07/07/1993 Agreement
Jaann!, I. Itolbagt
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
MEMORANDUM
TO:
Dent Pierce
Public Works Director
FROM:
Ruth Ann Jantzen LlLJ'fJ
Deputy Clerk ;;::r ·
DATE:
September 14, 1993
------------------------------------------------------------------------------------------------------------------------
On July 7, 1993, the Board of County Commissioners approved execution qf a
Management Agreementwith the Big Pine Athletic Association to operate and supervise
the Big Pine Youth Center out of the Blue Heron Building on Big Pine Key.
Enclosed for return to the Big Pine Athletic Association is a fully executed
duplicate original of the subject contract.
For your infonnation, also enclosed is a tQJ!Y of the Funding Agreement with the
Big Pine Athletic Association . The duplicate original of this Agreement is being sent to
Melonie Bryan for forwarding to the Big Pine Athletic Association.
If you have any questions on the above, please contact me.
cc: County Attorney
Finance
County Administrator, w/o document
Risk Management
Budget Director
File
,t
AGREEMENT
This Agreement, made and entered into this 7th day of
July, 1993 by and between Monroe County, Florida, a political
subdivision of the State of Florida, hereinafter COUNTY and BIG
PINE ATHLETIC ASSOCIATION, a non-profit corporation under the
laws of the State of Florida, hereinafter, BPAA.
WITNESSETH:
WHEREAS, BPAA is a not-for-profit corporation established
for the provision of actiyities for the wholeso~e development of
youths' personal, social, physical, emotional and spiritual
growth; and
WHEREAS, BPAA provides such activities in a wholesome,
alcohol-free and drug-free environment for young people of Monroe
County; and
WHEREAS, it is a legitimate public purpose to provide
facilities and services for recreational use and social functions
of the community in a wholesome environment free from drugs and
alcohol; and
WHEREAS, the COUNTY, for and in consideration of the rentals
hereinafter to be paid, and in further consideration of the
convenants hereinafter to be kept and performed by BPAA, does
lease unto BPAA that certain property described a~ follo~: ~~
t...:J W'
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TRACT A, SECTION 26, TOWNSHIP 66 SOUTH,~AA;NGE~9 ~EAST,
MONROE COUNTY, FLORIDA, ACCORDING TO A MAP OF PRc.1PERTIES8oWN.E:D BY
J . G. MCKAY, JR., AS TRUSTEE FOR EL RADABOB LI'Ql)IDATION TRUST,
IN SECTIONS 14, 15, 22, 23 AND 26, ALL IN TOWN$.HIP ~ SOUTH,
RANGE.. 29 EAST, BIG PINE KEY, MONROE COUNTY, FLORIDA, WHICH'" MAP
WAS PREPARED BY C.G. BAILEY & ASSOCIATION AND Q~ATED 1$.Y, 1972,
SAID TRACT A CONTAINING 1.07 ACRES MORE OR LESS' ~
also referred to as the Blue Heron Building, located on Big Pine
Key, Monroe County, Florida subject to the following terms and
conditions which the parties hereto agree shall apply:
1. TERM: The term of this Agreement shall be for three (3)
years, commencing ~, 1993, and shall be
terminated after said period, unless extended pursuant to the
terms of this agreement.
2. EXTENSIONS: This agreement may be extended for one additional
period of three (3) years if BPAA provides written notification
to the COUNTY of BPAA'S intent to extend the Agreement at least
thirty (30) days prior to the expiration of the Agreement. Such
extension is not available, however, if the COUNTY has provided
written notification of its intent not to consent to an extension
at least sixty (60) days prior to the expiration date of this
agreement.
3. RENTAL: BPAA agrees to pay to the COUNTY, as rent for said
property during the term of this lease, the sum of One Dollar
($1.00) per year, to be paid on or before the anniversary date of
each year for the term of this agreement, or any extension
thereof.
4. PAYMENT OF RENT: The rent shall be paid as specified above,
and in the event that any installment shall remain unpaid for a
period of thirty days after the same shall have become due and
payable, the COUNTY may, at its option, consider BPAA a tenant
at sufferance, and may immediately enter upon said premises and
take possession thereof. In such event, or in the event of any
other defaul t by BPAA unc;:ier the terms and condi tions of this
agreement which shall continue for a period of thirty days from
the time of notice to BPAA of such default, shall also entitle
the COUNTY to the same remedy.
5. USE OF PREMISES: The premises described above shall be
actively used as a youth center for the Big Pine Key area. The
COUNTY hereby enters into this Agreement with BPAA to supervise
and operate the youth center. BPAA shall at all times be
responsible for assuring that the operation of the center does
not create a nuisance or become used for any illegal or immoral
purposes, including allowing any alcoholic beverages or unlawful
narcotics to be possessed, used or consumed by persons on the
premises or allowing persons under the influence of alcohol or
unlawful narcotics to enter the premises, and that the center
complies with any applicable federal, state and county laws,
statues and ordinances.
6. IMPROVEMENTS: The COUNTY may remodel, renovate or
reconstruct any buildings, structures or additions thereto
existing on the premises.
7. CANCELLATION: Ei ther of the parties hereto may cancel this
agreement with or without cause by giving the other party sixty
(60) days written notice sent certified mail of its intentions to
do so.
