FY1994..10/20/1993 Agreement
IlIIIR!' "I.. a.(balt
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
M~MQBAH12!1~
TO:
Division of Management Services
c/o County Administrator ~.
Isabel C. DeSantis, Deputy Clerk ~.e.
November 24, 1993
FROM:
DATE:
On October 20, 1993, the Board authorized execution of a Funding
Agreement between Monroe County and the Big Pine Key Athletic
Association, in the amount of $18,000.00; and Hospice of the
Florida Keys, Inc., in the amount of $48,000.00, to provide
assistance to Monroe County.
Enclosed are duplicate originals of the subject Agreements
executed and sealed by all parties which should be returned to
the providers.
cc: County Attorney
Finance
File
- 'T ~i
FUNDING AGREEMENT -?' "'..-
o VJ::
% "fT' '0-".....",
This Agreement is made as of the 20th day o~~(:Octier~..,
1993, between the BOARD OF COUNTY COMMISSIONERS OF M@~RQE ~NTit
FLORIDA, (hereinafter "Board") and BIG PINE ~y ATIg.ETI~
.-<...
ASSOCIATION, (hereinafter "BPKAA"). t...:J
N
WHEREAS, BPKAA is a not-for-profit corporation:"'established
for the provision of activities for the wholesome development of
youths' personal, social, physical, emotional and spiritual
growth; and
WHEREAS, BPKAA provides StIch activities in a wholesome,
alcohol-free and drtlg-free environment for young people of Monroe
County; and
WHEREAS, it is a legitimate ptIblic purpose to provide
facilities and services for recreational use and social ftIDctions
of the community in a wholesome environment free from drugs and
alcohol; now, therefore,
IN CONSIDERATION of stIch services rendered, BPKAA and the
Board agree as follows:
1. AMOUNT OF AGREEMENT. The Board, in consideration of
BPKAA sllbstantially and satisfactorily performing and carrying
out the dtlties and obligations of the Board as to provide
facilities and services for recreational \ISe for YOtIng people
living i.n Monroe County, Florida, shall pay to BPKAA the StIrn of
Eighteen Tho\lSand Dollars ($18,000) for fiscal year 1993-94.
2. TERM. This Agreement shall commence October 1, 1993,
-
and terminate September 30, 1994, unless earlier terminated
pursuant to other provisions herein.
3. PAYMENT. Payment will be paid monthly as hereinafter
set forth. On or before the 15th of each month, BPKAA shall
stlbmi t to the Board its req\leS t for reimb\lrSement. Evidence of
payment shall be in the form of cancelled checks s\lbmitted by
BPKAA to the Board. After the Clerk of the Board examines and
approves the monthly reqtlest for reimbtlrsement, the Board shall
reimbtlrse BPKAA. However, the total of said monthly payments in
the aggregate sum shall not exceed the total amount of Eighteen
Thousand Dollars ($18,000) during the term of this agreement.
4. SCOPE OF SERVICES. BPKAA, for the consideration named,
covenants and agrees with the Board to substantially and
satisfactorily perform and carry out the duties of the Board in
providing activities in a wholesome environment free from drugs
and alcohol to young persons living in Monroe County, Florida.
5. RECORDS. BPKAA shall maintain appropriate records to
insure a proper accounting of all funds and expenditures, and
shall provide a clear financial audit trail to allow for full
accountability of funds received from said Board. Access to
these records shall be provided during weekdays, 8 a. m. to 5
p.m., upon request of the Board, the State of Florida, or
authorized agents and representatives of the Board or State.
BPF~ shall be responsible for repayment of any and all
audit exceptions which are identified by the Auditor General of
the State of Florida, the Clerk of Court for Monroe County, an
independent auditor, or their agents and representatives. In the
event of an audit exception, the current fiscal year contract
amount or subsequent fiscal year contract amounts shall be offset
by the amount of the audit exception. In the event this
agreement is not renewed or continued in subsequent years through
new or amended contracts, BPKAA shall be billed by the Board for
the amount of the audit exception and BPKAA shall promptly repay
any audit exception.
