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Certificates of InsuranceDATE (MM1DD/YYYY) ACORD RTIFICATE 4F LIABILITY INSURANCE 12�ll�zoo9 TM' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER 247-5121 FAX: (305) 2488543 - (305) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EXTENDBELOW. OR ones & Com any T.R. J 1� HOLDER. THIS CERTIFICATE DOES NOT AMEND ALTER THE COVERAGE AFFORDED BY THE POLICIES 1780 N Krome Avenue FL 33030 INSURERS AFFORDING COVERAGE NAIC # Homestead INSURER A: Assurance CO. Of America INSURED Blaylock Oil Company INSURER B: P . 0. Drawer 310 INSURER C: INSURER D: Homestead FL 33090-0310 INSURERE: coy ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGD THE POLICIES OF INSURANC E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MAY PER ANY RESPECT TO WHICH THISCERTIFICATENS REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REQU , ANTD CONDITIONS OF SUCH POLICIES. POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS THE INSURANCE AFFORDED BY THE LIMITS INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MMIDD/YY DATE MM/DDIYY1NSR LIMITS A R $ GENERAL LIABILITY DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY MI aoccurrence)$ $ MED EXP An one on) CLAIMS MADE � OCCUR PERSONAL ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP A $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO -El LOC POLICY F JECT COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY A (Ea accident) ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Per person) SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY EA AC $ ANY AUTO OTHER THAN AUTO ONLY: r A OCCURRENCF EXCESS/UMBRELLA LIABILITY -EACH $ F� OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION WC STATU- X OTH- ER A WORKERS COMPENSATION AND $ 110001000 EMPLOYERS' LIABILITY E.L. EACH ACCIDENT ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WC 02 9015 95 01 1, 000 000 4 / 1 / 2 0 0 9 4 / 1 / 2 O l O E.L. DISEASE - EA EMPLOYEE $ � If yes, describe under E.L. DISEASE -POLICY LIMIT $ 11000,F000 PE IAL PROVISIONS below OTHER f rDESCRIFTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS -Payment of Premium. Subjec t Policy Limits, Terms Conditions and Exclusions. 0 Day N otice of Cancellation for Non CCI N C 1n, a yx CERTIFICATE HOLDER CANCELLATION POLICIES BE CANCELLED BEFORE THE SHOULD ANY OF THE ABOVE DESCRIBED Monroe Count Board of County EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Commissioners * 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 1100 Simonton Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Room 2 —213 INSURER ITS AGENTSADR REP ESENTATIVES. Key West, FL 33040 AUTHORIZED REPRESE I A � v Thomas R. Jone , e o d © ACORD CORPORATION 1988 ACORD 25 (2001108) Page 1 of 2 INS025 (0108).08a IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS 1 WAIVED subject to the terms and conditions of the policy, certain policies may require an endorsement. A statemen t on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insu rance on the reverse side of this form does not constitute a contract between the issuing p insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) Page 2 of 2 INS025 (0108).08a DATE (MMIDDIYYYY) coROF LIABILIY INSUANCE BPAYLJ1 03 30 to PRODUCER THIS IFICATE IS ISSU D AS A MA OF I CERTIFICATE 10 PROD ONLY AND CONFERS NO RIGHTS UPON THE CERT tin Inc.HOLD ,ER: TRIG RTIFICATE DOES NOT AMEND, EXTEND OR B8 Insurance Marketing, ALTEIR THE COV RAGE AFFORDED BY THE POLICIES BELOW P.O. Box 551267Y Fort Lauderdale FL 33355-1267 - Phone: 954-452-4900 Fax:954-452-0 50 INSURERS AFFOR ING COVERAGE NAIC # INSURED n IWURER.A.�,, Ameri Guarantee Lia bility yM.