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Certificates of Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... ... ......................... ii'i::' Attltlllte CA~~ERNATIONAL, INC. LEIGH W. MCCREARY 6161 BLUE LAGOON DR SUITE 420 MIAMI FL 33126 Leigh W. McCreary 266 - 9954 . .f ................................................................................................................................................................................................................................................................................................ ... ...... .................. ........,..,... ......."........., .'.::::::::::::::::::::::::':::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::' '::::.:i:::,ttt}i!J))fftt11tt:itt\(A1ttl1i(>tt\:ljt::T1i:tCJ?tn:)l{~tltftt! :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::'::::::::.::::::CStt::::::::::::::::::::.: ISSUE DATE (MMIDDIYY) :::::::::::1J):l1i~:::I::If::I:IJ)~::I::::I1i:::::~:.E::::::::11':a::Id:~i:"::~IlJ:::::::::::::::::::::::::::::::::::::::::::.:::::.:::::::::::::::::::::::::::.::::::::::::::::::::::::::::::::::::::::':' 03/05/96 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A LEITER FLORIDA RETAIL FEDERATION INSURED COMPANY B LEITER COMPANY C LEITER BENDER & ASSOCIATES ARCHITECTS BARBARA ARTHUR 720 CAROLINE STREET KEY WEST FL 33040 COMPANY D LEITER ~~~~NY E 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. CO. LTR TYPE OF INSURANCE POLICY NUMBER : POLICY EFFECTIVE: POLICY EXPIKA TION DATE(MMIDDIYY) : DATE (MMIDDIYY) : LIMITS CLAIMS MADE OCCUR. A PP P 0 v EO B v R I S K M,~ 'l.! '~i G F r" f ~~ T : BY '-1!a 71~ O;<'IC. : C-~~ DATE 3'-7 ~/? : GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. $ PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Anyone fire) $ MED. EXPENSE (Anyone person) $ COMMERCIAL GENERAL LIABILITY OWNER'S & CONTRACTOR'S PROTo AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY '-":' ~ !VER: N/~ / YES COMBINED SINGLE LIMIT .F<.eceived H.isk tvlgrnt. & Loss Control ['J/\TE _ 3 -7 --7? ll'\i!Tj,/1.~ ____~_____-_ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE 01/01/97 ...... ......... ... ......,..., -..... . ....... .. - -... ......... .. ... ... ..... ......" ....... """" ............ ......,........... . , . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . , .... ...,..,....,............., ... ........,........,....,...,..... , ...............,.... ...... ... ,.....,.. .... ...... ........ -.,.................... . ..........,.. ....... ........ .: ~.J9Q.~.PQQ : $ 500, 000 . '''$ fOo''- aCio' A WORKER'S COMPENSATION AND 0520150560000 01/01/96 : STATUTORY LIMITS EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPLOYEE A EMPLOYERS' LIABILITY OTHER DESCRIPTION OF OPERA TIONSILOCA TIONSlVEmCLES/SPECIAL ITEMS :::q~t("Cf*.::nQl4i)ltt(/??>>:////!i//\>>>?/2//////}/.://2//\>>?