Certificates of Insurance
. '......,. -.,................ ..'.,. .................... ................................... ... ............. ..............,... '........-...................... ..."................ '.......
. . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . .
... . "...."... .......... ..... .......... ........ -....... -..... -,. ...........",..................... ..........., ......... -............. ............. ....
.... .......... .,. .... -.... .......... .... ......... .... ..... ......... ,-.-. ... ...................... .... ..... ... ................. ....... ..........
.... . ... ....... .... .... ....... ... ..... ..... ............ ..... ... ....... ....... .... ... ........... ..... .............................. ................
..... ..... .................. ....... ......... ........... .............. ....... '............. ......... .... ................ .......... ..........
... N~.~I.I. .mE.R.2Cmlm~t'IEll>1f.S~~~mE
<) 1II.... · :;::,>"""."..,.,.,.,.":::.,,>:.,:',>..,.,,,,..,,.,>,,>,,,,.>:,:,:::,..,.: .."'..... . ',... .<....'d..:......"',..........
PRODUCER
CMI INTERNATIONAL, INC.
LEIGH W. MCCREARY
6161 BLUE LAGOON DR SUITE 420
MIAMI FL 33126
CSR ISSUE DATE (MMIDDIYY)
.8ENDERD::. 07/05/94
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
INSURIID
COMPANIES AFFORDING COVERAGE
Leigh W. McCreary
266-9954
A
WESTERN WORLD INSURANCE CO.
Bender & Delaune Architects,
720 Caroline Street
Key West FL 33040
B
COMPANY C
LEITER
COMPANY D
LEITER
COMPANY E
LEITER
Ar-pRCr",IFD 8Y R! SF, M,f ~"~ !"GEMENT
py ~tJ;Y/~~ {9~ .? /3~
DME ~.: . ~
N/L.::t::- YES
WAIVER:
lHIS IS TO CERTIFY 1HAT lHE POUCIES OF INSURANCE llSTED BELO\V FaA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR lHE POllCY PERIOD
INDICATED, NOlWIlHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OlHER DOCUMENT WIlH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, lHE INSURANCE AFFORDED BY lHE POUCIES DESCRIBED HEREIN IS SUBJECT TO AlL TIlE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMlTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO:
LTR:
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE: POLICY EXPIRATION
DATE(MMIDD/YY) DATE (MMIDDIYY)
LIMITS
GENERAL LIABILITY
A COMMERCIAL GENERAL LIABILITY : NGL 08677
CLAIMS MADE: X : OCCUR.
OWNER'S 4 CONTRACTOR'S PROTo
10/25/93
10/25/94
GENERAL AGGREGATE $ 600,000
PRODUCTS-COMP/OP AGG. S 300,000
PERSONAL & ADV. INJURY S 300,000
EACH OCCURRENCE S 300,000
FIRE DAMAGE (Anyone fire) S 50,000
MED. EXPENSE (Any one person) S 1 , 000
COMBINED SINGLE
LIMIT
SCHEDULED AurOS
I{,ecetved
R<jsk ~~1gIr~t. & Loss Control
[lATE _.~_.~...~_Z....= / ~.=,?:~ __
I}\1TCtAL H"_'_~~'~'~.''7!i?_---P..k
BODILY INJURY
(Per person)
NON-OWNED AurOS
GARAGE LIABILITY
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
: EXCESS LIABILITY
. UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
AGGREGATE
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
EACH ACCIDENT
DISEASE-POLICY LIMIT
DISEASE-EACH EMPLOYEE
OTHER
DESCRIYfION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS
CERTIFICATE HOLDER IS ALSO NAMED ADDITIONAL INSURED ATIMA
MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS
310 FLEMING STREET
KEY WEST FL 33040
SHOULD ANY OF lHE ABOVE DESCRIBED POliCIES BE CANCElLED BEFORE TIlE
EXPIRATION DATE lHEREOF, lHE ISSUING COMPANY WILLENDEA VOR TO
MAIL19-- DAYS WRIITEN NOTICE TO TIlE CERTIflCATE HOlDER NAMED TO mE
LEFf, BUT FAILURE TO MAIL SUCH NonCE SHAlL IMPOSE NO OBUGA nON OR
UABIUTY OF ANY KIND UPON lHE COMPANY, ITS AGENTS OR REPRESENTATIVES.