� INSURER B zurich American Ins of IL Bla lock Oil Co INSURER C: Wesco Insurance Company PO ox 310 �� '- Homestead FL 33090 P I kR, " r, I 1�J 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. POLICY EFFECTIVE POLICY EXPIRA ION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYYYY DATE MMIDDIYYYY EACH OCCURRENCE $ 11,0 0 0, 0 0 0 GENERAL LIABILITY B X X COMMERCIAL GENERAL LIABILITY CP09 40 2 0 92 -0 0 12 / 31 / 0 9 12/31/10 PREMISES (Ea occurence) $ 10 0 r 0 0 0 CLAIMS MADE 4 X OCCUR MED EXP (Any one person) s5,000 ADV INJURY $ 1 000 PERSONAL &, ,f000 GENERAL AGGREGATE s 2, 0 0 0, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , O O O , 0 0 0 7X POLICY PRO- LOc EmpBenef 11000,000 JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 0 0 0 , 0 0 0 A X ANY AUTO C P09 4 0 2 0 9 2 - 0 0 12 / 31 / 0 9 12/31/10 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) 1 ' AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ 3, 0 0 0, O O O A X OCCUR F-ICLAIMSMADE UMB9402093-00 12/31/09 12/31/10 AGGREGATE $ 3 , 000 , 000 DEDUCTIBLE OA $ X RETENTION $ 10 , 0 0 0 - $ WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS' LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 12662 0 4 / 01 / 10 0 4 / 01 / 11 E.L. EACH ACCIDENT $ 1, 000 , 000 OFFICEWMEMBER EXCLUDED? � E.L. DISEASE - EA EMPLOYE $ 1 , 0 0 0 , 0 0 0 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1 , 0 0 0 , 0 0 0 SPECIAL PROVISIONS below OTHER A Uninsured Motorist CP09402092-00 12/ 1/09 12/31/10 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDO S MENT I SPECIAL P VI IONS Wholesale Fuel & Lube Oil Distributor located at 724 S. Flagler Ave, Homestead, FL 33030 & 33 SW 4th Street,Homestead,FL 33030.See attached vehicle schedule -pollution liability CA 99 48 & MCS-90 applicable to autos. Certificate Holder is listed as additional insured on GL and Auto. *Except 10 days notice for non payment of premium. /'► A 1►1/'►CI 1 AT1�1111 CERTIFICATE HOLDER " ^""" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL_ DAYS WRITTEN C.. 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 Monroe County Board of REPRESENTATIVES. County Conmassioners AUTHORIZED REPRESENTATIVE 1100 Simonton Street, Rm 2-213 Joel Johnson -00*1 __jICey West FL 33040 ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: JJ �1 ACORL7' CERTIFICATE OF LIABILITY INSURANCE MOO IYYYI) DA06130111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. fNPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies on this certificate does not confer rights to the PRODUCER 954452 0 BB Insurance Marketing, Inc. 9rtq,d52-04 P.O. Box 551267 art Lauderdale, FL 33355-1267 oN Johnson JUN NAIM. osema anchez c No E : 954-052 No): 95d-452-0450 Sema bimi.com BLAYL INSU S AFFORDING COVERAGE NAIC i Imo® Blaylock Oil Co PO Box 310 1MUNR Homestead, FL 33090 RISK M merican uarantee & Liability26247 ch Am can Ins of IL 278`.>3 c ; eld Employers Ins. Co. 561499 INSURER D : INSURER E : rti nrrrr 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. TYPE OF INSURANCE MOM LIMITS B GENERAL LIABILITY X COMMERCIALGE'•IEF'ALLABILITY CLPIhAS-MADE a OCCUR X PO$402092-01 h 1 1/1 12131MI EACH OCCURRENCE $ 1,000,00 p M'.E761TFI1curre ce $ 100,0 MEG EXP (Pay one ce*scnl S 5,00 cl PERSONAL & ADV INJURY $ 1,000,0 / !' !) GEtERAL AGGREGATE $ Z000,00 .L Gd3GRFGATE LIMIT ?PPL r6 PER: PRO- POLICY LOC PRODUCTS - SDVP/OP A�3G $ 2,000,00 Ent Benef S 1.000.0 A AUTOMOBILE LIABILITY ^,fJr �! ?o X CP09402f)92-01 12/31110 12/31/11 C014P NED SW-4-E LIMIT IEa accidenb $ 1,000,00 BODILY INJURY IPer person) S X ALL UWrlED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NOPi-CW`.IED