/)/:::HH~~p~tlt~nQ~r}<;</:::<::::::::""""'''' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILLENDEAVOR TO MAILlL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND PON THE COMPANY, ITS AGENT OR REPRESENTATIVES. ::::: AUTHORIZED REPRESENTA COUNTY OF MONROE/RISK MANAGE- MENT/MARATHON HRS PROJECT KAY MILLER 5100 COLLEGE ROAD KEY WEST FL 33040\ :::::::':",:,:::::::::::::::::::::::::::::::"::::"::.:....:::::::;;::::::::::.::::.:::::::::::::.::::::::::::::::::;::::;;:;::::::::;:::::::::::::::::::::::::::;:::::::::::::::::::::;::::::::::::::::::::::;::;::.::;;::::.:;:;:;::::::::::::;:::::::;;:::::.::::::::<::::AdoM;:d6RPORArtON::i:990::: ........ .,. ... ... , . ....,... ........., ... ..... .... ...... ....... ...,.....,...,..,.. . . ....".........,.............,. .....,.. ... .... ....., ...... '" .... ........ ..,.......................,.. .............. ..... ...... ...,. ....... ... .. ............... -....... .;~99g:~~~~'i(7!~)::': A~Dttlllte ___AlEc.HIMSURANCE ISSUE DATE (MM/DD/YY) PRODUCER Broker Capital Assurance Services, Inc. 2700 Westhall Lane, Suite 210 Maitland, FL 32751-7299 Agent CMI International 6161 Blue Lagoon Drive, Ste. 420 Miami, FL 33126 INSURED 5-6-96 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND J CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE I DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ! POLICIES BELOW. ! . ."--,--".~-_._,,._..._-_..~.__._.- --- .... ...,....-..".- '-'''--'-1 COMPANIES AFFORDING COVERAGE f~T~~~NY A Steadfast Insurance Company f~T~~~NY B Bender & Assoc. Architects, P.A. 720 Caroline Street Key West, FL 33040 f~T~~~NY C UAT}_:~ g!~&i_=ff?-_- ,I)tt/ f~T~~~NY D E'-11T~Al , f~T~~~NY E COVERAGES 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. CO ilTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS '''''"''--~'''''''~~~'~~~-~'''''''-1lo'P...~~-.:t.IIi.:+~~'''~~_~.''.IW_~IIliiIlIl-~I.*IlPIIt~~~"_..."'IJI;f't''''''~'''' GENERAL LIABiliTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. GENERAL AGGREGATE $ PRODUCTS.COMP/OP AGG. $ PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Anyone fire) $ MED. EXPENSE (Anyone person) $ OWNER'S & CONTRACTOR'S PROTo AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS GARAGE LIABILITY APPPOVFD RV pIS"~ ~,H"! 1.('r!>~r\t7 BY o,e/~ ~~ COMBINED SINGLE LIMIT OA.TE ~-((j' -'/k- N/A /' YES BODILY INJURY (Per person) $ V/! 1VrR: BODILY INJURY (Per accident) PROPERTY DAMAGE . ....._~",.....,~..,.'..........".~.-.w,.IY~'~......~""'~,....'''*~..N1~.t"....._:...,''''''''''-._-'fo-.~t'_<~"~::!W""lB",""_'''~ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ $ !A OTHER Professional Liability EOC 794721-02 1-5-96 1-5-97 STATUTORY LIMITS EACH ACCIDENT $ DISEASE-POLICY LIMIT $ DISEASE-EACH EMPLOYEE $ $1,000,000 Each Claim $1,000,000 Aggregate ($10,000 Ded/Claim) WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY r- DESCRIPTION OF OPERA TIONS/LOCA TIONS/VEHICLES/SPECIAL ITEMS ~~~~~~~'Y_-'''' "__-..~..,;;:"I..'1'~. ::_~~.~_~~...~..__O.~4II~""""""""-,"~,~_~,,,~,,,,,,,,~~ THIS IS A CLAIMS MADE POLICY. COVERAGE APPLIES ONLY TO THOSE CLAIMS WHICH FIRST OCCUR AND ARE FIRST REPORTED TO THE COMPANY DURING THE POLICY TERM. i f CERTIFICATE HOLDER I I 1 Board of County Commissioners Monroe County Attn: Risk Management/Kay Miller 5100 College Road Key West, FL 33040 CANCELLA TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO M~I~, ,?O DAYS WRI:-TEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHAlL.JMPOSE NO OBLIGATION OR . "r, '.