Loading...
Certificates of InsuranceTHE 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. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY CL2571808 06/01/2010 06/01/2011 EACH OCCURRENCE $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY[--] C F-]LOC PRODUCTS - COMP/OP AGG $ NOWND AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESWUMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE i $ 1?ETENT:Ot� $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY I I I TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER %EN&ENT/SPECIAL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY PROVISIONS As Additional Insured: Monroe County Board of County Commissioners .+L-..I 19-MOM I G nvLVG1t 1 OTinri (305) 743-0396 Monroe County Board of County Commissioners 1100 Simonton St. Room #1-213 Key West FL 33040- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Of jA KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001/08) ir►ien�c ,.,�e. „� ACORD CORPORATION 1988 .. """" `w I wwl..n, Page 1 of 2 �,� CERTIFICATE OF LIABILITY INSURANCE OP ID CH DATE(MM/DD/YYYY) JAYNE-1 05 27 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AtlaOR 101Ontic KennedySuite Pacific-Key DrC est 203 � �- r Fl\/M R THE CO�ERAGE AFFORDED Bt:K. I HIS ERTIFICATE DOES Y HE POLICFIES BE END OW. Key West FL 33040 Phone:305-294-7696 Fax:305-294-7 83 INSURED Jayne's Cleaning Service c PO Box 431439 Big Pine Key FL 33043 I COVERAGES INSURERS FFO DING COVERAGE ` ' ' °r 3NSMlfl A: Progressive Cos. f� A I INSURER B: INF,R.Q� t 'I�IrR D: R j NAIC # 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. MR LTR DUL NSRC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ CLAIMS MADE F-1 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY MPROF-] LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ A X ANY AUTO 04725859-0 05/27/10 05/27/11 (Ea accident) ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (Per person) $ 10 0 0 0 0 HIRED AUTOS BODILY INJURY $ 3 0 0 0 0 0 NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ 5 0 0 0 0 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ $ ' AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR F� CLAIMS MADE DEDUCTIBLE $ RETENTION $ • $ WORKERS COMPENSATION _ AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? , �j' E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 2007 Cadillac Escalade SUv 1GYFK66867R177687 CERTIFICATE HOLDER CANCFI_I ATInN Monroe County Board of County Commissioners 1100 Simonton St Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MCBCCOM DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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. AUT0119UFRESENTATIVE An^Imr% Olt /AAAA/AA\ U 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MONROE COUNTY, FLORIDA Request For Waiver of Insurance Requirements It is requested that the insurance requirements, as specified in the County's Schedule of Insurance Requirements, be waived or modified on the following contract. Contractor: � y/t/E 'S I=1 N/,A/G �eA !// C F%ir/Of • � T Contract for: IWOAI, 41AaoA% Address of Contractor: /�. Q. �o ,� �/� / y3 � �=21 330 9.3 Phone: (30,5).--9,9.3 ' Az� Scope of Work: ZIAivi�o 2i A L Reason for Waiver: _ T A /')') � X � /�j�% / jeo Y�'� �1I�G���%f /�yS C �'�1�• Policies Waiver EXJS011A1 will apply to: �— Signature of Contractor: _p �,�,(,`� , (J,,G(/tj„G�j2Q.bJOL Risk Management Date County Administrator appeal: Approved: Date: Board of County Commissioners appeal: Meeting Date: Not Approved Not Approved: Approved: Not Approved. - STATE OF FLORIDA 08-08-2002 DEPARTMENT OF INSURANCE DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATION LAW NON -CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation Law. EFFECTIVE 0 8/ 0 6/ 2 0 0 2 EXPIRATION DATE N/A PERSON JURGENSOHN JAYNE SSN 263-35-4223 FEIN 650115495 BUSINESS JAYNE CLEANING SERVICE INC P 0 BOX 431439 BIG PINE KEY = FL 33043 NOTE: Pursuant to Chapter 4 4 0 . 