................ -......... ...................
A.CQItt)':~S~$-Jil96)':'/.:'.>.:.:..'"
c.c ~[J~ ~
LeighW. McCrea j
'I irJA LL) me C/lfa
(1" . . . . ..' AC<>RJ)CORPo
..,........................,......................,........................................ ............ ... ........ ..... ..............,.......................,................,.......,. ,.,..,.,.....
.... ........,........ ........... ........... ................. ... ...,. ... ........ ............. ... .... ... ...... ..... ....... ,..................................... ......... ............................
.. . .....,..... ..... .... ........... ... ......... ....... '... .... ,... ............ ...... ... ...... ,....... ........................ .............,. ....................
.... ... .......... ,... ... ....... ..... ... .,.... ,.... ....... ....... .... .... ..... '" ..... ...........,................................ ....... ,................
... ....... ... ..... .... .......... ......... .... .... .... ..... .... .... ...... .... ." .... .......... ......... ........... ............,.......... '" ...........
u At~t.III..12EHlml12.1I1EITIJD~S.I.:I~E< .tSR ISSUE DATE (MMIDD/YY)
::::.:::::::::::::::::.:::::::::::::::::::::::::.:.:-:::.:.:.:.:-:.:::-:.::::::::::::::::::::::::::>:::::::::::::::::::>:::::::>:::::::::::::: .:::::::::-:::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:::.:::::.:::::::::::::::::::BENDERD:::::::::.... 07/01 /94
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.
.... ............. '....
....... ... ... '......
........,..,. -...
PRODUCER
CMI INTERNATIONAL, INC.
LEIGH W. MCCREARY
6161 BLUE LAGOON DR SUITE 420
MIAMI FL 33126
Leigh W. McCreary
266-9954
COMPANIES AFFORDING COVERAGE
Bender & Delaune Architects,
720 Caroline Street
Key West FL 33040
COMPANY A
LEITER
COMPANY B
LEITER
COMPANY C
LEITER
COMPANY D
LEITER
STEADFAST INSURANCE COMPANY
INSURED
FLORIDA RETAIL FEDERATION
t.~np"\'FT' RV Pl~" M^~'^GFMENT
C-:>OO,.,' '".t/1 r
pV / 1/' ,
. r1 / i. :
. ................V,/ / 1)'( tq "L(
flATE f ;/
lHIS IS TO CERTIFY mAT lHE POUCIES OF INSURANCE USTED BELO\V HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR lliE POllCY PERIOD
INDICATED, NOlWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OlliER DOCUMENT WIlli RESPECT TO WHICH lHIS
CERTIfICATE MAY BE ISSUED OR MAY PERTAIN, mE INSURANCE AFFORDED BY lHE POliCIES DESCRIBED HEREIN IS SUBJECT TO ALL lHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POliCIES. liMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO:
LTR:
TYPE 01' INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE(MMIDDIYY) DATE (MMIDDIYY)
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL UABD.JTY
CLAIMS MADE:
: OCCUR.
GENERAL AGGREGATE
PRODUCfS-COMP/OP AGG.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
. MED. EXPENSE (Any one person) S
AUfOMOBILE LIABILITY
ANY AurO
ALL OWNED AurOS
SCHEDULED AUTOS
HIRED AurOS
NON-OWNED AurOS
GARAGE UABD.JTY
IQsk IvIgTYit> &,,;
DATE -__2_:_!.!.:>~~_
Lft.JT'f; " r ~ () y
.. . ..I\~, "~--''''''-Wq-4''''''''''''-~_''~''''''___~''~n.