~."l':'.'" ......~,... L1ABILI F5 NY KIND UPON TH COMPANY, ITS AGENTS:b~::~~~.'~RESENTATI~ES.__., J_~CORD 25-9 (7/90) cc: ~ // / R I~ 5t!!!'5/ ~~41' JUC?J14-C-o C{, FJ~ ORPORA TION 1990 ! 05/10/96 14:47 FAX 1+305 296 2727 BENDER ASSOC ~002 ThePrudentlal ~ ..... Prudentia' Property and Casualty I nsuranee mpany 1III ~I~IIIII~ "'III~ IIIIIII~ I~II~ IIIIIIIII~IIIIIIIIIII~ 1~lln P. O. Box 2627 l:..~&ren..uillll 5=1 !a"~' A Subs.dlary of The Prudential In....r.nc. Company of Amer.ca Named Insured and P.O. Address Bender Nancy G Dba Bender Associates Arcitects PA 619 Elizabeth Street Key West FL 33040-6874 Car Policy Amended Declarations Policy Number: . 39 lfA652282 Agency DatE 7534~9 5 CGAB 806 AprR('''~~ 2' "'" .~ O<It: &F"_~~~--"- "C~ U~:13'-:: /' ?_ Client ServJces 1-600-437-&5S6 Claims · 1-800-437-3535 R: ~I!~ /' vFS ,",'., ___ 1_,_ This pol icy period covers 6 months, from 12/03/95 to 06/03/96, 12:01 A.M. The Effective Date of this Pol icy Change is 12/03/95 at place of garaging. Listed below are names and birth dates of licensed drivers resIdent in your household. 1 Bender Nancy Groff 09/1&/50 '2 Bender Bert lesl ie 07/30/47 Listed below are the ears covered by your pol icy. CAR YEAR MAKE MODEL BODY TYPE VEHiCLE 10 NU~BER TERRITORY SYMBOL CLASS CODE 1 1994 Mitsubishi Expo Wag 4X2 JA3EDS9G9RZ017684 036 c 7 1 1 1 20 2 1992 Mitsubisni E c: 1 i ps e G Hchbk 3D 4A3CSS4U7NE099294 036 J 8 1 1 320 Lfsted below are your policy coverages, I i m its and pr-emiums. If a premium enarge does not appear. that coverage is not provided. COVERAGES liMITS PREMIUMS 'Car 1 Car 2 Bod j 1 Y I nj u r y Each Person Each Accident Property Damage Each Accident $ 50.000 Unjn~ured Motorists Boelly Injury Each Person S 100)000 Each Accident $ 300,000 Pcrson~ 1 f nj ury Protect ion Co 1 1 i s ion Oeductib1c - $ 250 Comprehensive Deductible - $ 250 Towing - $50 Each Disablement s s $ 94 $ 118 100,000 300.000 $ 39 $ 76 S 50 S 76 TOTAL PREMIUM PER CAR T8TAL POL1CY PREMIUM $ 27 $ 38 $ 90 $ 132 S 49 S 93 $ 3 $ 3 ... ilia ... .. .... ... ... .., -.. --. $ 378 S 510 5 888 bc5'6 /,e ~ a/J-e.CJ c../~ C C' ~L LL- 6/6 0 ~ 'E./ '-~ PAC 681 ED. 1/90 PAGE AE27-012251 > 05/10/96 14:47 FAX 1+305 296 2727 BENDER ASSOC f4l 003 Po 1 i cy Number 39 ltA6S2282 Your pol icy is made up of your appl ication. your most recent DeclaratIons, and the forms and endorsements 1 isted below. Forms and endorsements beIng made part of your pol icy with this transactIon are provided In separate booklets or are indexed and reproduced on pages~which follow. FORM NUMBER EDITION DATE POLICY FORMS AND MANDATORY ENDORSEMENTS PAC 186 ~/86 Car Policy, Parts 1. 