Certificates of Insurance
OK~~ErY ~o~~~~E
(305) 294-4641
BOARD OF COUNTY COMMISSIONERS
MAYOR, Jack London, District 2
Mayor Pro Tern, A Earl Cheal, District 4
Wilhelmina Harvey, District 1
Shirley Freeman, District 3
Mary Kay Reich, District 5
MEMORANDUM
To:
Beth Leto
County Attorney's Office
Kay Bahleda ~
Risk Management
From:
Date:
May 10, 1993
Subject:
Big Brothers, Big Sisters Funding Agreement
General & Vehicle Liability Insurance
-------~-------~--------------------------------------------------
Enclosed please find the original, siglled insurance certificate
for subject policies. Upon arrival of the Workers Compensation
certificate of coverage this agreement will comply with insurance
specifications. I have called BB/BS again today to confirm ap-
proximate date we can expect certificate. I will forward same to
you upon receipt.
If you have any questions, please call.
S~~I~~~~=~=~S~~2===================S=~=~=~=l=~=!=S=~=~=~===~=~===!=~=~=~=~=~=~=S=~================l~~~~=~~r~~==2~~2~~~~=
F'RODUCEF:
JACK L~ KIRBY INSe INCa
41. 'i ,S HE F: S C H E L S T !~~ E E T
..J{'iCr~.:~::GNV I LL.E... FL,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND
EXTEND !JF~ f)L TEh~ THE CD1.)EF~AGE fiFFOF:DED BY THE FOLICIES BELOW"
ZIP CODE 3221.0
COMPANIES AFFORDING COVERAGE
\~~
\,b\
. COMPANY LETTEI~~ A ST" F'f~iUL. f- IF:Et\MAF~INE l :t
----------.-.--.----.---------------..--.-.--..------ i ,,- ~ ~~ .
i, COM F' ANY L t. T T E~: B HE I,: 1 TAG E L 1. F E 1 N ::j n CD f:'
IN:3UPED j11J
MONf-<OE COUNTY CDMP~iNY LET-j EJ\ C r-". /
BIG BROTHERS-BIG SISTERS ~
I", [', i::r,"-I 1:.- {'I 1:..- I: ,i_-',:,,_-','n\: ['Hl'. i~.'...,i, ....,: ,~-l:.:"-I' .,,'L ;..r. h!-,.'L -iI ..;;; r.' ir ~ i 1'1 . rl:{'\,:.~l :~<:,' (~,..}t"\ t-01 1A
r n., n1.i._./,\ ....1...'.-' I __ !'d 'd. 1\0\,,,, 11_ ~',1 '.J,;,,~) _\...., J. ,C-
KEY WEST} ~L! '- V
I IF' . COilE 33041 i CQi.iPM.IY LETTER E f)X/'j, ,,__. _."~.-:{~. -~____
CO V ERA G E S = = = =:: = =:: =:::: =:: = = = = = = = = = = =:: = =:: = = ~:::: = = = =:: = = =:::::::: = = =:: = = = = = =:::: = =:::::: = = = = = = = =.:: :ih<i "'.:::>:1:;: :::.:::=- =::=.. = -'= '=-~-=:=-=-=:_= = = = = = = =:::: =
THIS IS TO CE~:T IFY TH~;T POLl CIES OF INSUF{ANCE LISTED BELOW HAt)E BEEN ISSUED TO THE IN~;UF:ED NAt-lED f~BOI)E. FOra: 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} TI~E INSURANCE AFFORDED BY THE POI_IeIES DESCRIBED HEREIN IS SUBJECT
TO f~LL THE T[Rit:Jt' E/CL!J3IONS.: ~:iND CONDIrION~3 OF sucH POL.IC:U::Jr: LIMITS SHOWN M{'iY H{i\JE BEEN REDUCED BY' P~iID CLAIMS.
- ......- -.-...- _.. - '.- -- -.- .-.-...- -- -.. --.-- .-..- .--. -... - .,- ..-_.. _..._ __.._ __ 0- _ ___.... .... .... .......__ ....._.. _. ..._ __ _...._ _. ._...._ _.... _ _ .._......_.._._ _. _.._ _...__ _ ....__ _ ____.__ _._ ___._.... ____..._..____.___._ ____ _.___ ____ __ __ ______._ _.__
-....-.. - -....- -. -. --. - -....-..- -- .-..- -- -.-. -.-. -- ---.--..--......" - - -.-.-...- -- ----. ........- .--. - ___ _.._..... _..... ..... ..0-- _ _ __ ____ __".".___.' ...... __ _....___...____. .____ __. _ __.... "..._.. ___ ___._...___....__. ______._.__ __ ________ ______
co
L Tf<
TYPE OF INSURANCE
POLICY POLICY
POLICY NUMBER EFFft DATE EXP. DATE
LINITS
.-.---------.-.-.---------_.___.__.____h__.____________..___.____~_______._..____._________________________._.______~_______________________._____________
-----------.-.---------.-------.--.---------------------_____~____H_.___________.________________.~___________________________________
'GENERAL LIABILITY
AI (X) COMMERCIAL GENERAL LIABILITY
1 () CLAIMS MADE (X) OCCUR~
, ( ) OWNER'S & CONTRACTOR!S PROT.