6. INDEMNIFICATION AND HOLD HARMLESS. BPKAA covenants and
agrees to indemnify and hold harmless Monroe County Board of
County Commissioners from any and all claims for bodily injury
(including death) , personal l.nJury, and property damage
(including property owned by Monroe County) and any other losses,
damages, and expenses (including attorney's fees) which arise out
of, in connection with, or by reason of services rendered under
this agreement by BPKAA or any of its agents, employees,
officers, subcontractors, in any tier, occasioned by the
negligence or other wrongful act or omission of BPKAA or its
subcontractors in any tier, their employees or agents. In
the event the completion of services is delayed or suspended as a
result of BPKAA's failure to purchase or maintain required
insurance, BPKAA shall indemnify the Board from any and all
increased expenses resulting from such delay. The first Ten
Dollars ($10.00) of remuneration paid to BPKAA is for the
indemnification provided above. The extent of liability is in no
way limited to, reduced, or lessened by the insurance require-
ments contained elsewhere within this agreement.
7. INDEPENDENT CONTRACTOR. At all times and for all
purposes hereunder, BPKAA is an independent contractor and not an
employee of the Board. No statement contained in this agreement
shall be construed so as to find BPKAA or any of its employees,
contractors, servants or agents to be employees of the Board.
8. COMPLIANCE WITH LAW. In providing all services
pursuant: to this agreement, BPKAA shall abide by all statutes,
ordinances, rules and regulations pertaining to or regulating the
provisions of, such services, including those now in effect and
hereinafter adopted. Any violation of said statutes, ordinances,
rules or regulations shall constitute a material breach of this
agreement and shall entitle the Board to terminate this contract
immediately upon delivery of written notice of termination to
BPKAA.
9. PROFESSIONAL RESPONSIBILITY AND LICENSING. BPKAA shall
assure that all professionals have current and appropriate
professional licenses and professional liability insurance
coverage. Funding by the Board is contingent upon retention of
appropriate local, state and/or federal certification and/or
licensure of BPKAA's program and staff.
10. INSURANCE. BPKAA shall obtain, prior to the commence-
ment of work governed by this agreement, at BPKAA's own expense,
that insurance specified in the insurance schedules attached
hereto and incorporated herein by reference. BPKAA will also
insure that all subcontractors, in any tier, have obtained the
insurance as specified in the attached schedules. BPKAA will not
be reimbursed for any work commenced prior to coverage with
required insurance. BPKAA will not be reimbursed for any
services governed by this contract until satisfactory evidence of
the required insurance has been furnished to the Board via either
Monroe County's certificate of insurance or a certified copy of
the actual insurance policy. Delays in the commencement of work,
resulting from the failure of BPKAA to provide satisfactory
evidence of the required insurance, shall not extend deadlines
specified in this agreement. BPKAA shall maintain the required
insurance throughout the entire term of this agreement. Failure
to comply with this prov1s10n may result in the immediate
termination of reimbursement.
The Board, at its sole option, has the right to request a
certified copy of any or all insurance policies required by this
agreement. If a certificate of insurance is provided, the
County-prepared form must be used. "Accord Forms" are not
acceptable.
All insurance policies must specify that they are not
subject to cancellation, non-renewal, material change, or
reduction in coverage unless a minimum of thirty (30) days prior
notification is given to the Board by the insurer. The standard
language of "endeavor to provide notification" is insufficient.
The acceptance and/or approval of BPKAA's insurance shall not be
construed as relieving BPKAA from any liability or obligation
assumed under this agreement or imposed by law.
Monroe County, Monroe County Board of County Commissioners,
its employees and officials shall be included as "additional
insureds" on all policies, except for worker's compensation.
Any deviations from these general insurance requirements
must be requested in writing on the County-prepared form entitled
"Request for Waiver or Modification of Insurance Requirements"
and approved by Monroe County's Risk Manager.
11. !10DIFICATIONS AND AMENDMENTS. Any and all modifica-
tions of the services and/or reimbursement of services shall 'be
amended by an agreement amendment, which must be approved in
writing by the Board.
12. NO ASSIGNMENT. BPKAA shall not assign this agreement
except in writing and with the prior written approval of the
Board, which approval shall be subject to such conditions and
provisions as the Board may deem necessary. This agreement shall
be incorporated by reference into any assignment and any assignee
shall comply with all of the provisions herein. Unless expressly
provided for therein, such approval shall in no manner or event
be deemed to impose any obligation upon the Board in addition to
the total agreed upon reimbursement amount for the services of
BPKAA.