COMBINED SINGLE
LIMIT
BOOIL Y INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
B
WORKER'S COMPENSATION
AND
;0520150560000
01/01/94
01/01/95
DISEASE-POLICY LIMIT
DISEASE-EACH EMPLOYEE
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EMPLOYERS' LIABILITY
: arHER
A jProfessional Liab.
: EOC7994 721
01/05/94
01/05/95
Ea. Claim
Aggregate
$1,000,000
$1,000,000
DESCRIYrION or OPERATIONSILOCATIONSIVEWCLESISPECIAL rrEMS
.CERTIFtCATFffiof}o'ER)):::<::::::;::;::::"::":':':-:'" .
.. .......... ..... ....... ..... ............ ...........
............ ............... ... ...-:-:::::::>/:::>CANC.ELLA.ttON>>....
.... .................,...
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
310 FLEMING STREET
KEY WEST FL 33040
SHOUlD ANY OF lliE ABOVE DESCRIBED POliCIES BE CANCELLED BEFORE THE
EXPIRATION DATE lHEREOF, lHE ISSUING COMPANY WIll.ENDEAVOR TO
MAIL_ DA YS WRITTEN NOTICE TO THE CERTIFlCA TE HOlDER NAMED TO lHE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHAll. IMPOSE NO OBUGA TION OR
liABIliTY OF ANY KIND UPON lHE COMPANY, ITS AGENTS OR REPRESENTATIVES.
.KcQjiji:2$~s::(7&O)::.i:::::.;:::;::::::::::::::::::::::::.:.:....
'.' ................... ............ ....... ......... ........:.:-:...:.:.:.....:.:.:....:<::..:~:~.~.9~...~.~....~.c:.c:r~.~...
uJ m{lClRQjJ
:'::'::.:::<::.:ACQi{I)':cOltr
...................................... .
.................................... ..
... .
. . . .
... .
....... At>>t..I... ..
................. ....... ........ .... ................ ........ ....... ..... ...... ........... ... ..... ................................ ........................ ................................ ...... ............................... ......... ............. .....
..... ........................................ ..... ..... ... ....... ........... ....... ... .... ... .................. .............. ......................... ... .. .......................... ... ........ . ......... ... ........... ... ... ......... ...................
. .................. ................... ..... ... ....... ...... ....... ...... .......... .... ... ..... ........ ... ......... .... ... ..... .............. ... ..... ..... ..... ... ... .................. ... ...... .. ............ .............. ............ ...............
........ ..... ......... .... ......... ........ ...... ..... ... ...... ..... ... .... ...... .... ... ..... ............. ........... ...... ..... .... .......... ... ... ... ... . ...... .................... .... ... ..... .. .............. ....... .... ...... ....................
.. .... ............. .... .... .... ..... .......... .... ....... ... ...... ... ... ........... ...... ..... ........ ... ..... ........... ..... ....... ............. ....... .. ... .......................... .... ... ..... ........ ........... ...... ....... ... ...........
..... ........ ....... ... ............. ........... .... ..... ........ ...... ........... ........ ... ....... .... ....... ..... ...... ... .... ....... ... ... ......... ... ................................. ...... ............................. .... ........... ......
....IEBIIIIII.IEUIJS....IIISI.IIJlIIIII......i.......................... ........................................U.........C$lf.. .................. ISSUE DATE (MM/DD/YY)
. :::.:::::.::::::::::::::::::::::::::::::::::::::>::::::::::::::::::/:::::::::><:::::)\:::}:::::::::/::/::::::::::::::::::):jjj::::::::::::::::::C::::::::C::::::://:f::::::::Uk\"\::::):::::::::\:::::::C\):::::::::::::::))::::::::::::}::::)::::::::::::)::::::::::::::):BBNDBRD: 03/03/95
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.