I ( )
, ;' "
I '. :
BB0060001.1
~) l ;l21 :"/~7: 3
Oi/21/'?-4
I ~~aBuEfs~~~~~~E~EAGG.
I r', E r: ,-. t1 ~ t ."'. I + ,:.. [I" T '. J III [I \l
I r 3\ .:'l.ili I-I L. t'\ 1-;. \:. .1. f\ ow _If', I
I EACH OCCURRENCE
I ~l~~ ~~~~~~E(1~~yO~~EF~~~~)
$ l,OOO!OOO
$ 1'} 000'/000
l '5()O~OOO
-$ 500,000
'$ 1 00 ~ 000
$ 5:1000
------.----~----~-----.---..--._~-----~._.___.._M_____-.---~.-______._.M__________~..___.___.__~__.___~_____----~-.------.-.-----.--.-----"_________M_______
IAUTOMOBILE LIABILITY
AI ,~ ) f;NY 8UJQ_ . _.._
J ( ) ALL uWNtu AUIU~
i ( ) SCHEDULED AUTOS
i (X) HIRED AUTOS
I (X) NON-OWNED AUTOS
( ) GARAGE LIABILITY
I ( )
BB00600011
01/21/:'7:3
01/21/94
COMBINED SINGLE LIMIT
.+
+-
500!000
BODILY INJURY (PER PERSON) $
BUD I L Y I NJU~:Y (F'Er~ fiCe)
PF:OPEF~TY' Di;tlj~GE
$
-.- - --.- .- - ...- - .- -. -.. -.. - - - -.- .- .- - --.- - -. .- - ..-. -.- - - - - - -- ..- - -- - - - -. - .- - -. -- ..- ..... - - - - .- '- - _M .-.- -- -.- _ _ _ _._._ _. _ _... _ _ ,._ _ __ __ _. _ _ _ M_ _ _ _ _.. _ _ _ _ _._ _ _ __ __ _ _ ._ _._ _ _ _ _ _... _ _ _ _ __ _ _ _ _ _ _ __
. E" "'l j\ E' C C' I ,. .-. H ..: T .,. '.:
I ...,,~ .-......... L J. H_.I J. L... I T
( ) UMB~~ELLA FGF~1i
I ( ) OTHER THAN UMBRELLA FORM
I
I j' ,lo. ,-. u :1'''\ ."\ I J' [, r-t r ' ,n C
CtiL11 L LL _1\.tu:NLL
, f~GGF:EGA TE
:$
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-.-.--.---..----------------.----.-~---------------------...-.--______~M___..______________._______________.________._________________________
WORKER!S COMPENSATION
t~j-..JD
EhPL.OYEF:' S LI(~BILITY
() STATUTORY LIMITS
I EACH ACCIDENT
f D J SEA S E>.' F' G LIe Y L I r.i I T
I DrSE^SC-EArH CMDLnycE
i _.L.._n..,L ~ L- I - L
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IOTHEP
B I ACCIDENT POLICY'
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I SRB:;~;lXB[n~A
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01/21/93 01/21/94 I ~~l~~ltP~x~~:~E:;~~~~~
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-.-- --. -.- -- -.......- --.-- -.. - -.......--.. -- ..... -.'.- .--'--- -.... -- -..-..... --- ____.M. -.-- _.'_ ____.___ __ ________ ___M _.. _.._ _..___._ ____.._....___.__ __..__ ___.__.._______ ___ _._._._ .____ ______~____._..______
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES/SPECIAL ITEMS
ADDITIONAL INSURED: MONROE COUNTY; MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
ITS EMPLOYEES AND OFFICIALS} AS FUNDING
==================~=====================================================================================================
CERTIFICATE HOLDER
CANCELLATION
MONROE COUNTY..MONROE COUNTY
BOARD OF COUNTY COMM~
ITS EMP.AND OFFICIALS
MONROE COUNTY!Fla
ZIF' CODE'3J041
S H pU ~ ~f.~ 0 N Y [}~' THE ~ ~{(1~! E D~ P C F: I ~ ~ D F' Q L ~ ~: ! ~~; \ ,~E ~: A NeE ~_ ~ E ~I BE F D ~E .. THE
Ell~' Ir.~H i ,t Or~ DH TE THEr1~EUF.. I dE I~~JUINi.j LUFiPFlf~ r WILL. Ef~lIEHl)OR Tu MA IL
45 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"
~._-----_._----------.----~-------'-_._--_._______M___--_.~---------_._.._-------____________.______________--------~~--____.__M___________________
f.iUTHDF~IZED REf'f.';-=.:.c 'E?:i:.r~. -...;.::I-I.II)E ~..' /' /,
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