13 t. NON-DISCRIMINATION. BPKAA shall not discriminate
against any person on the basis of race, creed, color, national
origin, sex or sexual orientation, age, physical handicap, or any
other characteristic or aspect which is not job-related in its
recruiting, hiring, promoting, terminating or any other area
affecting employment under this agreement. At all times, BPKAA
shall comply with all applicable laws and regulations with regard
to employing the most qualified person(s) for positions under
this agreement. BPKAA shall not discriminate against any person
on the basis of race, creed, color, national origin, sex or
sexual orientation, age, physical handicap, financial status or
any other characteristic or aspect in its providing of services.
14. AUTHORIZED SIGNATORY. The signatory for BPKAA, below,
certifies and warrants that:
(a) BPKAA' s name in this agreement is the full name as
designated in its corporate charter, if a corporation, or the
full name under which BPKAA is authorized to do business in the
State of Florida;
(b) He or she is empowered to act and contract for BPKAA;
and
(c) This agreement has been approved by the Board of
Directors of BPKAA, if BPKAA is a corporation.
15. NOTICE. Any notice required or permitted under this
agreement shall be in writing and hand-delivered or mailed,
postage pre-paid, by certified mail, return receipt requested, to
the other party as follows:
For Board:
Monroe County Attorney
310 Fleming St., Rm. 29
Key West, Florida 33040
For BPKAA:
Keith Jones
President
Big Pine Key Athletic Association
P.O. Box 89
Big Pine Key, Florida 33043
16. CONSENT TO JURISDICTION. This agreement shall be
construed by and governed under the laws of the State of Florida
and venue for any action arising under this agreement shall be in
Monroe County, Florida.
17 " NON-WAIVER. Any waiver of any breach of covenants
herein contained to be kept and performed by BPKAA shall not be
deemed or considered as a continuing waiver and shall not operate
to bar or prevent the Board from declaring a forfeiture for any
succeeding breach, either of the same conditions or covenants or
otherwise.
18. AVAILABILITY OF FUNDS. If funds cannot be obtained or
cannot be continued at a level sufficient to allow for continued
reimbursement of expenditures for services specified herein, this
agreement may be terminated immediately at the option of the
Board by written notice of termination delivered to BPKAA. The
Board shall not be obligated to pay for any services or goods
provided. by BPKAA after BPKAA has received written notice of
termination, unless otherwise required by law.
19. PURCHASE OF PROPERTY. All property, whether real or
personal, purchased with funds provided under this agreement,
shall become the property of Monroe County and shall be accounted
for pursuant to statutory requirements.
20. ENTIRE AGREEMENT. This agreement constitutes the
entire agreement of the parties hereto with respect to the
subject matter hereof and supersedes any and all prior agreements
with respect to such subject matter between BPKAA and the Board.
IN WITNESS WHEREOF, the parties hereto have caused these
presents to be executed as of the day and year first written
above.
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE OUNTY, FLORIDA
~-~_..._- ~
/ - ..~
~...~~
a1.rman
ByA~u~ c~;~
By
i-
+~
BIG PINE KEY AHTLETIC
ASSOCIATION
i/
By /&F
v
r't
D~,:J
~''-<
--,
-tc/\J2' () C I 0 r.'}
t1v'\(
rt/l.> Z- N \e.
,'\,~ s.~ if ti{ f ~'T \ A t: A. r- I' ^ ~ :")",0 ~ d 1. -f d.
Iltv Cv. ..J \-IL,",-,_
d M1 0+ tVO~-'fll.A be (L! /1 c,) I;) j
1)( f2'/~
'-
/ / 'i
J \ .~.: \
. _ c::"'0 \"...,)
tv fi C ! s jJ e /15 <.).J /1 / I ~I) f\j OVv'-.J T'J.1A t
leo&. '81. ~-w "J!Chr3
2l1l120:l UOfM!wwoo A.,
~r ~~YAM 1 S3~Yr
......: .
.;-
. /...
. I ~.
. .'.~.
\--!rl [1
(jJ '-'ltr!f.
\J
f\,"\~1\Y 'IJ,~
.v~~~
-ji.
. .
. .
~ ~"t-
;',. OF f\,. o"~
JAMES L WYATT JR
My Commieeion CC287.12
ex,w.. May 18, 1"7
...
