Progressive Select Insurance Co. DANNYL. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: June 1, 2009
TO: Maria Slavik
Risk Administrator
FROM: Pamela G. Hanco%�.C.
At the May 20, 2009, Board of County Commissioner's meeting, the Board granted
approval for Mayor to sign title transferring County Vehicle No. 0970-5875, 2006 Ford F-150
(VIN 1FTRF12297NA37801), to insurance company.
Enclosed is the original Bill of Sale and the Certificate of Title for your handling. Should
you have any questions please do not hesitate to contact this office.
cc: County Attorney
Finance
File/
Mai Lan SaHalaches to:Dept al Highway Safety and
Motor Wticlx Nee Kirkman Building,Tallahassee,FL 323M-05W A04823
Attention Number Year
Make T
TM Menber
aL
Q1FTRF12297NA37801 2007 I FORD 1 PKyF v✓r 4582 I veaae Rega NoT 87770738� ����
Registered Owner. Date of Issue 02/14/2007
a/ Lien Release
0 MONROE COUNTY BOCC Interest in the deserted veldt is hereby released
PO BOX 1980 By
J KEY WEST FL 33041-1980 The
Um Date
Um
IMPORTANT INFORMATION
1. When ownership of the vehicle described herein is
O transferred
the
by Seleller lla sectUST ion al the bottom te in full of
W �1w1 Trt thecertificateonllle
-
F 2. Upon sale of this vehicle,the seller must complete
MONROE COUNTY BOCC the notice of sale on the reverse side of his form.
Q PO BOX 1980 3. Remove your license plate from the vehicle �
Iaa' KEY WEST FL 33041-1980 4 See the web address below for more information and
Me appropriate tome required the purchaser to
Bile NMregisterthe vebide mobile home or vessellc :
Isollosellsilimileellisiliiiiillifeliiiillisilislill IIII http f/www hsmv state n us/hImUtitlinfhtml
'' . • ■
r - ` £ CR _ .FICA►TE F, TITLES ' \ -em
Number
y IdenNktl Vessellon Number Veer Make Body 1L-BHP MOAN) lk T —
G r-
rt lien Mims< It •• a.
5 1FTRF12297NA37501 2007 FORD PK 4562 97770736 Interest:ithe deserted rehkle Is MI My released
[Nee
Color Primary Bend Secondary Brand �N Here PAW Issue Data By
5
�N PHI n PRIVATE Ink
Odometer Status Er Pepe Manufactm or OH use Hull Malarial Prop Date of Issue
532 MILES 01/05/2007 ACTUAL T 102/14/2007 Dale
RegWered Ommer
MONROE COUNTY BOCC ti
PO BOX 1980
KEY WEST FL 33041-1880
IRI laeitholder
• NONE ''=p
CC
s'
I
W
DM510N OF MOTOR VDIICLES TALLAHASSEE 441AX FLORIDA DEPARTMENT OF HIGFNVAY SAFETY MD MOTOR VEHICLES i-
ifs
N�-826 770 �� o
l'
•
Cad A.Ford Fred 0 Dkkmson.Ill -'
C.