PRODUCER
CMI INTERNATIONAL, INC.
LEIGH W. MCCREARY
6161 BLUE LAGOON DR SUITE 420
MIAMI FL 33126
Leigh W. McCreary
266-9954
INSURED
Received
l\ls!< Mgmt. &. Loss Control
. .. ........... .. . ..D^TE ....$(1./f'r....
?
iN ITIAL
Bender & Associates Architects
720 Caroline Street
Key West FL 33040
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
E
WESTERN WORLD INSURANCE CO.
FLORIDA RETAIL FEDERATION
'AP'PROVEO' 'ay .t{ISK 'MAN AGEM"E"Nl'
/ ". . ?
8Y~C7~~~"~~
.....DATE.~~...~..2..~~.z>'~.........
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 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MM/DDNY) DATE (MM/DDNY)
GENERAL AGGREGATE .... ..... . '.. $..~. <>. ~ .,..Q.Q .().. .
NGL08677 10/25/94 10/25/95 PRODUCTS-COMP/OP AGG. :$300,000
PERSONAL & ADV. INJURY :. ~ ..~.Q.(). ~.9 <>. ~.
EACH OCCURRENCE :$300,000
FIRE DAMAGE (Anyone fire) . . . . .'. .~. . . . .~. ~ .'. .~.Q .(). . .
MED. EXPENSE (Anyone person): $ 1,000
AUTOMOBilE LIABilITY COMBINED SINGLE
ANY AUTO LIMIT
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODIL Y INJURY
NON-OWNED AUTOS (Per accident)
GARAGE LIABILITY
PROPERTY DAMAGE
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
B WORKER'S COMPENSATION 0520150560000 01/01/95 01/01/96
AND
DISEASE- POLICY LIMIT
EMPlOYERS'LlABILlTY
DISEASE- EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/lOCATIONSNEHIClES/SPECIAl ITEMS
CERTIFICATE HOLDER IS ALSO NAMED ADDITIONAL INSURED ATlMA
<:Q~ll!lflqA!i)~'~~Q~/ //y//yy\/\\\/y.:::\:t!:::::.))\://}//C/::')))//.)))\\)U/~AN~ittj[iQN/}>:::::><::::::::::::-:-:-""" .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL~ 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 UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
MONROE COUNTY BOARD OF COUNTY
COMMISSI:ONERS
5100 COLLEGE ROAD
KEY WEST FL 33040
....... Lei ~ ,f!'\ Ll)m Cl~tH2L~
A(;:(fflP~$~~(1!~9f<U.w~1000S'Ag9~P9~P9~~t~&l!j~~~f
C(:~ vrf~
AtDttlllt~
CE"'lfICA~EiOf_U"'NCE
ISSUE DATE (MM/DD/YY)
PRODUCER Broker
Capital Assurance Services, Inc.
2700 Westhall Lane, Suite 210
Maitland, FL 32751-7299
Agent
CMI International, Inc.
5805 Blue Lagoon Dr., Ste. 280
Miami, FL 33126
INSURED
1-12-95
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
f~T~~~NY A
Steadfast Insurance Company
f~T~~NY B
Bender & Associates Architects PA
720 Caroline Street
Key West, FL 33040
f~T~~~NY C
BY
BY RISK M~ANAGEME T
~ -- O,e Ie;
/// / ~ CLf::'-;e 1::::.