100) , (g) 2 , F . S . , a sole pro� pprietor partner , or an officer of a corporation who elects exemption. from the Florida Workers Compensation Law may not recover benefits or n p y compensation under Chapter 440. PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF INSURANCE DIVISION OF WORKERS' COMPENSATION NON -CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 0 8l 0 6l 2 0 02 EXPIRATION: N/A PERSON: JURGENSOHN JAYNE SSN: 263-35-4223 FEIN: 650115495 BUSINESS: JAYNE CLEANING SERVICE INC P 0 BOX 431439 BIG PINE KEY FL 33043 H E R E NOTE: Pursuant to chapter 440.10(1 ), (g) , 2 , F , S . , a sole proprietor, partner, or officer of an corporation who elects exemption from the Florida Workers' Compensation Law may not recover benefits or compensation under Chapter 440. CUT HERE * Carry bottom portion on the job, keep upper portion for your records. 0 western Surety Company RIDER It is hereby mutually agreed and understood by and between the Principal and Western Surety Company, that instead of as originally written: The definition of employee found in section 4 of the bond be amended to read as follows: The owners are hereby excluded from the coverage of the bond. No further changes other than above. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, limits or conditions of the Bond , except as hereinabove set forth. vmw �� ix��xxx4Rixxa4 4^ ���,iyyX � g#a° 6 � 3 rd Se �� x s eC Y effective on the day of p t emb e r 2009 atd U clock a.m. standard time. =tea► a s Laic NN asJro ; x °achl oning part of Bond No 70788767 issues 2; xx. 'YX ERN SURETY COMPANY of Sioux Falls, South Dakota to > JayneIs Cleaning Service, Inc. Signed this 8 th day of September 2009 WESTER SURETY COMPANY toe.y Form 128-4-2002 `� Paul T. Bruflat, Se or Vice President ODIVY Western Surety Company JANITORIAL SERVICE BOND Bond No. 70788767 In consideration of an agreed premium, Western Surety Company, a South Dakota corporation, hereby agrees to indemnify Jayne s Cleaning Service, Inc. of 253 PIRATES RD. , LITTLE TORCH KEY, FL 33042 (the "Obligee"), against loss of money or other property, real or personal, belonging to any and all subscribers (the "Subscriber") to its services, or in which the Subscriber has a pecuniary interest, or for which the Subscriber is legally liable, which the Subscriber shall sustain as the result of any fraudulent or dishonest act, as hereinafter defined, of an Employee or Employees of the Obligee acting alone or in collusion with others, and for which the Obligee is liable, the amount of indemnity on each of such Employees being ONE HUNDRED THOUSAND AND N01100 DOLLARS ($ $100 , 000.00 ), THE FOREGOING AGREEMENT IS SUBJECT TO THE FOLLOWING CONDITIONS AND LIMITATIONS: TERM OF BOND: ' _ SECTION 1. The term of this bond begins with the 03 day of September 2009 _,at 12:00 o'clock night, standard time, at the address of the Obligee above given, and ends at 12:00 o'clock night, standard time, on the effective date of the cancellation of this bond in its entirety. DISCOVERY PERIOD: SECTION 2. Loss is covered under this bond only (a) if 'sustained through any act or acts committed by any Employee of Obligee while this bond is in force as to such Employee, and (b) if discovered prior to the expiration or sooner cancellation of this bond in its entirety as provided in Section 11, or from its cancellation or termination in its entirety in any other manner, whichever shall first happen. DEFINITION OF EMPLOYEE: SECTION 3. The word Employee or Employees, as used in this bond, shall be deemed to mean, respectively, one or -more of the natural persons (except directors or trustees of the Obligee, if a corporation, who are not also officers or employees thereof in some other capacity) while in the regular service of the Obligee in the ordinary course of the Obligee's business during the term of this bond, and whom the Obligee compensates by salary or wages and has the right to govern and direct in the performance of such service, for whom a premium has been paid, and who are engaged in such service within any of the States of the United States of America, or within the District of Columbia, Puerto Rico, the Virgin Islands, or elsewhere for a limited period, but not to mean brokers, factors, commission merchants, consignees, contractors, or