Dketlor Execute
Director :0
j
TRANSFER Or TITLE BY SELLER(The setlbn met be complete/ 0 the hire of sale J
Attleal midairc V Um the Ell b=mime.wahacce. II "e anddu IA cot the ! l ownership
I w Fichteo= •eu'mv p W 'Y It CI b V
'Iti: 1 vwNobe lieelrvmu r l' waflers or d n be lace a nnInul rest in tin vehicle or arch decanted H heathy hvnMmrA lo'
n PodlEivelkNwid ddre
cellar nW9elIlly Vn=e 'EllerDate bold
I.We hdee gthl.❑I NE npndv.derenvnid.LJUU. Jul_ L Lla c.u.th Mlc.daenM undl hatch./tvilly Eta In N=IHA Only knnwl=Aae me odometer eW a
U I reflects ArnA ma M1n@I E EX(ISs( P MCCILIVIC.1L F DCFB. U 3 i3F10 r'INF A('1llAJ M11FA06:
UNDER PENALTIES OF PERJURY,!DECLARE TAT I HAVE READ THE FOREGOING DOCUMENT AHD THAT THE FACTS STATED N IT ME TRUE g
SW k ull era
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Prim 61636
en
3311136144a,I tcsiNettber _ IN 316 rw tnue=ee
Audio"Nn.< Isane wrbrr
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t t Sim Here Hata
ITHIHat PriniH t A
} NOTICE.310 OD PENALTY M RFODNFp BY LAW F NOT SUBMITTED FOR TRANSFER WITHN 30 DAYS AFTER 011E OF PURCHASE
L
: n4'.V +Thf d H6 ,111 > STATE CI FILO2RIDA' `v ' I -
: � wseLanwr I wx1+ F L S`� � `l
r 1., ' �
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
Neil Kirkman Building - Tallahassee, FL 32399-0620
Notice of Sale of Motor Vehicle, Mobile Home or Vessel
Section 319.22(2), Florida Statutes. provides that hy filing this form. you can a\oid any civil liahility for the operation of thc sold motor vehicle. vessel or 1l10hik home. In
addition to filing this form. we suggest you keep a copy of your bill of sale (we suggest it be notarized). cl'rtiflcate of title or other type of transaction document showing till'
\chide was sold. Complete the information below, tear the top portion of this document at the perforation and mail to the address above or submit to your local tax
collector's office or license plate agency.
I have this~day of V117 ,~, transferred by assignment of and delivered Florida Certificat~ 9f Title to: .2 ~ 3 (;)
o . s: I fIe 171()/ OI..J c.utlt!:.... J(c1. Bid) 0" oLio
Name:Purchaser(s) rY'DJY"e..S6IVe eo Co'- n'S. ". Address ^1,'4,,,,,,,' ~L. ~J'S7 Selling PriceS 12,"76.""
UND~R PENALTIES ~RJ~;, I DECLA~ THA, . FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE,
Sellers Signature ~ . /(. Co-Seller's Signature
NOTE: THE SUBMISSION OF THIS FORM, ACCURATELY MPLETED, TO A TAX COLLECTOR'S OFFICE, LICENSE PLATE AGENCY OR TO THE
ADDRESS ABOVE WILL ALLOW THE TITLE CLERK TO UPDATE THE DMV DATABASE TO REFLECT THE TITLE RECORD AS "SOLD". HOWEVER, THE
OWNERSHIP STATUS WILL NOT CHANGE UNTIL THE PURCHASER APPLIES FOR AND IS ISSUED A CERTIFICATE OF TITLE.
.
.
.
ODOII,IETER CERTIFICATION - Federal and 'Iale laws require that you ,tale the mileage 111 connect inn with (r,msfer of ownership. Failure ((I "(lmplele or providing a false slalemenll11ay result in fines andlur impri,onment.
Sellin~ Dealer's
l.ifl'n~e ~u.
Selling Dealer',
'anu.':
fax
~o.
Tax
C..lIeded:
Sdlin~ Dealer', .\ddre,,, -
Date S..ld:
-;
PUlTha!!lt'r'~ 'amel": f:
\ddress:
::
L\\,' '[,Ill' [h,,[[hh D' "I D" ,hgll .'d"lliclCr 11<'" lead, I
1,1
IG
\ nu tenth" milt" dat~ r~:ld ~mJ to Ilk' "\.',1 of illY klh)\\ kdg.e lh,il II rclkJ..:.t~a~.1y.ltl.mjj~ III I lit'
\ thi,:le dL'"..:rib('d ht"fcin. ll!lk~... one ~\f th,,' l)dlllnet~r'Ii.Ill'I1lL'llI }'Io" k, 1:-. \-'hl'i..'h'd
f
~
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C \1110": UO "III' CHEl'K
IIOX IF ACn .\t.
\III.L\GE
I 'hClt,'hv ,:l'rl\l\ Ih,It III the ht'q III IllY Klh)\\kdgt" {ht" \ldUllh'{'.:I J..';IJing
!ctl.....:h lill' ,1I111)Ulll ,d' md";I~~' in.fM:~jlLllliJ!lf;':~:hilld!:.w_lJmil,~.
I hees,..r it, mechanlcallimils applies tll S digit ..domel.'rsl
I ht.'I't'hy ..:t.'rtify that Iht' llt.iO!ll"'!l'l' rt.'ading ls..JlQt.lb.t."1ltlUJllmil~,
\\\R"I:-\G . IIDO'IETER ()ISCREP\:-\CY.