.J -;;l ?r - 7'-5
N/A /' YES
Received COMPANY
t\1~,k, Mgmt. & Loss ConrrolTER D DATE
DA TE 4/ .;t / '7 s:- f~T~~NY E WAIVER:
i COVERAGES INlltAL .. .~ =~:
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 EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY)
LIMITS
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
,-.-:.>ot"tI'~-~~"'''V'CIIIi'i,~_~~~,,,,,,".-,",,-.~,,e*..r;,__~,~~~.~,,~''t~.''''''"_'~-Il''''__~___~
COMBINED SINGLE
LIMIT
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
'7l
, ,j
EACH OCCURRENCE
AGGREGATE
$
$
WORKER'S COMPENSATION
AND
""t Rt
l,{jt'l:'l':'~' {"~/ ,~
STATUTORY LIMITS
EACH ACCIDENT $
DISEASE-POLICY LIMIT $
DISEASE-EACH EMPLOYEE $
EMPLOYERS' LIABILITY
A OTHER Professional
Liability
EOC 7994721-01
1-5-95
1-5-96
$1,000,000 Each Claim
$1,000,000 Aggregate
($10,000 Ded/Claim)
CANCELLATION
1 ,~~O~~~-S (! /90)_ c.t; :
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ 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 UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
Monroe County Board of County
Commissioners
310 Fleming Street
Key West, FL 33040
-:~tf
@ACORD CORPORATION 1990
...- ._-'.,..,--;_._",,_*.h...,.._,'""',__.........N"..o "'....~_.' """'--"'~--'"'<>-"""~'__';__'41>'" ..-...._......,._.._..,_........~_._,_"....-_,.._...._._".;;_--.,,,__. .;-,..,._._"__.-,.,,,..~~_
r;::
. ThePrudentlal ~
~
Prudential Property and Casualty
Insurance Company
1111111111111 11111 1111 11111 1111111111 111111111111111111111111111111111111111111111111111111 111I
P. O. Box 2627
Jack~nnvillA FL ~22~2
A Subsidiary of The Prudential Insurance
Company of Amer i ca
Client Services
1-800-437-5556
Claims
1-800-437-3535
Bender Nancy G Dba Bender &
Associates Arcitects PA
619 E1 izabeth Street
Key West FL 33040-6874
Car Policy Renewal Declarations ~.
Policy Number: 39 4A652282 }~!-'~. (I'- k..
Agency Data: 753449 5 CGAB 806 L t:-L" ,
{.L <". .
~,;
p:
fi,flPR0V[n B' R1Sr~ pn,:t\r,r~,.rt-.Il
Named Insured
and P.O. Address
_.~~
C."" ~ \. '
BY ~~'~1u ~}"~
DATE ,:';2 / Cj
WAIVER: N/A VES~.~
This policy period covers 6 months,
from 12/03/96 to 06/03/97, 12:01 A.M.
at place of garaging.
Listed below are names and birth dates of 1 icensed drivers resident in your household.
1 Bender Nancy Groff
09/16/50 2 Bender Bert Lesl ie
07/30/47
Listed below are the cars covered by your pol icy.
CAR YEAR MAKE
MODEL
BODY TYPE
VEHICLE 10 NUMBER
TERRITORY SYMBOL
CLASS CODE
1
2
1994
1992
Mitsubishi Expo Wag 4X2
Mitsubishi Ecl ipse G Hchbk 3D
JA3ED59G9RZ017684
4A3CS54U7NE099294
036
036
C
J
7111 20
811220
Listed below and within "Important Messages", are your pol icy coverages, 1 imi ts, and premiums.
If a premium charge does not appear, that coverage is not provided.
COVERAGES LIMITS PREMIUMS
Car 1 Car 2
Bod i 1 Y I nj u r y $ 90 $ 102
Each Person $ 100,000
Each Accident $ 300,000
Property Damage $ 45 $ 50
Each Accident $ 50,000
Uninsured Motorists $ 83 $ 83
Bod i 1 Y I nj u r y
Each Person $ 100,000
Each Accident $ 300,000
Personal Injury Protection $ 27 $ 35
Co 1 1 i s i on
Deductible - $ 250 $ 86 $ 114
Comprehensive
Deductible - $ 250 $ 43 $ 71
Towing - $50 Each Disablement $ 3 $ 3
------ ------
TOTAL PREMIUM PER CAR $ 377 $ 458
TOTAL POLICY PREMIUM $ 835
PAC 681 ED. 1/90 WA
PAGE 1 OF 2
AE12-012748
.JI
Pol icy Number
39 4A652282
Your policy 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
4/86
Car Policy, Parts 1, 2, and 3
Appl icable pol icy parts are those for which a
premium charge is shown in the Declarations.