other agents or representatives of the same general character. FRAUDULENT OR DISHONEST ACT: SECTION 4. A FRAUDULENT OR DISHONEST ACT OF AN EMPLOYEE OF THE OBLIGEE SHALL MEAN AN ACT WHICH IS PUNISHABLE UNDER THE CRIMINAL CODE IN THE JURISDICTION WITHIN WHICH ACT OCCURRED, FOR WHICH SAID EMPLOYEE IS TRIED AND CONVICTED BY A COURT OF PROPER JURISDICTION. MERGER OR CONSOLIDATION: SECTION 5. If any natural persons shall be taken into the regular service of the Obligee through merger or consolidation with some other concern, the Obligee shall give the Surety written notice thereof and shall pay an additional premium on any increase in the number of Employees covered under this bond as a result of such merger or consolidation computed pro r ata from the date of such merger or consolidation to the end of the current premium period. NON -ACCUMULATION OF LIABILITY: SECTION 6. Regardless of the number of gears this bond shall continue in force and the number of premiums which shall be payable or paid, the liability of the Surety under this bond shall not be cumulative in amounts from year to year or from period to period. LIMIT OF LIABILITY UNDER THIS BOND AND PRIOR INSURANCE: SECTION 7. With respect to loss or losses caused by an Employee or which are chargeable to such Employee as provided in Section 4 and which occur partly under this bond and partly under other bonds or policies issued by the Surety to the Obligee or to any predecessor in interest of the Obligee and terminated or cancelled or allowed to expire and in which the period for discovery has not expired at the time any such loss or losses thereunder are discovered, the total liability of the Surety under this bond and under such other bonds or policies shall not exceed, in the aggregate, the amount carried under this bond on such loss or losses or the amount available to the Obligee under such other bonds or policies, as limited by the terms and conditions thereof, for any such loss or losses, if the latter amount be the larger. DEDUCTIBLE: SECTION 8. The Surety shall not be liable under this bond on account of any loss or losses through fraudulent or dishonest acts committed by any Employee of Obligee, unless the amount of such loss or losses, after deducting the net amount of all reimbursement and/or recovery, including any cash deposit taken by the Obligee, obtained or made by the Obligee or the Surety on account thereof, prior to payment by the Surety of such loss or losses, shall be in excess of ONE HUNDRED DOLLARS ($100.00), and then for such excess only, but in no event for more than the amount of insurance carried on such Employee under this bond. If more than one Employee commits the fraudulent or dishonest act resulting in such loss or losses, said deductible amount shall apply to each Employee so involved. Form 1375-10-2002 ACORV CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 07/01/2011 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 DO A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER H IMPORTANT: If the certificate holder is an ADDITI FNS i s) must endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polirequire�an endorsement. A s ement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER JUL Insurance, Inc. 30233 Overseas Highway P.O. Box 430534 Big Pine Kq7, FL 33043- MONROE RISK MAN PHOIsaksen (A/C, N No, Ezt): (305 872-0097 (q C, No): (305) 872-1005 E-MAIL Isakse @bellsouth.net TOMER 10 ,Ja e's Cleaning Service, Inc. URER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A Mount Vernon Fire Insurance Co Jayne's Cleaning Service, Inc. INSURER B P.O. Box 431439 INSURER C INSURER D INSURER E Big Pine Key FL 33043- INSURER F , COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSRLTR TYPE OF INSURANCE INSR IWO POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL LIABILITY r_+COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR L2571808A 6/O1/2011 / / ( / / 6/O1/2012 / / / / EACH OCCURRENCE $ 300,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300,000 GENT AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS - COMP/OP AG_G - — 1 $� ..