2, and 3 Appl icable pol icy parts are those for whjch a premium charge is shown in the Declarations. Florida Special State Provisions Car Policy, Parts 4, G. and 7 Appl ieable pel icy parts are those for which a premium charge is .shown in the Declarations. PAC 226/Fl PAC 1 90 I F L 05/92 4/87 OTHER CHARGES & CREDITS The Deluxe Package Discount applies to your pol icy. The Multi-Car Discount a~plies to your policy. A 5 a f e t y 0 e vie e 0 i s c au n tap p 1 i est 0 Car (s) 1, 2. An Anti-Lock Brake Discount appl ies to Carts) 2. Listed below are the Loss Payees/Additional Interests present on the policy. CAR 2 Barnett Bank 1010 Kennedy Dr Key West FL 33040 L'sted below are Important Messages about your policy. Personal Injury Protection Option! Your pol icy is free of any accident, conviction or inexperienced driver surcharge. ihe IIStackingl1 referred to in PAC 4/FL, UNINSURED MOTORISTS, ap~lies to all cars ~ isted on the policy. A G DRINKWATER AGENT PAC 681 {D. 1/90 PAGE 2 951203960126 05/31/96 10:57 FAX 1+305 296 2727 BENDER ASSOC ~003 ..aprudentlal. Prudenti,.1 lroperty and Casu.ltv Insuran ...omp.ny and Affiliatid Camp.. I Sub.ldlerl.. of The Prudential Inlurance Company of Am.rlel 11111" ., IIIIIII~ 111111111I III IIIII1 I111 11m I~ III ~11111 P. Q. Box 2627 jar=kc:.nn\lill~ FI ~27~2 Renewal Billing Statement Car Policy Policy Number 394A662282-7 B i 11 to: APPRO 'EO BY RJSK M^N~Gf~ENT Bender Nancy G Dba Bender & Associates Arcitects PA 8Y__ 619 Elizabeth Street Key West FL 33040-6874"~'~ ::i:I'!i;if&J:;r'ti~~ 06/03/96 O,R. t~ / "'3 --?/- C~K " f,P Pot icy Period ~om 06/03/96 YES L to 12/03/96 Account Balance as of: 05/01/96 r':). . "\1/~ f ~11~~~;.:..;:T':.':i:;!:\: ;:j1::i'::[::~:i;:;::i!!!I~f,~II!i!:~~1~ili .:~::':':~;:~!i::j_lr~i~:; '~1i!;~~j~1[i~rl'''~!il!::~1~!i~~~;I\~::ii::::l1]!;i!;:#:_Ij:;l;::"~'i:.:!';:; .:;:;i;;1;~:'."":.. :.~~=~~ 0.00 835.00 0.00 835.00 0.00 835~OO FuTl payment - The.re IS no servIce charge. - * Two payment - There is a $2 service charge included in the Initial Amount Due and no ~harge on the second i'nstal1ment. ;~ Four payment - There is a ~2 service charge included In the Initial Amount Cue and'a-$-l service-charge..-.for each-remaining jnstallment. ARTHUR G DRINKWATER Your Prudential Representative. at... ........... ........1-305-670-0088 or C 1 i ent Serv ices at..... . 1-800-437-5556 To report a claim, call. . . . . . . . .. .1-800-437-3535 ~~~~~~~~RGE Full Two Four Payment Option. Payment Payment Payment To make ehanaes to VOlJr POlicy or obtain billing information, call: InltiJlI Amount Due 835.00 420.00 2 11 00 Remaining Instal ""'Ints 1 3 ! Inst811ments including '* ,'c service charge 0 f .. 417.00 210 00 N8)(t Bill Due Date 08/02/96 07/09/96 1j1.;!It,~.I~..:~.!f~;i~U~~$.'.;ANO OATES Look for other messages on the, reverse~ Thank you for insuring with The Prudential. o ~ t (; c h her ( . , Delach he're. :::'i .. 05/31/96 10:57 FAX 1+305 296 2727 BENDER ASSOC [l1 004 ,dPrudent.818 Prud."+~r Pre... .y and Casualty Insurar (_H ~omplny IIW Im~ ~~ ~IIIII~ lid II ~~IIII ~ IIIIIIIIIIII~ 111~IIIIIIIJllllj 1III P. O. Sox 2627 1.1lt!ln::nnvIUA 1=1 ~'7~' A SUbaldlary of The Prudential InsurancliI Company of America Car Policy Renewal Decfarations Policy Number: 39 4A652282' Agency Data: 7534lt9 5 CGAB 806 Client Services' , -800-437-5556 Claims 1-800-437~ 353S Named Insured and P.O. Address Bender Nancy G Dba Bender & Associates Arcitects PA 619 ElIzabeth Street Key West FL 33040-68]4 This policy period covers 6 months, from 06/03/96 to 12/03/96, 12:01 A.M. at place of garaging. L.sted below are names and birth dates of licensed drivers resident in your household. 