AUTOS ' vF BODILY INJURY IPer accident) S PROM'PTY Da.Mb ,.r (Psr accident) $ q UMBRELLA LIAB EXCESS LIAB X OCCUP LLAIMS-MADE UMB9402093-01 IV31MO 12/31/11 FA(NCKTI.IRRF r7 S 4,000,0 AVVREVA L $ 4,000,0 DFD. ICTIR F $ X I 10 Cs WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Ar,YPROPRIETORIPAR-hIF'RIFXECI_r7VE YIN F)C OFERJMEMB�2 EX( LUDED� (Mandatory In NH) II yes, describe under aumis N I A NO-47776 04/01/11 04101/12 X - " T. - E.L.EAC- ACCIDENT $ 1,000,00 E L. DISEASE - C4 EMP_OYE $ 1,000,00 E.L. DL.,EASE - POLIC'f LIMIT 1 ninsure Motorist 12/31PID 12/31/11 1 Property In Transi CP09402092.01 12/31/10 12131M I Per occur 50, FDeSCFaPTION OF OPERATIONS I LOCATIONS I VEHICLES to h ACORD 101, Addiftnel Remade Schedule, it more apaca Is required) lseale Fuel & Lube Oil Distributor located at 724 3Flagler Avestead, FL 33030 & 33 SW 4th Street,Homestead F 33030 & AMS.DixietHomstead FLPollution liability CA 99 49 & MU00 a pplicable to autos. dicate Holder is listed as additional insured on GL and Auto. Monroe County Board of County Commissioners 1100 Simonton Street, Rm 2-213 Key West, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN ACCORDANCE VATH THE POLICY PROVISIONS. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 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 CLAMS. POUCY EFFECTIVE POLICY EXPIRATION CO TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYY) DATE I MM, D LIMITS LTA GENERAL LIABILITY GENERAL AGGREGATE s 2,000,000 X COMMERCIAL GENERAL LIABILITY PRODM UCTS - COP AGG $ 2 000,000 1 i A t CLAIMS MADE ®OCCUR 9323565 12/31/08 12/31/09 INJURY s 1,000,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE i$ 1,000,000 FIRE DAMAGE (Any one fire) S 100,000 MED EXP (Any one person) AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X ANY AUro ALL OWNED AUTOS BODILY INJURY A SCHEDULED AUTOS 9323565 12/31/08 12/31/09 (Per person) BODILY INJURY X HIRED AUTOS X NON -OWNED AUTOS i (Per accident) PROPERTY DAMAGE GARAGE IJABlLfTY AUTO ONLY, EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY; EACH ACCIDENT AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE s A X UMBRELLA FORM 9323566 12/31/08 12131/09 AGGREGATE s 3,000,000 OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND I WC ST. LI EMPLOYERS' LIABILITYORY EL EACH ACCIDENT THE PROPRIETOR/ INCL EL DISEASE POLICY LIMIT PARTNERSIEXECUTIVE OFFICERS ARE� :EXCLI I I EL DISEASE - EA EMPLOYEE 14 OTHER I DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS SEE ATTACHED PAGE 1450900 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON ST ROOM 1-213 KEY WEST FL 33040 I I ­ ­ ................................. ................. 38 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE 1#0 OBLIGATION ON LIABILITY OF ANY KIND UPON THE COMP!f ITS AG OR RIEPRIESENTATIVES. AUTHORIZED REPRESENTATIVE,-% -e •`.::, �}v.?,. :?_.�.,.ti i, . t .\ jr r r• • f#= ''% ''= • 'S' `• w 4��51i:•:9M•OdAii•.�2�\^:ri.::\:t40TTidt+}}}:• �h•.4-Y. f.. .`• d^•%•.}th''i• • \ t .L..?•.. -.... •h;�::•:A vv PRODUCER r • v:- - -- - -- - -- - - - : - -•. :. �}ti^: ;:::: �N:NN: r:vtrtwvrr.Svvra: cttvr{ • "k�'''' DATE(MM/DD/YY1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY Home Office: P.O. Box 328 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Owatonna, MN 55060 COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR Phone: 1-888-333-4949 A FEDERATED SERVICE INSURANCE COMPANY INSURED BLAYLOCK OIL CO 145�8-0 724 S FLAGLER AVE COMPANY B COMPANY HOMESTEAD FL 33030 C COMPANY D kti'•7R\x t,? •�rf- I'U. f{\'S'` \ i]v^/, `•f{:t�'t•: ' fi:: 'f''t: �. t`,�+'c"+L ?L ?yam t . 1 r�;ttitti. •.. t f a•7�:?17ii.