� - - PRO- POLICY Ti ii-OC / / / / NOWND �$ AUTOMOBILE ugawTr ' ANY AUTO --;, ALL OWNED AUTOS SCHEDULED AUTOS —1 HIRED AUTOS j / / / / COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) --------------- j $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ �I NON -OWNED AUTOS / x / / / _— _ $ UMBRELLA uqe OCCUR �I _ i14 / / / / EACH OCCURRENCE $ AGGREGATE $ ExcESs uAe CLAIMS -MADE / / / / — DEDUCTIBLE / / / / $ $ RETENTION $ / / / / WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE / / / / / / / / WC STATU- OTH- TORY IMITS EIR E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A / / / / E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below / / / E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured: Monroe County Board of County Commissioners CERTIFICATE HOLDER CANCELLATION ( ) - (305) 743-0396 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County AUTHORIZED REPRESENTATIVE Commissioners 1100 Simonton St. Room #1-213 Key West 4 FL 33040- ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD PR99RFff1YF' ATLANTIC PACIFIC INC 382 PRSPRTY FRM ' 23 PALM BCH GARDENS, FL 33410 56' 624 Certificate of Insurance Certificate Holder Insured Additional Insured JAYNE'S CLEANING SERVICE MONRO COUNTY BOCC INC 1100 SIMONTON S PO BOX 43 14 39 KEY WEST, EL 33040 BIG PINE KEY, EL 33043 Policy number: 04725859-2 Underwritten by: PROGRESSIVE EXPRESS INS COMPANY May': 5, 2012 Page' of ; Agent ATLANTIC PACIFIC INC 11382 PRSPRTY FRM 123 PALM BCH GARDENS, FL 33410 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated, This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. Policy Eflective Date: May 27, 2012 Policy Expiration Date: May 27, 2013 insurance coverage(s) Limits BODILY INJURY/PROPERTY DAMAGE $100,0005300,000550,000 ... ............... ....... ......... ........... .............................. ........ ............. ............... ...... I ........... ............. PERSONAL INJURY PROTECTION $10,000 W60 DED - NAMED INSD & RELATIVE Description of Location/Vehicles/Special Items Scheduled autos only ... ..................................................................................................................................... 2007 CADILLAC ESCALADE ESV 1 GYFK66867RI77687 Stated Amount $30,000 COMPREHENSIVE $500 DED COLLISION $500 DED RENTAL REIMBURSEMENT $30 PER DAY ($900 MAX) Certificate number 13612NET859 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. APPr20 E GI By WAI N .,� ._ BrSI Ue/-k. CC: At& GG- ��wC.LJ ,ac=oR,D►® `.►� CERTIFICATE OF LIABILITY INSURANCE DATE (MM roD 0�/20/2012012 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poilcy(les) must be endorsed. 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 endomement(s). PRODUCER Isaksen Insurance, Inc. 30233 Overseas Highway P.O. Box 430534 Big Pine Key, FL 33043- CONTACT NAME: PHONE (305) 872-0097 FAX (303) 872-1009 EMAIL .Isaksen@bellsouth.not INSURE S AFFORDING COVERAGE NAIC# INSURERA140unt Vernon Fire Insurance Co INSURE13 Jayne's Cleaning Service, Inc. P.O. Box 431439 Big Pine Key FL 33043— INSURER a: INSURER C: INSURER 0 : INSURER E : 1 INSURER F: COVERAGES CFRTIFICATF NI IMRFR• RFVICIAN NI IMWFR- 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. ILTR TYPE OF INSURANCE POLICY NUMBER MOLLY YFF POLICY EYY LIMITS A GENERALLIABILITY 2L25718088 6/29/2012 6/29/2013 EACH OCCURRENCE S 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR / / / / / / / / DAMAGE TO RENTE(T- PR I occurrence S 100,000 MED E_XP (Ary one arson) $ 5,000 PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300000 / / / / GEN'L AGGREGATE LIMIT APPLIES PER. POLICY PRO-JPCT LOCAPP&VP BY 6K MANrR7G�IG�3 / / / / / / / / PRODUCTS - COMP/OP AGG $ [. NONMD S AUTOMOBILE LIABILITY CO M81 .IN L UM 'Ea acadert S ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 1 � r / / / / / / / / BODILY INJURY (Per person) $ BODILY INJURY (Per acc<deM) S NON -OWNED HIRED AUTCS AUTOS c '� /� / / / / PROPERTY DAMAGE Per m $ / / / / $ UMBRELLA LIAB HCLAIMS-MADE OCCUR / / / / EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR / / / / DIED I RETENTION $ $ / / / / WORKERS