Insurance
r-w".."...,,-"w"'_.............'".."....M..M._..".._......'M.~
PROPUCER AN^P THE NAMED fNSU1UEP
..............._....CERTI'FfCATE...-b-F.I1ABi'[rT'7Ir\fS.URANC.e..--.-W....-M"-...."...-...
Street
nus CERTIFiCATE fS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONfERS THE CERTIFICATE
HOLDER. THIS CERTJ AMEND. EXTEND, OR
AL fER THE CO
INSUR,ER A: Prime Insurance Company
INSURER B:
iNSURER C:
INSURER 0:
INSURER E:
INSURER F:
INSVFUiiO
N~tlo:nal SpedalEvenfs As.sociation lne
6321 N, Avom::l$le Ave, Ste.. 103
Chicago, It 60631
COVERAGES
TYPE OF INSURANCE
GENeRAL LtABIl,ITV
COMME.RCIAl GENERAl tiA!3JtJlY
~ CLA!MS MADE OCCUR
i:8:J COMMl!!RC~Al.,. lJABIUTY
MANUSCRIPT POLICY
GENt Af.'.,GREGATi:' UMlT APPUfiS PER
POLICY NUMllleR
SC1 001 051
t'lLIMITS SHOWN ARE
THOSE IN EFFECT AS
OF POLICY INCEPTION"
A
DJIoUTQ I.lABltfl'Y
ANY AUTO
ALL l)',iI,INE:D AtrfOS
SCHEUlJlED Amos
I3~?Q
Coveragel$. limited to only . Il'l$ut'edattivitiesoroperations Identified in the Policy_
Datedf Event: 3120/2010 Location: l\ttallory Square
Add1tionallnsurfJIdand Certif~te. Holder:DeJ Mgt& Promotions
o CERTIFICATE HOLDER
County of Monroe
AUention;
Monroe: County, Fl 33040
ADDITIONAL INSURED
~ (!,: h' rut//? ('~
UDA.F~030 10AUG2005
Page t of 1
$
Mar 10 2010 8:26PM
HP LASERJET FAX
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-_Ed"
MoNROE COUNTY, FLORIDA
Request For Waiver
. 01
Inm....
......
It is tequesQld .
Requirements,
~_h'aetor:
Co.tract for:
dle County's Sched.ule of~
F\ ~ '''''''t''
\ n "'+1.. ~'"1:?
A...... ore.tractor: pO
~ ,,:; ~ wert. 1 c:::\- ~ 3D'" \
Plane: .:x> :5 - 2. q :2... 0 q 6 b
, ,
:"t
SeopeofWOIt)- E'oJC;"~ ~~Tlt:r):::t - fu..+ti~ Q"") f1~ C~1
, \1'") ~... \4e..~.
.... for Wahl':
l\)t- ~e\J4!,.. ~f"" ou>n "~r)~ Oo""~..
==~....... l..Oc:f:'~ ~~'Ii~
s........ of Coplnletor:
G. ~ 'f"tS.Y"
Net ApproVed
...t......t:
Date: ~3- Ll.::JD
COUll'" Adeit.htrator Appeal:
'Ap,rewed
Not Approved
..
BItt:: ,"!
. .
.ard 01 CeUDty eo.......n Appeal:
. .~. Approved
Not ApprG'fed
M_iDJ Date:
'"'.
A..in"'iion laltruetlo.
#4719.2
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