~
~
~
'"
Purchasl;'r :\tu";[
~l~Il Ill'rl'
('()-Pur,:h~BE'r \It!'.r
Sign Hl'1't'
111'11-1: 11.:-'1'..'
f'ntll Ht're
/:
'"
S",lIt'r/ \~t'nt \hl'-I
~1:;Jl 11l'f'~'
\ul'liun "amc I ,,- hen \pplkabh:":
Pnlll Ilert'
\IH_:rion LH en...e '\llmnt::'f
Selling Dealer's
l.in'l1st' ~o.
Sdllng Dealer',
"lume:
lax
:\0.
Tax
('oIlN'led:
'"
'"
~
St'lIing Dcult'r', \ddrt'o;;s;
lIat. .Sold:
Pur(:haser's ~alI1t'ls):
\ddress:
p
li\\-~' "Ial,,' ill;!l 1111' 0 ~ Ill' D h di).!l\ , dl\il'lt'iI.'r
\'l'"d, ern .1
IlG
Il'lltlhl ini\t.':-. ,bt-.. l~',ld Jnl! ~\' !IlL' l'nl "f illY knu\\kJt!l' ih:1l1t rille.d.~Jb~__,allllil..Imilf-ue 111 tIlt'
dll~:le ,.k',,,nh..'J hl,'ft'll\' unk'~, (111\ i'l Ih(' (\lh'!1),'!L'{ l~!,\~k., ;..,:L'..:'l,:\...cd
(' \11\0": IJO '0 I ( HECK
IIOX IF \( IT \1.
\III.E.\GE
I II.l'Ii.'(n ~'1'1 '1,111.111,1 :11l' h',J ,.f k \'\\k'dt!l' l~h,' I \dilI 11t'h'f fl',hlllli:!
'IlL' .ill],lUII, ,\1 n\ll,,~~~ h,L~liill_Jl.r.jn..~.l.:.hl!!lli:.a~
I Excess ..fit, meehankallimits applies 10 S digit odometerS)
I ht'rcl"'~ ~'<.'lIil:- lh:l! the' Id,lllIl'kr J\',hlill~ j~Jl!!lJh_t;__..(,:lu.al mil~!
II \R"I'\G - O[)()'IETER D1SCREP.\:-\CY.
z:
g
Pun:ha!'Jer \1:)...1
Ht.'IT
('o~Purchaser \111'(
"ign Ht:r~'
:<
f
11-'1','
l'r'lil tkr,'
, I :::::~ : ',:"" ",
-F!i'"
i Sl>lIing Ih'all'r\
\lU..'tiun 'amt I "-hen \pplkahlel:
-.\lJ~li"l1l.i,'l'Il...~' ~lilnh~'r
"'it.l1in1: Ilt'aler'...
r,,,
fa,
( . ulll;'rtt'd:
1 l.il,t.II......'\().~______ ':.Imt':
'io.
(Jat. Sold,
Sl'llin~ Ol'all'r\ _\ddr...V';:
Pun..:ha..t.r.... 'Ullh.t...l:
\c1dre.....;:
-
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i t,,:,"',~,~______ ~~---~-__=;::;~-==~
"LJ'''D''
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'l'lilll.."
rdl,"'d:,! th.t'. "l'tll~ll1!ill'aJ;tf ,'I
I h__nut lhr_~H,:lual lIlih~a~~.
\\\K'I"G . 1111(1\ 1 \-.I ER IlISCREP\"1 '\.
ill !'\n'_\-~ I,Lib_11IX1'hanlr~d_lirni~_1
; F\l't...... of it.... ftll'dutnkai limit... applit,.. tt) E' digit OClfHllch'r,)
(u~Punha...t'r \Iu,'
IL'll'
Ill'l __.~__.-,.____-___-.._____--__'_____-__. ---..--.-.--.-..------~----,-..--'--
\lIt'lion '011111;' t ,\ ht'n .\pplk.lhh~f: _ ________~_- .--,---..-------~-,---
@
II i
PROGREJI/YE
9rgreee.e 1.
