COI Expires 05/19/2009
A CORDnA CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYVY)
10/29/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Seitlin ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
9800 NW 41 Street, Suite 300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Miami FL 33178 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
(305) 591-0090 (786) 662-6227
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Travelers Casualty &: Surety Co 19038
Charley Toppino &: Sons, Inc. INSURER B: Travelers Indemnity Co. of CT 25682
~--
P.O. Box 787 INSURER C: SeaBright Insurance Company 15563 ~~-
Key West FL 33041 INSURER D:
i INSURER E:
Cert ID 21326
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.
iNS-RTAOD'iT------- POUCY NUMBER POUCY EFFECTIve POLICY EXPIRATION
LIMITS
A
x~ ; _ COMMERCIAL GENERALLlABI L1TY
l__~_J OCCUR
DTC03202M181-TIA-09
5/19/2009
5/19/2010
~ EACH OCCURRENCE ! $ __ ---__l,JtO"O_L.OJLO_
I DAMAGE TO RENTED
~- PREMISES lea occurefl~l --l-!.------~ __~_90,().O 0
~ MED EX~J~ny on~~~~~nJ____~~___________________~_.'_QO 0
I PERSONAL & ADV INJUR~___~~______~-,_Q_g..Q!.()Q_9
I GENERAL AGGREGATE l!------~-~Q.Q ,-QQ_()_
PRODUCTS - COMP/OP AGG ! $ 2 , 0 ~_Q~_()~_~
LOC
B
AUTOMOBILE LIABILITY
X ANY AUTO
l---1 ALL OWNED AUTOS
l_-J SCHEDULED AUTOS
~~~ HIRED AUTOS
lJ NON-OWNED AUTOS
I
DT8103202M181-TCT-09
5/19/2009
COMBINED SINGLE LIMIT $
5/19/2010 (Ea accident)
BODIL Y INJURY i$
(Per person) !
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
1,000,00Q.
'\0\ ·
A
X OCCUR
CLAIMS MAOE
DTSMCUP3202M181TIL09
5/19/2009
5/19/2010
AUTO ONLY - EA ACCIDENT $
EA ACC $
AGG $
L~~H OC~~REN~~_________J__~___.___~_~_QQ~_,. 0 ~9
~_~C3_~_~E~_!~______ _.~__ _______5~_q__gQ.!_09q
,-.-----..-------...--. ----. u--...--.t _~__.______.___
OTHER THAN
AUTO ONLY:
EXCESS/UMBRELLA LIABILITY
DEDUCTIBLE
C
$ 10,000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERlEXECUTIVE
OFFICERlMEMBER EXCLUDED?
~~~I~~~~~~1gNS below
OTHER
BB1090373
5/19/2009
5/19/2010
$
10TH-I
. -t----------.------ --
E.L. EACH ACCIDENT $ . 1,000, OOQ.
E.L. DISEASE - EA EMPLOYE $ 1, 000, 00 Q __
E. L. DISEASE - POLICY LIMIT $ 1, 000 , 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Project#0919- Palm Drive Bridge Repair.
The Monroe County Board of County Commissioners, its employees and officials, as Contractors are
Additional Insureds with respects to General Liability and Auto Liability when required by written
contract, subject to the te~s, conditions and exclusions of the policy.
CERTIFICATE HOLDER
CANCELLATION
1100 Simonton Street
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2L DAYS WRITTEN
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
REPRESENTATIVES.
AUTHOR~DREPRESENTAnVE ~ ~
@ ACORD CORPORATION 1988
Monroe County
Key West FL 33040
I
ACORD 25 (2001/08)
Page 1 of 1
10/29/2009
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 WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing 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 (2001/08)
Page 2 of 1
0768570-01/BN
IN/O/C 116697837/1 1 561627
G18105
693666
FLORIDA NOTICE TO OWNER
WARNING! FLORIDA'S CONSTRUCTION LIEN LAW ALLOWS SOME UNPAID CONTRACTORS~
SUBCONTRACTORS~ AND MATERI~L SUPPLIERS TO FILE LIENS AGAINST YOUR PROPERTY
EVEN IF YOU HAVE MADE PAYMENT IN FULL.
UNDER FLORIDA LAW, .YOUR FAILURE TO MAKE SURE THAT WE ARE PAID MAY RESULT IN A
LIEN AGAINST YOUR PROPERTY AND YOUR PAYING TWICE.
TO AVOID A LIEN AND :PAYING TWICE, YOU MUST OBTAIN A WRITTEN RELEASE FROM US
EVERY TIME YOU P A YYOUR CONTRACTOR.
NOTICE TO OWNER AND NOTICE TO CONTRACTOR
FLORIDA STATUES 716.06 AND 255.05
MONROE COUNTY BCC
500 WHITEHEAD ST KEY WEST, FL 33040
To: 126418011
The undersigned hererby informs you that he or she has furnished or is furnishing services of materials as follows:
GEN BLDG MA TLS.for the: improvement of the real property identified as MILE MARKER 15 and situated upon
that certain lot(s) or parcel(s) of land in MONROE COUNTY, FL, legally described as follows: PALM DR
BRIDGE - KEY WEST.
That the name of ther person who furnished the laborers or material, or performed the labor or services, or supplied
the machinery, tools or equipment for which said lien is claimed is
HD SUPPLYI WHITE CAP CONST SUPPLY
501 W CHURCH ST ORLANDO, FL 32805
under an order given by BELLA CONSTRUCTION OF KEY WEST
If there is a payment Bond then this notice will advise you that we intend to look to the contractor's bond for
protection.
Florida law prescribes the se:rving of this notice and restricts your right to make payments under your contract in
accordance with Section 713.06, Florida Statutes.
I~v1PORTANT INFORMATION FOR YOUR PROTECTION
Under Florida's law, those ~rho work on your property or provide materials and are not paid have a right to enforce
their claim for payment against your property. This claim is known as a construction lien.
If your contractor fails to pay subcontractors or material suppliers or neglects to make other legally required
payments, the people who are owed money may look to your property for payment, EVEN IF YOU HAVE PAID
YOUR CONTRACTOR I~~ FULL.
PROTECT YOURSELF:.
--RECOGNIZE that this Notice to Owner may result in a lien against your property unless all those supplying a
Notice to Owner have been paid.
--LEARN more about the Construction Lien Law, Chapter 713, Part I, Florida Statues, and the meaning of this
notice by contacting an attorney or the Florida Department of Business and Professional Regulation.
Claimant: HD SUPPL Y/ WHITE CAP CONST SUPPLY
By: ~ ~.,;) ~ I Date: Tuesday, January 12, 2010
Agent Lil Stephens Murray
AZ Lien Services, Inc., PO Box 36750, Tucson, Arizona 85740 (520) 293-2503 or (800) 854-0548
Copies to:: (Those persons listed in Section 713.06(2)(a) and (b), Florida Statutes).
General Contractor: CHARLEY TOPPINO & SONS INC.
PO 787
KEY WEST, FL 33041
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