"ptiJ 21. 199.1
I ~t I'rin' ;ng
WO(~(<EI{St COMPI~NSA l~ION
INSURANCF: R[QUIREM(~N'rs
FO({
CONTI{AC~I'
lll~rrWEEN
MONI{OE COUN~I'Y, I;I.JORII)A
AND
BIG PINE ATHLETIC ASSOCIATION
Prior to the commencement of work governed by this contract, the Contractor shall ohtain
Workers' Compensation Insurance with limits sullicient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
$100,000 Bodily Injury by Accident
$500,000 f30dily I~jury by Disease, policy linlits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
state of Norida and the company or companies must maintain a minimum rating of A-VI, as
assigned by the A.M. Best Cornpany.
If the Contractor has been approved by the Florida's Department of L.'lbor, as an authorized sclf-
insurer, the County s~all recognize and honor the Contractor's status. The Contractor may be
required to submit a Letter of Authorization issued by the Department of Labor and a Certificate
ofInsurance, providing details on the Contractor's Excess Insurance Program.
I f the Contractor participates in a self-insurance fund, a Certificate of I nsurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
Adnlinistrativc ~1rudion
114709.1
wel
81
..
April 22. 1<)9.1
I sl l'rinC.ing
(;I~NEI{AL 1_~IAnll.lJl'Y
INS(JI{ANCf~ REQUIJ{EI\1ICNrrS
F() J{
C()N'"j'I{ACrr
II I~:'J.'V I~I!:N
MONI{OE COUN').Y, FlJ()I{II)A
AN])
BIG PINE ATHLETIC ASSOCIATION
Prior to the commencement of work governed by this contract, thc Contractor shall obtain
- General Liability Insurance. Coverage shall be maintained throughout the life of the contract and
include, as a 111ininlum:
· Prcnlises Operations
· Products and Cornplctcd ()perations
· Blanket Contractual Liability
· PcrsonallnjufY Liability ..
· Expandcd Definition of Property Damage
The minimum lilnits acceptable shaH be:
$1,000,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 500,000' pier Person
$ 1,000,000 per Occurrence
$ J 00,000 f>roperty Da.rnagc
An Occurrence Fonn policy is preferred. If coverage is provided on a Claims Madc policy, its
provisions should include coverage for claims Jiled on or aller the effective date of this contract.
In addition, the period for which claims may be reported should extcnd 'or a minimum of twelve
(12) months following the acceptancc of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
policies issucd to satisfy the abovc requirements.
Adrnini::;Crnlivc In\1.n.ction
GLJ
1/4709.1
56
-.
^r)fil 22. 19-).1
1 ~t I'rinlinl~
VEIIICLE LIAIJll.llrrV
INSUltANCE REQUII~EMEN~rS
IrO I{
C()N']'RAC~r
llErrWEEN
MONI~OE COUN1Y, IC[.lOIl.II)A
AND
~IG PINE ATHLETIC ASSOCIATION
Recognizing that the work governed by this contract requires the use of vehicles, the C()nlractor,
prior to the COl11111CnCClncnt of work, shall obtain V chicle Ijability I nsurancc. Coverage shall be
rnaintained throughout the life of the contract and include, as a mininlUlTI, liability coverage for:
· Owned, Non-Owned, and Ilired Vehicles
The Illinimunllitnits acceptable shall be:
$100,000 Combined Single Limit (CSL,)
If split limits are provided, the Jl1ininlurn lirnits acceptable shall be:
,
$ 50,000 per Person
$100,000 per Occurrence
$ 25,000 Property Damage
"fhe Monroe County Board of County Comnlissioners shall be nanlcd as Additional Insured on all
policies issued to satisfy the above rcquirclncnts.
Adlninistrnli\'c In:d.nldion
1;4709. t
VLl
75
r
f
l
AtDttlllt~
CERl'lflCAl'EOF INSURANCE
ISSUE DATE (MM/DD/YY)
PRODUCER
. '".
. ..
f THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATioN' O~~r[Y''''ANb
) 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
.. :,~
f~T~~~NY rc
NAUTILUS INS.
f~T~~~NY B !)on00'fFO BY RISK MAN~~FMfNT
~
Ll clJ oJ
NfA 'f-, YES
o IVI B
co.
INSURED
NOV
~ , lOr""
o l' \J,
u:: : ~~: ..-...~
COMPANY ~ Tf.