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/FL
05/92
4/87
OTHER CHARGES & CREDITS
The Deluxe Package Discount appl ies to your pol icy.
The Multi-Car Discount appl ies to your pol icy.
A Safety Dev ice 0 i scount app 1 i es to Car (s) 1, 2.
An Anti-Lock Brake Discount appl ies to Car(s) 2.
Listed below are the Loss Payees/Additional Interests present on the pol icy.
CAR 2 Barnett Bank 1010 Kennedy Dr Key West FL
33040
Listed below are Important Messages about your policy.
Personal Injury Protection
Option I
This document is a dupl icate of the one previously issued.
IMPORTANT: Your pol icy premium may have changed due to rating by make and model of your
car. Please check the vehicle description shown.
Your pol icy is free of any accident, conviction or inexperienced driver surcharge.
The IIStackingll referred to in PAC 4/FL, UNINSURED MOTORISTS, appl ies to all cars
1 isted on the pol icy.
THE COMPANY MUST RECEIVE YOUR PREMIUM PAYMENT BY THE EFFECTIVE 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 WA
PAGE 2 OF 2
961203961031
..J I
........... ...... ....... ..... ........... ........... ........... ...... ....... ........,. ........... .... ............................... .............. '" ... ..... .......... ............
A COROTM .......I.glll'I.lllg......I.'......gllll.gll~.......11.111111.11
..................................... .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . ' . . . . . .
..... ............ ................,.
......................... ......... ... DATE (MM/DDIYY)
.:-:.CS.R.:.:-:.:.:.:-:.:-:.:.:.:.:.:.:-:.:.:.:.:.:.:.:.....
':iii~~*~~H!i!<'/!>;;:' 12/09/96
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
PRODUCER
eMI INTERNATIONAL, INC.
LEIGH W. MCCREARY
6161 BLUE LAGOON DR SUITE 420
MIAMI FL 33126
Leigh W. McCreary
Phone No. 2 66 - 9 954
INSURED
Fax No.
COMPANY
A
WESTERN WORLD INSURANCE CO.
BENDER & ASSOCIATES ARCHITECTS
720 CAROLINE STREET
KEY WEST FL 33040
COMPANY
B
APPRnvEO BY RISK MANAGEMENT
COMPANY BY
C
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 EXPIRATION
DATE (MM/DDNY) DATE (MM/DDIYY)
LIMITS
GENERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY NGL43 328
CLAIMS MADE ~ OCCUR
OWNER'S & CONTRACTOR'S PROT
10/25/96
GENERAL AGGREGATE $ 500 , 000
10/25/97 PRODUCTS - COMP/OP AGG $ INC I L . ABOV
PERSONAL & ADV INJURY $ 500 , 000
EACH OCCURRENCE $ 500 , 000
FIRE DAMAGE (Anyone fire) $ 50 , 000
MED EXP (Anyone person) 1, 000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
GARAGE LIABILITY
ANY AUTO
BODILY INJURY
(Per accident)
JNl}'i/"}
PROPERTY DAMAGE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS'L1ABILlTY
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGA TE
EACH OCCURRENCE
AGGREGA TE
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
EL DISEASE - POLICY LIMIT
EL DISEASE - EA EMPLOYEE
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER IS ALSO NAMED ADDITIONAL INSURED ATIMA
MONROEC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
..!L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
5100 COLLEGE ROAD
KEY WEST FL 33040
::~~9~P)~$S$Jtl~~:f:-:<:::::::::::::::::::::-:""'" .
. .....~~~.~l-1.~...... ~c::C::~~~.