1:901 Old cucar Rd
Building B.Sole 300
Miami.FL 33157
Telephone 3052527119
Facs"mla 3052346162
BILL OF SALE
State of Florida Claim # 09(813648
County of Dade
KNOWN ALL MEN BY THESE PRESENTS: Monroe County Board of County Commissioners
That in consideration of Twelve Thousand Eight Hundred Forty Eight Dollars$12,848.00in hand paid by
Progressive Select Insurance Company, hereinafter referred to as Buyer,the receipt of which sum is
hereby acknowledged and the undersigned does bargain, sell and convey to the said buyer the following
described Property.
Vehicle Year,Make and Model: 2006 Ford F-150
Vehicle Identification Number: 1 FTRF 12297NA37801
As is, and does hereby covenant and agree to warrant and defend the sale of said Property unto the said
buyer against any lawful claim and demand of all and every person or persons whatsoever. (This property
is sold as accepted and is not guaranteed.)
THIS A EEMENT made and entered into on this ZDJ4 day of 2009 by and between(Buyer) Pro-
ess. a American Insura ce Com n and Monroe County Bo of County Commissioners(Seller).
L.-en V) 1 _T
Seller Sign [ re / to t?JL3
$ .l 1 NV L. K LHAGE, CLERK
„/ UTY CLERK
Please check the appropriate line:
_ The Seller produced the following identification: DiL#
f irract+r.w.r.Lcs
OO MONROE COUNTY ATTORNEY
PRO ED AS1TO/�OR, 1:
t gtt 0- e /
CYNTHIA L. HALL
A.SSIS .ANT COUNTY ATTORNEY
S iA
DANNYL. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: June 8, 2009
TO: Maria Slavik
Risk Administrator
FROM: Pamela G. Hancoc,
At the May 20, 2009, Board of County Commissioner's meeting, the Board granted
approval for Mayor to sign title transferring County Vehicle No. 0970-5875, 2006 Ford F-150
(VIN 1FTRF12297NA37801), to insurance company.
Enclosed are two Motor Vehicle Power of Attorney/Odometer Disclosure Forms that
Progressive Insurance requested,for your handling. Should you have any questions please do not
hesitate to contact this office.
cc: County Attorney
Finance
File
4if :^Y 'ri sc -1 a 'Egli �'a
` .n+:AwCA]LG:La.L4K w Ara V'a•'a s wq.�•e p.ya gy'.a 01.mraY taSiF wfi'. �7
STATE OF FLORIDA )ti
•r ;1= DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES (I R:. . Sider •T
�( T DIVISION OF MOTOR VEHICLES
Neil Kirkman B ling-Tallahassee 3239E 0610
t T MOTOR VEHICLE POWER OF ATTORNEY/ODOMETER DISCLOSURE yY
ThisformMay TT 0 b titlepip UJhla by l hoflero talc hasbe lost.Thisf peeb I toth s.m ItM1 person 'xer -IP of ADomey
imprisonment
VEHICLE DESCRIPTION
Flue! a
IFrQ 122Qa7N�}3r7gor 12oot, 7FO2D J 1.'rl: )
PART A.TRANSFEROR(SELLER'S)POWER OF ATTORNEY TO DISCLOSE MILEAGE J �),^)
(wr MPH r-•e Cola,'1• B s✓ •1 C•Ari fyT C men slip e.
I fP. Sellsrs N PP _ )');�,
em 1 .y- _:F authority. transfertile t sate( y l i to age 1 L aia I th h a.: b 1 abovecu f f h f 05)
9
-on WARNING:Petard n and Starerepo m D.d yougad f rn Iaay f , v.P f 1 inners DI P a r T lela t cP r r ray e If in fine;or imprisonment
I STATE HAT THI"MOTOR VEHICLE L DIGH OR El6 DIGIT ODOMETER NOW READS I WILljiTu
DATE
N.`TENT-13
I LES READ I 0 B. 01 AND TO THE BEST OE MY KNOWLEDGE THAT IT REFLECTS THE AQTUAL MILEAGE OF THE
V EHC E DESCRIBED IN THIS DOCUMENT UNLESS,ONE OE THE Fgl LQWND IS CHECKED
1 ,
CAUTION
El
nli Ill BY CERTIFY THAT F CTHE
$S I ()I rav l<v IF ,F ne 01]'ttn TT Fr NEAOINO FEFLFGI;THE
(3, AM0.NI Of M EA G IN.BCBSS OF ITS MEQHANQALLIMI-TS
.
e J 'e Hi RUMCERTIFY HIV TFI Fl di A)N oTT1lE<,ICTUAL MREAUE
t
OZ,
F r<• WARNING DOMETER DISCREPA CY Fr� '.
o n y p 1
s. T ! "` -_ a N,:4/ e.r-gG 'Y . NCugen )
T
1, ire C Salk P ,el Nam.