1 S.nder Nancy Groff 09/16/50 2 Bender Bert Leslie 07/30/47 Listed below are the cars covered by your policy. CAR YEAR MAKE MODEL BODY TYPE VEHICLE 10 NUMBER TERRITORY SYMBOL CLASS CODE 2 1994 1992 Mitsubishi Expo Wag 4X2 Mitsubishi Ec1 ipse G Hchbk 3D JA3ED59G9RZ017684 4A3CSS4U7NE099294 0;6 036 C J 7111 20 811220 Listed below and within "'mportant Messages", are your policy coverages, 1 imi ts, and premiums. I f a prem,i urn charge does not appear, that coverage is not provided. COVERAGES LIMITS PREMIUMS Car 1 Car 2 30d I 1 Y rnJury $ 90 S 102 Each Person S 100.000 Each Accident S 300,000 Property Damage S 45 S 50 Each Accident S 50,000 1insured Motorists S 83 S 83 Bod i 1 y Injury Each Person $ 100,000 Each Accident S 300.000 ~rsonal Injury Protection $ 27 $ 35 :0 1 1 j s i on Deductible - S 250 S 86 $ 114 :omprehens ive Deductible - S 250 S 43 S' 71 ~ ow j n g - $ 50 Each D;sablement S 3 $ 3 ------ _ 4IIl .... _ .. ... 40TAl PREMIUM PER CAR $ 377 S 458 .01 A L POLICY PREMIUM S 8~5 " B~ ^ r ~ R 1 f n 1 /qo PAGE 1 OF 2 AE1~-OO~7qO 05/31/96 10:57 FAX 1+305 296 272i BENDER ASSOC ~005 '-.. ' Po 1 i cy Number 39 4A652282 Your pol icy ;s made ,up of your appl ication~,.your most recent Declaratjons. and the forms and endorsements 1 isted below. Forms and endorsements being made part of your pol icy with this transaction are provided in separate booklets or are indexed and reproduced on pages which follow. FORM NUMBER EDITION DATE POLICY FORMS AND MANDATORY ENDORSEMENTS PAC 186 4/86 Car Policy. Parts 1, 2. and 3 Applicable policy parts are those for which a prem.j um char ge i s shown in, the Dee 11 r e t ions. Florida Special State Provisions Car Pol icy, Parts 4, 6. and 7 Appl'icable pol icy parts are those for which a premium charge is shown in the Declarations. PAC 226 FL PAC 190;t: L 05/92 4/87 OTHER CHARGES & CREDITS The Deluxe Package Discount applies to your policy. The fJlulti-Car Discount applies to your policy,. A Safety Device Discount appljes to Car(s) 1,2. An Anti-Lock Brake Discount applies to Car(s) 2. , Listed below are the Loss Payees/Additional Interests present on tne pol icy. C,o.R 2 Barnett Bank 1010 Kennedy ,Dr Key West FL ~3040 Listed below are Important Messages about your policy. Per sona 1 I nj ury Protect,i on Opt j on 'J ~MPORTANT: Your pol icy premium may have changed due to rating by make and model of your car. Please check the vehicle descr.lption shown.. Your pol icy ;s free of any accident. conviction or inexperienced driver surcharge. The "Stacking" referred to in PAC 4/FL. UNINSURED MOTORISTS. appl jes to all cars 1 is:ed on the policy. THE COMPANY MUST RECEIVE YOUR PREMIUM PAYKENT BY THE EFFECT'VE DATE OF YOUR RENEWAL FOR COVERAGE TO CONTINUE. YOUR CHECK OR MONEY-ORDER WILL NOT BE DEEMED PAYMENT UNLESS HONORED BY YOUR BANK. A G DRINKWATER AGENT' PAC 681 ED. 1/90 PAGE 2 OF 2 960603960501 05/:Jl/9B 10:57 FAX 1~305 296 2727 BENDER ASSOC [4] 002 "ThePrudentlal ~ ~ Prudel Property and Casualty Insurat.. ::ompany '. I 1111I1 ~I~' __ _ ~I ~ IIIII~ 1111111111111 UIIII~ IIIIII~ 11111111111111111 1111111 P. O. Box 2627 ~at'.llu:.nnvill~ 1=1 ~2222 A Subs idiary of The Prudential Insuranclll Caml3~tny of Am.riel IKE 1002321 Client Services 1-800-437-5556 Claims 1-800-437-3535 Policy, Number:. 