LETTER 'U
:~ ;h Onyj
COMPANY WA lVER:
LETTER E
j 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.
lco
fL TR
l
r
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
;".1 ,:~" /'~ .....:. t.; '1 ;::: .....
~ .'" t. .. ..
. ... '''' ..- .~ ~,',
.....~ ~ '.. ....
.. .' .' ~...."
., .. :' .'1
CLAIMS MADE
OCCUR.
, . ".' ':,;::.C GENERAL AGGREGATE
PRODUCTS-COMP/OP AGG.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
$ .
$
$
$
$
OWNER'S & CONTRACTOR'S PROTo
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
MED. EXPENSE (Anyone person) $
COMBINED SINGLE $
LIMIT
BODIL Y INJURY $
(Per person)
BODIL Y INJURY $
(Per accident)
PROPERTY DAMAGE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
":~'~U!~~'~~~"-.wN: ~
EACH OCCURRENCE
AGGREGATE
$
$
WORKER'S COMPENSATION
STATUTORY LIMITS
AND
EMPLOYERS' LIABILITY
OTHER
~r ..rt'>-=-~~""~_Ill!I:_~-.......'Il7"""'~~~'-.~~.....".a;.
EACH ACCIDENT $
DISEASE-POLICY LIMIT $
DISReeeWed EMPLOYEE $
!usk Mgmt. & Loss Conti:or'~''''''
//-- 7-- ?3
~
oft::..-
DATE
i
I DESCRIPTION OF OPERA TIONS/LOCA TIONS/VEHICLES/SPECIAL ITEMS
i
!
I .. ,: " ... .:. ,.. ..':. . .
'. ~ u: : ~ f\~~ ~ ) :.;. i.\ ':: 1..} . ::"} \"
CERTIFICATE HOLDER
INITIAL
t ..~ ; ',~
~h ~.:.
. .~. ," 1::- r.... ;-; ,--';
l :-,.
i\;
;....i .
; i
f::: r.l ('j F~ D
i i ;'
..~ ..~ . . , I "..~. '_. u. ......H . ...' .... p_,
i...~ J.J {'.~ r~'i ..t ~:::; ~~::~ uL i ) f\~ i::. ;-< ~~)
!"~ ; '~'" ~::
:'::; H () L! h!
H :::::
/; ~) 1) I 'r T r::; (.1 ('j L..
'r f",: :'::; 1 i ;~.- ;::' :'.-
...... . . "0 .. ~ . ...... '.
''''''~-''..:''''''''~'~'''''''--'''''''''''~''_':''_'''''''''''''''''''_'''Y'::l>i-.
CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL -LJDAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
i\! : i i": j! i.....1 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
j- n (.:; 1".j !', LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENT A TIVE--~'-~-~~'~'-'~-'H" ~~ ..,- .....
ACORD 25-S
-, !::
~/,~... ,~;::~...,.;~~(;"
,f
",J.
~,;., ./
{' jI,/F
@ACORD CORPORATION 1990
)4
Ray H~mpson & Assoc.
P. O. Box 1617
Big Pine Key, Fl. 3)043
I A AND
CONFERS NO RIGHTS UPON THE CERnFlCATE HOLDER. THIS CERTIFICA'
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T.
POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
INSURED
COMPANY A
LETTER Lumbermans Mutua 1
COMPANY B
LETTER
,I}
~~ J)fi
i-JI L)~
\J '~
,"C
C
Big Pine Athletic Assoc., Jnc.
P. O. Box 89
Big Pine Key, Fl. 33043
COMPANY C
LETTER
COMPANY D
LErrER
COMPANY E
LETTER
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 ORCONDlnON 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
TYP! 0' INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POUCY EXPIAAnON
DA TE (MM/DDIVY) DA TE (MM/DDIVV)
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR,
OWNER'S I CONTRACTOR'S PROTo
" -..
GENERAL AGGREGATE S
PRODUCTS-COMP/OP AGG. I
PERSONAL & ADV. INJURY S
EACH OCCURRENCE I
FIRE DAMAGE (Anyon. fire) I
MED, EXPENSE (Any one petIOft) S
4 AUTOM08lLl LIABILITY COMBINED SINGLE
I
ANV AUTO UMIT
ALL OWNED AUTOS Rec:ei~'ed 80DIL V INJURV
Risk Mgmt'0~ntrOJ s
SCHEDULED AUTOS (Per peraon)
i HIRED AUTOS BODILY INJURV
- DATE ~ / ?J .