CI-
*1G fit" S'wl.n+un Street' E ke iv TIL e.si- A._ $.3o'Jo �)
SI“I in 440k
S] _ Nese
P� rle ensILIPN _ peek/oho
IQ")
U.
(Prim N D
Met
' )
- as t t zp
f RI )
- - -- - E—_
PART BTRANSFEREE(PURCHASER)POWER OF ATTOgryEV OflEVIEW TTLE DOCUMENTS AND ACKNOWLEDGE DISCLOSURE(PatlB is invalid unlessP has been mpleletl)
IW.. . _ Want - - _. -P N I D :.. F B ad I .
attorney in-fautf the P irpose of and wrthflI authority to ply f titleOtte arida. g'stratum to file d lo signthe g_disclosure the title ler the
ye wre rIE-cubf above only il the disclosurediselosure IS exactly as the disoloarre crylipletaa berms WARNING Panora la, an.State lab require Malat y s stare the mileagein )
der iinm
On with farsfe r of ownership PmvRrg a false tatement y resu 1 in hues es oimprisonmentIr
MILES DATE READ
THIS MOTOR VEHICLE S
TO THEBEST OF MA KNOWLEDGE THAAT IT REFLECTSTHE ACTUAL MILE GE OFTENDIS
HE dijk
IHAT C ❑ ❑❑ri ❑❑ s
— — AGE OF THE � ..
VEHICLE DESCRIBED IN THIS DOCUMENT UNLESS LONE OF THEF_OLLOVVIND IS CHE N-p 1114444
CAUTIONieks
- :
I HEREBY CERTIFY THAT TO THE BLS I OF LLP EQHKNOWLEDGE
AL LIMITS
b-E OO 1[HEq READING REFLECTS IIII
AMOJ TO M EAGE IN EXCE$SOFT$MEEIIANIGAL LIMITS .Y
( . F I HEREBY CERTIFY THAT THE ODOMETER READING IS NDTTIEE ACTUAL MILEAGE y`)
nk a — - WARNING ODOMETER DISCREPANCY
r
,by Scam,Gabor; eANamn --_ -
O. 2 (FO10 n e inessiessi _- F b .ship,Dusiness r
Lek
'1
`y ¢ Hu •Addles`_—_ IN __. -_ .. $onry lip r .
�• _._-_ . -- .. _. ri _
1
eiefi
putter,t Bonds, Purelmaeas PrintedN
s � )
fCu Purchasers E9 aim . _ CoP rTe AP,NIeaN _... j
OFPurchaser'sann. Street AOOres>... _ _._ . _. _. —_ —
e.f
OFmay GAY Slate, Zln )
Y�~ PART C.CERTIFICATION BY ATTORNEY IN FACT(Person completing Part C must be the same persontransferring information and signing the title.)
1', 1
hereby certify that the mileage I have disclosed the Otte document r
v� above
consistent f th that p ded t abovepowers Iattorney F Further,uponexaminationIa 10 and anyreassignments 1 f the La ea e 4*.,
T b min mileagedisclosure ahavemadeea titlepursuant r thetpower attorney thesameunder
greater Il that previously stated on[h title reassigned
documents Thiscertificate f Intended to create.nor does T create any new or eaa f liability a r Federal or State law ya
Signature Date _ _. Printed Name ram)'
IllEr b.
y! Street Address _. City — — _ StateZip IT)•.
DMV COPY(WITH TITLE) -•
.�
4, . � Rf( NOTICE ANY ALTERATION OR ERASURE MAY VOID THIS DOCUMENT t r .. t V..SIR .... - ..A ...c N /••:-: `..