File /
0992687
POLICY NO.
S 5.000.000.00
AMOUNT OF POLICY AT TWE OF LOSS
0&'010.007
DATE ISSUED
0510112008
DATE EXPIRES
SWORN STATEMENT
IN
PROOF OF LOSS
x 0
o ):>
23109-58489 Z n.2
GAB RoIlinI FI.E NO. ~.- Z
Orr'l-<
683-199941 f'T'l ~
COIIII'ANY CLAM NO. ("") ..,.i(. r
OnA
MARSH USA, INC. c :;;0
AGENT x. r
-tOX
SUNRISE. FLORID~:-t~
AGENCY AT ~,..,
To the LEXINGTON INSURANCE COMPANY
of BOSTON. MA
At time of loss. by the above incIcaled policy of insurance, you insured -
MONROE COUNTY BOARD OF COUN1Y COMMISSIONERS Loss Location: Key West. Inri Airport. Key West. FL
against loss by RISKS OF DIRECT PHYSICAL DAMAGE to the property described accon:tiIlg to the terms and
oonditions of said poley and of all forms. endorsemenIs, transfers and assignments attached thereto.
TIME AND A RAMP COLLAPSE loss occurred about the hour of 7:00 o'clock ~ AM 0 PM
ORIGIN on the 08 day of APRIL yr -2!!.-. the cause and origin of the said loss were:
SECOON OF SUSPENDED INGRESS RAMP UNDER CONSTRUCTION AT KWIA COLLAPSED
The building described. or containing the property described, was occupied at the time of the 1088 as follows.
and for no other pwpoee whatever. AS AN INGRESS VEHICLE RAMP UNDER CONSTRUCTION
LEADING TO THE SECOND LEVEL AT THE KEY WEST INTERNATlOHNAL AIRPORT
N.lletme rille 1oIa. lie.... c:I)'OW iand in I1e property dMal>>ed I&ein.. OWNER
. No oller peraon or penDIS had tntDelesl...... orela.....ahnon. 8JlCECIt
OCCUPANCY
TITLE AND
INTEREST
CHANGES
UNDISPUTED INDEMNITY
FOR RAMP COLLAPSE
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NO EXCEPTIONS
Since the said policy was issued, there has been no assignment thereof. or change of interest, use,
occupancy. possession, location or exposure of the property described. except
NO EXCEPTIONS
THE TOTAL AMOUNT OF INSURANCE upon the property described by Ihis policy was, at the time of loss,
$ 5.000,000.00 . as R1OA!J particularly specified in the apportionment attached, besides which
thent was no policy or other contract of insurance, written or oral. valid or invalid.
THE ACTUAL CASH VALUE of said property at the time of the loss was _ _ _ $ UNDETERMINED
THE WHOlE LOSS AND DAMAGE was _______________________ $ TO BE DETERMINED
THE AMOUNT CLAIMED under the above numbered poley Is __ __ __.. _.. _ $ 11.060.13
The ..kllo8a did not orIglnata by any 8Ct. .... or pracurwnent on the ~ of ~ ........ or 811
~ nothhl8 has been Clone bj or WIth the ~ or COI.-nt of JOUI' Insa.inJd or fhis ~ to vIoIat
the condlllo.. of the policy. or rwnder It VoId.; no artIcI.- .. IMIlIIoII8d ....... or In annexa
~ but such _ ..... ..h~ or ......... 8t the .... of SIIId Ioea; no.~ saved ... I
any manner been ~Ied, and no atbI!nPt to d8ceMt the uId COllI...,. _ to the 8xteiIt of..1d loat
haS tal MI ........ been IriacIe. Anr oth8r lnfarnuItIon th8t may be niqulnJd will be fumI8hed an
COMIdereCI . part of.. proof.
'The........ of.. .... 01' the IM...-.&.n of proofs .., a ........~ of the..... .........~ .. not..... of.., of .. rtghIs.
CAUtION READ BEFORE ..... ....OW
IIId will ~ID iIjIft. dIhud, at...... 8Iy.... _...-.-.. of dIIim<<..
~ <<........ ~ ....,d.r.Iony01.. I*d......
TOTAL INSURANCE
VAWE
LOSS
AMOUNT CLAIMED
STATEMENTS
OF INSURED
SlIde fA
Countv d
Florida
Monroe
~ and swom to berantme Ihia
Form PR0765 (Rev.9I99)
2nd
..,.t....", PAMELA G. HANCOCK
/~:A:~.t'~~ MY COMMISSION' DO
i*{ J;j EXPIRES: February 7. 2012
~~.....~' Bonded Thru NotalY PubliC undetWlhl'
, ',Rf"f:\'
(5
ArreST: DANNY l. KOLHAGE, aERK
BY
DEPUTY CLERK
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