COMPENSATION / / / / VJCSTATU- OTH- AND EMPLOYERS' LIABILITY ANY PF40PRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Cle6cfiba ender DESCRIPTION OF OPERATIONS below N I A / / / / / / / / / / / / E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarlls Sc Mduls, it more space is required) Additional Insured: Monroe County BOCC vr=r� , Irrvn, c nv�t,�rc L:AN(:tLLA 1 IVN Monique Diaz SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County 1100 Simonton Street Suite2-268 Key West FL 33040- ACORD 25 (2010105) AUTHORIZED REPRESENTATIVE r ©1988-2010 ACORD COI IN5025 (201C05)111 The ACORD name and logo are registered marks of ACORD C.c-: rights reserved. �c ad DA>�II�DD�rYY�,, CERTIFICATE OF LIABILITY INSURANCE 07/09/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATRfELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING WSURERM, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the cer0cats hoer Is an ADDITIONAL INSURED, the policy(Iss) must be endOlaed. fl SUBROGATION I WAIVED, sut►ject to holder the terms end conditions Of the policy, Certsln poliola may require an endorsement. A statement on this certlflcate does nOt COnf@r rights t0 the eerKmate holder In lieu of 9UCh endorsome s). rloDDeaR IsakseA Insurance, Inc. (305) 872-0097 F Nol, I366I na-ioos ttilrAt , xeaksen@bellaouth.aet 30233 Overseas Highway P.O. Box 430534 INsuac AFfO COVERAGE NAK:S Big Pine Key, FL 33043- NSM"A United States Liability Ins. elcupm Jayne's Cleaning Service, Inc. A- 171 Aphenien Way BOB~ C o�nelf%u YI ImurD• THIS IS To D.NOTCERUIMTHSTANDINQ ANYREQUITHAT THE REMENT. ES OF I NSUPAKE LISTED BELOW HAVE BEEN 16151,111:1.1 1 v IRE 11vown " INDICATED. TERM OR CONDITION OF ANY CONTRACT OR OTHER I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIB EXCLUSIONS AND CONDITIONS OF SUCH ;POLICMS. LIMITS-SHOMM MAY HAVE BEEN REDUCED BY PAID CLAIM True oP seliRANcl ' " : • ". Polor IluNe>slr'`glum OENERALUASILITY Li6121�6': 6/29/2018 6/29/Z014 X COMMERCIAL GENERAL LIASe.IT-f'. •. :.' CLANS•MAbe OCCVR OWL AGGREGATE LIMIT APPLIES VER-.' i^. POLICY LOG / AUTOMOSU UlAeRITY Y • IS a.. ANY AUTO ALL Sr" SCHEDULED AUTOi AUTOII- HatEo AUTOS MMT08' , �/(� / . • a' / Ulo"LLA IJAe OCCUR. EXOM LIAR MS-MAOr D RETENTION/ , / / WORKERSCOMPINBATION . AND EMPLOYERT LIANSM Y /'N ANY PROPRIETORNARTNEKOMUTIVe • OFfK:ERMEMeiR i><CLUDE07 � / : / /- / Im damr In NHI DrWO POTION Un O Or9MTI S below DESCRIPTION OP oPERAT1oNS I LOCATIONS I VRNICLea, (AMe011 ADORD 1M, AAOINonel Reen,b SeMduN, N men npW N geMl� Additional insured:,Nonique Dias Kch=e Courity SOCC 1100 S' ton S�1' D NAMED ABOVE FOR THE POLICY PERIOD EO S. Rey DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE I 500,000. 100,000 F I 60OW I MED UP me Demon S 5 000 PERSONAL s INXW I .500 i 00o , GENERAL AWNGATE I 600,000 PRODUCTS - COMPIOP AGG s IN NOYM I C E LoMrr SOpILY INJURY (Per Pumm) I BODILY INJURY (PW roddem) S D I s EACH OCCURRENCE I AGGREGATE i E.LEACH ACCEM S E DISEASE - EA EbtPLOYe S EL DISEASE -POLICY LIMIT S west 1PL 33040 o 'r1 CERTIFICATE HOLDER CANCELLATION (305) 292-44BT., . '' ; SNOULO ANY OF THE ABOVE DESCRIBED POLIM OE CA14CELL tBFORE . rjpniejLie Lewirieki THE EXPIRATION DATE THEREOF, NOTJCR►; WILL BSJpE�ED IN A CORDA E WITH THE POLICY PROV1910NS`. Monroe County IBOCC r 1100 Simonton. St AUT" NrzsDkGPPXS ATONE C7 .. CD Suite 2-2W . Kay •Neat. rL. , 33040- ... N 0 ACORD 25 (2010/06) a ises.2010 ACORD CORPORATION. AN rights reserved. tared marks of ACORD regi INS025 (201= Ths ACORD name and logo are s l a�RD� VOTE {MM/VV/VVYY) CERTIFICATE OF LIABILITY INSURANCE �/1a�zols THiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANU CONFERS NO RIGHTS UPON THE CERTI FIGATE HOLDER. THIS CERTIFICATE OO ES NOT AFFIRMATIVELY OR NEGATIVELY AMEN o, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU RER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 14 the cart it'ica[e holder is an ADDITIONAL INSURED, the policy0 s) must be endors ecL 14 SUBROGATION IS WAIVED, su bjec[ to the terms and eon ditlons of the policy, certain policies may require an endors ern enL A s[a[emenf on Lhis certificate does nol confer rights