39 4A652282 753449 CGAB Named Insured and P.O. Address Bender Nancy G Dba Bender & Associates Arcitects PA 619 El lzabeth Street Key West FL 33040-6874 I u J 11..11.111..111.111.1.111.11.11.11111.1..11.1111.111.1.1.1 May 1. 1996 Dear Pol icyholder: Enclosed is the renewal package for your Car pol icy. ~t includes a renewal Declarations page and any forms which have been changed or added to your pol icy since the beginning of your last policy period. Please verify that the Declarations page shows the types and amourts of coverage you want. If not, please ask your Prudential representative for assistance or eal1 us at the number 1 isted above. We wi 11 be happy to help you. Also enc,losed ;s a premium statement and your 10 Cards (if tnis is an anni'versary renewal). Please make a payment by the due date shown on the statement to avoid any interruption in coverage. and carry the 10 card.(s) wjth you wher:l driv,ing.. If you wish to report a Joss, please call us at the claims number 1 isted above. Thank you for insuring with The Prudential. Sincerely, a~~ Regional Operation 7J'M..\ ~ \0 ()~ ~v / ,0-9~ fa ~ '65~ ..;\ \ 3 \'\ \p b AE13-0D3784 UI/~q/U~ l~:~J rAA l+JU~ Z~U ZlZl .t5.t.~V.t..K A:':JU\; JtJL-24-1995 14:34 'Ua. Ie z.lH(S [gJ P.a2 April 14 1"3 I.~ MONROE CO~NTY.ILOJW)A ...... lleq... ... Waiver 01 I....nma: ....~ JliI.scqaaICd dW. tJae: IJJsbraacD rcquircmca&s, 3S spccfRcd iD lbe Coua1Tc $c~1IIc or JasuraDcc ~u;:.~~ be wahat Dl' modified onlhc tbUowlDC QH1tmcL . O BErlDER & ASSOCIATt:.S ARCHl'l'J:;l;J.S, P.A. ~ar:. . Qmna foE; ArChitectural Services for Marathon PUblic Haalth unit 720 Caroline Street. ~or~ Key West, FL 33040 PJaac: Sco.Pc or Work:. (305) 296-1347 Architectural Services ~rorw~ We "era informed by my insurance company (Prudential) that since the Board of Commissioners has no financial intnr~st in tiji5-vchiclC nor is it leasina the vehicle, SitHUlf..:.w-~I'--.-- it (DaCC) cannot be listed as an acditional in::sured. .'~- -~~ . ,.: " . .' r..:;..... . R Not~ "~II.~~I ' / .~~ ~ AdIIIiaiSlr:uor appeal: AppRMXl: Not ApprowotI: Date; BaGnl or ~IY Canuais.sioaas appeal: ApptOYCd: Nul Approwxt MaaaiDg D'l~ WAIVER TOTAL P. (2J2 07/24/95 14:30 TX/RX NO.0065 P . 002 lfJ UUl 1 ~ ~. . ..,.' . U"( I ~U/ll~ lZ: V.I UUU4 J'J(LIYA\; \'LJ.~.l :J \' 't!:I vv~, YVA FAX . ,..,psheet MONROE COUNTY PlVdentiaJ Property 8I1d Casually InsulBl1Ce Company CONSTRUCTION MA~~T PNdontial Genend InsuRll1QD Company Received '7 - '2..L., ..q,~ Pudenti81 ConvneR;iallns\lrll1C8 Company 11m. ~ : ~ ~ SubskriatleS of TIle PrudenlIaIlnsurance Company or Amerlell ~entlaI~ PLEASE WRITE IN SLACK PEN ONLY Name: ~Jl'\n \\\c..~!':{S\)1l , . Phone Number: " ROC/Company: FAXNumber:3()S~ ~C1:J. - l\5SK Number of Pages: (including topsheet) ~ Document to be sent to: sende~ef) ~ P&C Client Service office Hours: Monday Tuesday - Friday Sent by: 8:45 - 4:30 8:30 - 5:00 Machine No. (904) 391-3640 Phone: 1-800-437-5556 Comments N\s ~. ~~;o~~~ Comb 58316 (SC) (10194) (01)