-}•�ti•}Yv"wr}}'•�.,eLttt�'tt L sY:s• •:-0b}:t' h h: xir:v \'•.4.••:v}'• .?f. 4 7 ': 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. LTTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDNY) POLICY EXPIRATION DATE (MMIDDIYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ ZOO OOO PRODUCTS - COMPIOP AGG $ 2,000W 000 000 X COMMERCIAL GENERAL LIABILITY A :...... CLAIMS MADE OCCUR 9323565 12/31 l08 e� 12/31 /09 PERSONAL & ADV INJURY $ 1 OOO OOO EACH OCCURRENCE $ 1 000 000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 100000 MED EXP (Any one person) $ AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS W23565 12/31 /08 1 W31 /09 BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ 3 000 000 AGGREGATE $ 3 OOO = A X UMBRELLA FORM W23566 12/31 /08 12/31 /09 $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY.. WC SI IMrr EL EACH ACCIDENT EL DISEASE - POLICY LIMIT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL gISEASE - EA EMPLOYEE $ OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATIONILWCATIONSIVB*CLFSWECIAL ITEMS CERTIfICATEHOLDER IS AN ADDITIONAL INSURED FOR CONDITIONS OF THE ADDITONAL INSURED BY CONTRACT ENDORSEMENT GENERAL LIABILITY. FOR BUSNiESS AUTO LIABILITY. CERTIFICATEIOLDER IS AN ADDITIONAL NISURED susiECT TO THE AUTO LIABILITY POLICY CONTAINS ENDORS®ilEN1 MCs410 : L: Y: tr �•L: ,h•.'Y .t }•:t1••.tt.}}`•.•�:.t : • • >: x?t.::%}}}rt+}- .Y. 145013W MONROE COUNTY BOARD OF 38 : We L • A�t{{'.rfr}.• .•.:.rN t : \X•f L: V::. a f:N: �•:t \•}'}:. Y-•A it r.•�".•:ti .:. •.. rtit•.•}}.'fh :"•J}:1:=�h'}... �:r::r ��h: •. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE COUNTY COMMISSIONERS EXPIRATION DATE THEREOF. THE ISSUNc;i COMPANY VO L ENDEAVOR TO MAIL 1100 SIMONTON ST ROOM 1-213 10_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, KEY WEST FL 33040 SLIT FAIWRE TO MAIL SUCH NOTICE SHALL WPOSE'NO'.O=MTION OR LAAMUTY OF ANY KIND UPON THE comp . ITS Amm OR REPREsEmTATIVES. AUTHORUM REPRESENTATIV ..:�'`'? ♦ • :. v;;. �,k•C},.}:5..}, ±(:v t • :?-}L�.:t to L.t . n...: }.. :-0 1 _ _ _ .......... ... . . .................. . . / /Yx** DATE MMDD Y ( ) A CC) RD u-N.J. TM....... .............................. .............................................. 11 / 1 0/09 .................................................................. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Home Office: P.O. BOX 328 COVERAGE AFFORDED BY THE POLICIES BELOW. Owatonna, MN 55060 COMPANIES AFFORDING COVERAGE RECEIV Phone: 1-888-333-4949 comrMl FE ERATED MUTUAL INSURANCE COMPANY OR A► FE ERATED SERVICE INSURANCE COMPANY INSURED BLAYLOCK O I L COI'ANN NOV54?2 0 0" 724 S FLAGLER AVE HOMESTEAD FL 33030 MONROE CO NTY C RISK MANAGPIENT D ­* ............................... * ........ * ....... * ...... * ........ * ............. ­* ....... * ......... * .................... * ......VE ............................................... THIS IS TO CERTIFY THAT" THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO......... 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 29000,000 X PRODUCTS - COMP/OP AGG $ 29000,000 COMMERCIAL GENERAL LIABILITY A CLAIMS MADE CJ OCCUR 9323565 12/31 /09 12/31 /10 PERSONAL & ADV INJURY $ 1 000 000 EACH OCCURRENCE $ 1,000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 1001000 MED EXP (Any one person) $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY $ ALL OWNED AUTOS A SCHEDULED AUTOS 9323565 12/31 /09 12/31 /10 (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS L— (Per accident) PROPERTY DAMAGE $ ��jp- " 44 GARAGE LIABILITY / AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ......... ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ 39000,000 AGGREGATE $ 3,000,000 A X UMBRELLA FORM 9323566 12/31 /09 12/31 /10 $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND 1 WC STATU- OTH- TORY LIMITS ER ::::::::'::::::::::: EMPLOYERS' LIABILITY ' EL EACH ACCIDENT EL DISEASE - POLICY LIMIT $ THE PROPRIETOR/ INCL R PARTNERS/EXECUTIVE EL DISEASE - EA EMPLOYEE $ OFFICERS ARE: EXCLI OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS SEE ATTACHED PAGE .... ;. ....i .................................................................................................................................. G; ::. N#AT asoseo MON RO E COUNTY BOARD OF .................................................................................................................................. 38 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE COUNTY COMMISSIONERS EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1100 SIMONTON ST ROOM 1 -21 3 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, KEY WEST FL 33040 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMP , ITS AGENTS OR REPRESENTATIVES. • AUTHORIZED REPRESENTATIV 1...e't . S�' '•, .R' }# #Q ------------- CERTIFICATE OF INSURANCE INSURED 145-098-0 BLAYLOCK OIL CO 724 S FLAGLER AVE HOMESTEAD FL 33030 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY. CERTIFICATEHOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. AUTO LIABILITY POLICY CONTAINS ENDORSEMENT MCS-90 POLLUTION LIABILITY COVERAGE PROVIDED ON THE BUSINESS AUTO SUBJECT TO THE CA-F-85 ENDORSEMENT. THIS ENDORSEMENT DOES PROVIDED COLLISION, UPSET AND OVERTURN COVERAGE SUBJECT TO THE CONDITIONS OF THE POLICY. CERTIFICATE HOLDER MONROE COUNTY BOARD OF 38 COUNTY COMMISSIONERS 1100 SIMONTON ST ROOM 1-213 KEY WEST FL 33040 le-scCMt)r C T" F C ` E F LIABILITY INSURANCE P ID JJ CA. �r t� �F.:�:F-a� .=r.i., ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BB Incur ince MayketI g, InCa MOLDER, THIS CERTIFICATE DOES 4140T AMEND, EXTEND OR P0. Box 551217 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW For't- Lauderdale FL 33355-1267 Phone: 954-452 _4 00 Fax.- 954-4 -2 -Q450, INSURERS AFFORDING COVERAGE I'`>IAIC ## _ ............ _ .. _.... _... ........_......_ _.. ..... _ ..._ .......... ........_.... _ _.-- _ _ ... _ _........ _...... ... ....... ........................ .... a'JS .�..Y S' tom:+?.' i 3J'� 'Y..F•. G:i.:. 4 i�' '. •P[ w:.L fJC.f..:' �.. A S .i -ic- nrican Ina of IL PO Box 31.0 <?s..F Homestead FL 33090 COVERAGES y� pC ti Or -A-. - C ^.. y ^ r'v- z .r" r e �.. w _ t t :w , .w :?Yft'^ iPE NAM q� r '%—tr.`rn iy. }^, ^J' 'w`,?r`r t `! :]Cy y t x i3 ': if, ;''i`'i� i tr. r. t h,. THE :`o01 s,.. . O :�0�:' �`t'r w },.�S S E.;.,,i � L�,..'V i`.'.c ,4E �p,j:^:3�'1- t.J vry..'. Y�c�,,. 'OTHER. '�W( ,..i��v`. .(: 6Y�.'.`�.�4^l t•5.3:��.6C � �l. X+' w��j�i-.«'.✓'� G �.•�''3'/1 .6..� s v {�,,;I vY �w ?�f..J' :SV .Y�Sw!"t �' - c�.. 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A'4.�::,�:''+�� i .,f�� �a . �<,r�%..t,.: a 3A Y'.:� �` .3�Y. � ds ^ :.: �« ^ ..:..:. ..... ......... >ti � � �d s � ., � �, <: � � x v � � � �'9' >D.....� ;,::i�"2 a'.,... a� •>� i ..3 � � ,,.:.'`. � s"'F �r a • fi a,.3'� Wholesale Fuel, Lug mil Distributor located at 724 S. Flagler A,,re, Hornes-tBald, FL 33C30 & 33 SW 4th Street , Ho-mestead , FL 33030 , see at.tac eed ,-vehicle schedul r PcIl%ition li.> ili ty Chi. 95 48 & MACS-9 a:Rp'.icable to a toz. cexti- 'i.,_ate Holder is 11 s tech as additional :-Ansured on GL and A-ato . CERTIFICATE HOLIER CANCELLATION E Ronrce County C Xd of County core-,issionexs '1o. Kev West TL 33040 CORD 2 (2009f01) 1988- 009 AC RD CORPORATION, All rlohts reserved,.C� l � r �.r�`• �� � f� r,l F G