to the LarLFcatP holder In lieu of such an dorserrrant(s)_ PRO VUC CR COr1T A' JaSOR K1 L'Y pa CrlGk NAMC ZsaK�en Sns-o r.arrue, Snc P orJE Fxq: (305) a"]2 009'/ lulx_ Ne): (j os>. �z too-s. 30346 Cverseac� H.i gY.way EM IL spar@.T kc+a 2r-isurance Com . O _ Bcnx 43D534 _ INSVRERI SI A FORDING COVERAGE NAIC Y gig piJ�e I{ey FL 33043 INsuRER A..Uni tac3 Star_Ps Liability Snsuraxlce . ayrtc S C1 ea111I2g SC'tvice, Tr1c _ INSVRERC _ — - - INSVRERE_ t T arpoi'a Sprinq� FL 34689 uas-�fRERF COVERAGES CERTIFICATE NUM BER:CL1571400572 REVISION NU M6E R: THIS IS TO CERTIFY TH qT THE POLICIES OE INSURANCE LISTED BEL01,V HAVE BEEN ISSUED TO TFiE INSVRE. NAME. ABOVE FOR THE POLICY PERIOD IN.ICAT E.. NVTWITH STAN.ING ANV REQUIREMEN I. 1 ERM OR CON.ITION OF ANY CONI RHCF OR OTHER DOCUMENT WITH RESPECT TO VJH ICH THIS CERTIFICATE MAY BE ISSIIFD OR MAY PERTAIN, THE IN SU RANCF AFFOR.EO BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI THE TERMS. EXCLUSIONS AND CON.ITIONS OP bUCH POl ICIES LIMITS SHOWN MAY HAVE BEEN RE.UCED BY PAID INSR--- Tl'pE OF IN 9URANCG AVVLIS VBR -PCILI =Y POLICY EFF -POL CY EXP L M rS LTR NVM BER MM/VV/VVYY MhV VVIVYYV S OO 000 ERc AL GENER ABIL ITV - � COMM 100 000 'CL161 ziasa 6/29/2oas 6/zo/zois L _ 5. 000 SOD. 000 . i ii _ I. Sr,ul udad I I I: AUTOMOBILE LIABILITY �-�- 4 WO RKERS CO MPENSATION ,I. ' I ` ' ---F - ---- ANO IMan ry 1 H) _ L 4 V ESC RIPTION OF OPERATIONS / LOCATIONS f VEH CLE (ACO Rp 1Ot, Atld [,o el R¢m arks Scb¢tlu a, may ba a[la cbetl "F pac I II,e d) TTac £ol lowing ccr ti £ice to 2-.01 I r is lis tadn a.� Additional TraSur_Fd on the policy: Monroe Couz'rty SOCO 1100 Simonton St. Kay West FL 3304V fx/ WAIVER N/A L,Q CERTIFICATE HOLDER _i CANCELLATION 1 - (305)292 —4487 L�vinsIti—MonigTae@L:S6}zr K J SPri7D L. ANY OF THE ...... IBEO POLICIES BE CAN CEL LE. BEFORE THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN M011t Oe Co IIi1 t.Y BOCC qCC ORDAN CE WITH THE POLICY PROVISIONS. Monicjue L�winslciQ [�� t-t 1100 Sunonton St -� �'VI� 3% (n �,�,a,�,�RIZFO REPRESENrArIVE KeY West, FL 33040 J t1 (J37�fL _ _ _ cj n '1988-2014 ACORD CORPORATION All rights reserved. ACORD 25 (2014/01) The ACORD name and logo era registered marks of ACORD —S.--., .. I JAYNE-1 OP ID: CH v- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 0512112014 THIS CERTIFICATE 13 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 13 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 endorsements . CONTACT PRODUCER Atlantic Pacific4(ey WestFAX 1010 Kennedy Dr, Suite 203 Key West, FL 33040 Clwisdne Y. Hernandez NAME: /C Ne: 305-294-7383 -305-294-7698 WC. E - E-MAc IL ADDRESS; chemandez a ins.com INSURER(S) AFFORDING COVERAGE NAIL r INSURER A : Progressive Express 02962 INSURED Jayne's Cleaning Service Inc PO Box 431439 Big Pine Key, FL 33043 NSURERB: INSURER C : INSURER D INSURER E INSURER F ... tenA^re r-COTICIrATC 1IIIMRCR• REVISION NUMBER: V V w G r\AV cv ..�..... ...-.. — • --•-• --... 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. ILTRR TYPE OF INSURANCE INM wV0 I POLICY NUMBER MN x MMIDOIYY LMrr$ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE El OCCUR DAMAGETO RENTEDS PREMISES Ea occurrence MED EXP (Any one person) E PERSONAL & ADV INJURY E GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S PRODUCTS- COMPlOPAGG E POLICY PRO ❑ LOC JECT E OTHER: AUTOMOSILE LIABILITY COMBINED SINGLE LIMIT Ea accident E BODILY INJURY (Per person) S 100,0 A ANY AUTO X 472585" 05/2712014 05/27/2015 BODILY INJURY (Per accident) S 300,0 ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident S 50,00 E UMBRELLA L AO OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAO CLAIMS -MADE DED I I RETENTION E E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE [NIA OFFICERJMEMBER EXCLUDED? (Mandatory In NMI PER OTH- STATUTE ER E L. EACH ACCIDENT S E.L.DISEASE EAEMPLOYEE S E.L. DISEASE -POLICY LIMIT E It yes. describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached r more space is required) ® 61 I tP WAIV NIA ex C C :�Ip MCBCCOM Monroe County Board aI dA NAOJ ]OHNow Commissioners alb �7'1 1100 Simonton Street Key West, FL 33040 19:1 Wd 8ZANN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ``''r� ��77 v ivao-Aum PA vRvi unrvrmiivnl. !an Cyrus rvsmr/ea. ACORD 25 (2014/01) 080a�t �it���90 are registered marks of ACORD JAYNE-1 OP ID: CH CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDNYYY) 06/2512015 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. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. 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). PRODUCER Atlantic Pacific -Key West 1010 Kennedy Dr, Suite 203 Key West, FL 33040 Christine Y. Hernandez AC NAME: PHONE 305-294-7696 AAIXC No : 305-294-7383 AIC Ext IL E-MAIL chernandez@apins.com INSURERS) AFFORDING COVERAGE NAIC A INSURERA: Progressive Express 02962 INSURED Jayne's Cleaning Service Inc INSURERB: INSURER C : PO Box 431439 Big Pine Key, FL 33043 INSURER D INSURER E : INSURER F: — GOVEKAGt, %.cr%Irrra.mlF_rwiviu ­ ------- 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. ILTR TYPE OF INSURANCE IN POLICY NUMBER 102 YYYY MMIDDIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X 04725859-5 05/27/2015 05/27/2016 EACH OCCURRENCE $ MA 0 NT PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & Ai INJURY $ GENERAL AGGREGATE $ Gi AGGREGATE LIMIT APPLIES PER. POLICY PRJECOT LOC OTHER. AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS PRODUCTS- COMPIOP AGG $ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 100,00 BODILY INJURY (Per accident) $ 300,00 PROPERTY DAMAGE Per accident $ 50,00 $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE N IA EACH OCCURRENCE $ AGGREGATE $ R STATUTE I I ER H- DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOP PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below I EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more spa is re ulred) "PP. V MA GENT DA•_� WANK • o Apr I - M. ,,i �p 31 MCBCCOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West, FL 33040 ;/1 ww� • ^^0n %0AT1Adl All rIn L.4o rccnrvc rl ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ATE ACVRe CERTIFICATE OF LIABILITY INSURANCE �/2i2001144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATA ELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the ceniftcats holder is an ADDITIONAL INSURED, the poliicy(iss) must be endorsed. 0 SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not caller rights to the eertilkaRs holder in Neu of such endorsemen s). PRODUCER Jason Kirkpatrick Isaksen Insurance:, Inc P (305)872-0097 (3os)a7a-loos 30346 Overseas Highway P.O. Box 430534 I N"me Big Pine Key FL 33043 juarmA.Vaited States Liability DaIRED lira e : Jayne's Cleaning Service, Inc. INSUMC: 171 Aphenien Way INSUR)Elt 0: i Tarpon Springs FL 34689 ) 04ulm F • I - j ..rw, ••11JAne1 A IMMUML-W WI IMRFQ• -- 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. LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ow TOF INSURANCa YPE ROM M POLICY WIN up M LIMITS GENERALLIAtWT/ EACH OCCURRENCE S 500,000 DAMAGE To IMN P r S 100, 000 X COMMERCIALGENERAL LIABILITY NED OUP WIT Oro Demon) S 51000 A CLAMS -MADE © OCCUR =1612146 /29/2014 /29/2015 PERSONAL SADV 0MRY S 500,000 GENERAL AGGREGATE 3 500,000, GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AOG s Inclu ded 6 FX-1 POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LMA BODILY INJURY (Pw Anon) S ANY AUTO BODILY INJURY IPr - p0m) S AUTOS ED AUTOPSC1*11S1ILED NON SNNED AUT PR AM-AHIRED P r S S 111019 01 A L" OCCUR EACH OCCURRENCE S AGGREDATE S MESS LIAB CLAMS -MADE oED RETENTION: S WORKEN CWIPEIMTION A AND EMPLOYEM LIABMTY ANY PROPRIETORNARTNERIEXECLInVE Ya OFFICERINEMBER EXCLUDEO'I (eandNM In NMI NIA EACH El EH ACCIDENT S E.L. DISEASE . EA EMPLOYE S E.L. DISEASE • POLICY UMrr S a Yoe weed. ardor DESCRIPTION OF OPERATIONS Wft DESCRIPTION Oi OPERATIONS / LOCAMM I VEIBC LEa 1AMen ACORD 101, Aa6lrenal RawrsAm Schedule. N Amon space to rwpalmo The following certificate holder is listed as Additional Insured on the PoliCy: Monroe County BOCC 1100 Simonton St., Key West rL 33040 APP V IANAGE� Y wa tic. �. � UA ,?,�O. (305)292-4487 Lewinski-Moniquelanonroecou Monroe County BOCC Monique Lewinski 1100 Simonton St Key West, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRF-0 REPRESENTATIVE ISAKSEN/CIMY ✓r �''� ACORD 2512010M) 01988-2010 ACORD CORPORATION. All rights mserved. INS025rJ01005).01 The ACORD name and logo are registered marks of ACORD ' ® A CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDI 16 7/13/2016 v 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Isaksen Insurance, Inc 30346 Overseas Highway P.O. BOX 430534 Big Pine Key FL 33043 CONTACT Jason Kirkpatrick NAME: PHONE (305)872-0097 ac No:(305)872-1005 PMAILSS:Jason@IsaksenInsurance.com INSURE S AFFORDING COVERAGE NAIC # INSURERA.United States Liability Insurance INSURED Jayne' s Cleaning Service, Inc. 171 Athenian Way Tarpon Springs FL 34689 INSURER B : INSURER C : INSURER D : INSURER E : INSURERF: _-..._........._.^^^ UILIVtFCAULZO NCRIIrI%R1IL-- •- - - -- - OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDM'YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS -MADE a OCCUR MED EXP (Any one person) $ 5,000 X CL1612146C 6/29/2016 6/29/2017 PERSONAL & ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 500,000 PRODUCTS - COMP/OP AGG $ Included PRO POLICY ❑ D LOC JECT OTHER: COMBINED SINGLE LIMIT (Ea accident) $ AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS ED NON-OWNHIRED PROPERTY DAMAGE Per accident $ AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGAT EXCESS LIAB H CLAIMS -MADE r- DED RETENTION $IPER WORKERS COMPENSATION STATU - EERH E.L. EACH A IbENT 51 AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASQ+jFJ1 EMPLOY OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) If yes, describe under E�+ E.L. DISEA &&ICY LIMI� DESCRIPTION OF OPERATIONS below :< �TI r1 W C 7 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) C n GEME�MQ�^(`�'�'p��� pROAE B WAIVE CC.ACIIt �ri I - M.�4►�P�� (305)292-4487 Lewinski-Monique@monroecou Monroe County BOCC 1100 Simonton St Key West, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J Kirkpatrick/JKIRK %W Iago- ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 r9m4n1) 0..1; KI.—h r• Date Entered: 6/9/2016 A� Q® CERTIFICATE OF LIABILITY INSURANCE DATE M(YY) 6/9/201/2016 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. 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 endorsemen s . PRODUCER Donovan Insurance Solutions CONTACT NAME: PNONE .(727)935-4858 aCN,:(877)226-9304 EMAIL ADDRESS, 1 E . Tarpon Avenue Tarpon Springs, FL 34689 INSURERS AFFORDING COVERAGE NAIC# INSURE RA:Progressive 24260 INSURED Jayne r s Cleaning Service INSURER B : INSURER C : Jayne Jurgensohn 171 Athenian Way INSURER D : INSURERE: Tarpon Springs, FL 34689 INSURER F : .. �...e.. . uanco. COVERAGES I.CR l lr IIiA 1 G n V 1e1 uG -------- 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. INSR LTR TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ADDL SUBR POLICY NUMBER RISK POLICY EFF MMIDD NAGEME POLICY EXP MMIDD/YYYY LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence)$ MED EXP (Any oneperson) $ ` PERSONAL & ADV INJURY $ BY I GENERAL AGGREGATE $ DATE/ WAIVER N/ YES GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ LOC PRODUCTS -COMP/OP AGG $ A OTHER: AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X 04725859-2 5/27/2016 ? /� ( ` \ i r 5/27/2017 SINGLE LIMIT Ea accident) $ BODILY INJURY (Per person) $ 100, 000 BODILY INJURY(Peraccident) s300,000 PROPERTY DAMAGE Per accident)$50,000 $ UMBRELLA LU1B OCCUR EACH OCCURRENCE $ EXCESS LIAR RECE D AGGREGATE $ HCLAIMS-MADE _ STATUTE ER $ �� y j O�� DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N . ANY PROPMETOR/PARTNEPJEXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) M yes, describe under DESCRIPTION OF OPERATIONS below N / A' MON OE COUNTY TTORNEY E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) r- 1� � 1 C] certificate holder is listed as additional insured I-) '-' c; c "1D Munroe County Risk Management 1111 12th St Suit 408 Key West, FL 33040 Att; Monique ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a.�nn i+nnnneATlf%LI All • -164c mcomadi The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com, Impressive Publishing 800-208-1977