~~. .... NON.QWNED AUTOS INmAL · ~ tJc5- (Per accident)
-. -....-......--.-........ .-
GARAGE LIABILITY
PROPERTY DAMAGE .
UCla UMlLlTY
UMBRELLA FOAM
'," *: OTHER THAN UMBRELLA FORM
WOMD'. COMPeN.AnON
EACH OCCURRENCE
AGGREGATE
.
..........--..- .......-.
.
AND
EMPLOYeRS' UA.,UTY
Binder #
091564493239003861
8/24/93
8/24/94
STATUTORY LIMITS .
EACH-AC(=-iDENT'~-.---' --'--. -1'00-- ,--
DISEAse=PoLlcv"LiMIT . ......-..s "5 00""
DISEASe":EACH EMPLOYEE S' 1 0 O' .'
A
OTHER
DESCRIPTION OF OPERA TIONSILOCA TIONSIVIHICLESlSPECIAL ITEII,
--
Athletic Associ~tion
CERTIFICATE :HOLDER
.~'-r
- '..,.- .:~, l...;",.~.". ~ .....::~..
" CANCELLAnON
';":'" .~
... .'. ~ .~--.:.;~.....~ .c.~~~.;-~.
i-. , 7... t."~:r:.
. ..~_. . _"~-:2f~
Monroe County, Risk Management
Attn: Donna Perez
5100 College Rd., Wing 2, Rm. 207
Key West, Florida 33040
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.
ACORD 25-8 (7/10)
AUTHORIZED REPRESENTATIVE .J .___/.,'
'--'I I /
T j m Ham p Son // / ) .~ .', / 'J .' / ..:.~ . < ~
~ - ~.~ """ -/ -'/CACORIJCORPORAnON 1990
~.6L, ~ ~
..\pril 22. 19?3
I st Printing
tPrrw \ ~ 8~J:ll~ 4... MONROE COUNTY, FLORIDA
72t~~ LM~~
I~C(lucst For Waivcr
of
Insuleancc [{cquircnlcnts
It is requested thallhe insurancc requirelllenls, as specified in the COUl1ly's Schedule of Insurance
Rcquircnlcnts, be \vaivcd or luodiLicd on the follo\ving conlract
Conlraclor: J~.q PINt. tmJ/.,We. ~~
Conlractfor: ~l>'~ ~ f2G~"~~",~tYt ~~~
Address of Contraclor: 'B p ~
~~tt
~.4, ~/N~ Kv; I t::L. 330&1 -~
Phone: ~ 7 ~ ~ Q)';>;> C1
.
ScopcofWork: --.1'~tJVlJ '!. ~ ~vt~"OI'\~ Af..'I1\JI.Jt,.,,,, ~ 't'ef.,&-M
.t~~ (/'9't(~~ ~ ~"Z"'l4l~ 6l:::- ~'" p,).)t. ~ ~
u.'~
Reason for Waiver: 1Z&jll"'lf 'dl~~J,v v.ck4r~",,~t':au<.~ Wc. ~u.f~<c
~P~l~ 1t1~",- ~~ 1141'1'11<' .~~A.s,4.. $,,~~
:;u.~"'ouIWI..,C,,,~ T-t'SIlIl~"'iAc.6j"f &,,~ ~ J~'~''''II-I ~.
UtJal*t .,/~ r~""~ .,.~~~ -+0 ~ '-"hM. c,~,.:IJs~.
-:z,e ~ ~1:t.ua:h";~~~'S~fi I.,'.t~ W.( 1101 ,-I .... ~~ J11~
. . Jov A4."f D-H.'^ flH'pH't' Dff.a<4- ~ ~,,~ i4.U 41111 V~ 4-
S.,,~ur~~oJ raclor: v.LA, "0(. ~ J 1'1.c.y.J&~S.c. 4.tJ..k"'I~ T:ItClU'lt,It.C!"..
. (}J 1- ( N f ~mo~" (_~ Not Approved
Risk Management " ~ ~.J.J\....av--
V l a
Dnle I \, l 1 qJ.
County Adlninislralor appeal:
Approved:
Nor ^ pprovcd:
Date:
Board of County C'oJnruissioners :Ippeal:
Approved:
NOl Approved:
Meeting Dale:
\"'1 AIVER