8. RETURN OF PREMISES: At the end of the term of this Agreement
or any extensions thereof, BPAA shall vacate and peacefully
surrender the premises to the COUNTY. BPAA shall not suffer or
permit any waste to occur to the premises during the term of this
lease.
9 · INDEPENDENT CONTRACTOR: At all times and for all purposes
hereunder, BPAA is an independent contractor and not an
employee of the Board of County Commissioners. No statement
contained in this agreement shall be construed so as to find
BPAA or any of its employees, contractors, servants or agents
to be employees of the Board of County Commissioners.
10. COSTS:
associated
The COUNTY will be
with this agreement
responsible for
of the premises,
all costs
regarding
maintenance of this building and improvements thereto. BPAA
will be responsible for all costs associated wi th utili ties in
connection with the premises leased hereunder.
11. INDEMNIFICATION AND HOLD HARMLESS: BPAA 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 injury, 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 BPAA or any of its agents, employees,
officers, subcontractors, . in any tier, occasioned by the
negligence or other wrongful act or omission of BPAA of its
subcontractors in any tier, their employees or agents.
12. INSURANCE: Prior to BPAA taking possession of the property
owned by the COUNTY, BPAA shall obtain, at their expense,
insurance as specified in the attached schedules, which are made
part of this lease agreement. BPAA will not be permitted to
occupy or use the leased property until satisfactory evidence of
the required insurance has been furnished to the COUNTY as
specified below. BPAA shall maintain the required insurance
throughout the entire term of this lease agreement and the return
of all property owned by the COUNTY.
BPAA shall provide, to the COUNTY, as satisfactory evidence of
the required insurance, either a certificate of insurance or a
certified copy of the actual insurance policy.
The COUNTY, at its sole option, has the right to request a
certified copy of any or all insurance policies required by this
agreement.
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 COUNTY by the insurer.
The acceptance and/or approval of BPAA'S insurance shall not be
construed as relieving BPAA from any liability or obligation
assumed under this contract or imposed by law.
13. COMPLIANCE WITH LAW: In providing all services pursuant to
this agreement, BPAA 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. Anything in paragraph four to contrary notwithstanding,
any violation of said statutes, ordinances, rules or regulations
shall consti tute a material breach of this agreement and shall
entitle the Board to terminate this lease immediately upon
delivery of written notice of termination to BPAA and the
COUNTY may thereupon reenter the premises.
14. PROFESSIONAL RESPONSIBILITY AND LICENSING: BPAA shall
assure that all professionals have current and appropriate
professional licenses and professional liability insurance
coverage.
15. MODIFICATIONS AND AMENDMENTS Any and all modifications of
the services and/or reimbursement of services shall be amended by
an agreement amendment, which must be approved in writing by the
Board.
16. NO ASSIGNMENT: BPAA shall not assign this agreement or
sublease the premises except in writing and with the prior
wri tten approval of the .Board of County Commissioners, 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 obligations upon the board in addition to
the total agreed upon reimbursement amount for the services of
BPAA.
17.NON-DISCRIMINATION: BPAA 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, BPAA
shall comply with all applicable laws and regulations with regard
to employing the most qualified person( s) for positions under
this agreement. BPAA 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.
18. AUTHORIZED SIGNATORY: The signatory for BPAA, below,
certifies and warrants that:
(a) BPAA'S name in this agreement is the full name as
designated in its corporate charter, if a corporation, or the
full name under which BPAA is authorized to do business in the
State of Floridai
(b) He or she is empowered to act and contract for BPAAi
(c) This agreement has been approved by the Board of
Directors of BPAA, if BPAA is a corporation.
19. NOTICE Any notice required
agreement shall be in writing and
postage pre-paid, by certified mail,
to the other party as follows:
or permitted under this
hand-delivered or mailed
return receipt requested,
FOR COUNTY
Monroe County Public Works
FOR CONTRACTOR
Big Pine Athletic Association
5100 College Road
Key West, Florida 33040
Post Office Box 89
Big Pine Key, Florida 33043
20. 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.
21. NON-WAIVER: Any waiver of any breach of covenants herein
contained to be kept and performed by BPAA 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 pf the same conditions or covenants or
otherwise.
IN WITNESS WHEREOF, the parties hereto have set their hands
and seals on the day first written above.
(seal)
Attest:
BOARD OF COUNTY COMMISSIONERS
DANNY L. KOLHAGE, CLERK OF MONROE UNTY, FLORIDA
BY ~~;h.,J
Depu CI
BY
Witness:
BIG PINE ATHLETIC ASSOCIATION
BY
dnMJ GVJrIf
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By~c;~J lk4e,1
BY
",t.Ry PilI.
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JAMESL WYATT JR
M1ComW~CC2.7812
Expir.. May 18,18G7
April 22" 1993
1 sl Printing
1\10NROE t:OUNTY, FLORIDA
INSU]{ANCE GUIDE
TO
CONTRAC1' ADMINISTRATION
General Insurance Requirements
for
Organizations Individuals
Leasing County Owned
Property
Prior to the Organization/Individual taking possession of the property owned by the
County, the OrganizationlIndividual shall obtain, at his/her own expense, insurance as
specified in the attached schedules, which are made part of this lease/rental agreement.
The Organization/Individual will not be permitted to occupy or use the leased property
until satisfactory evidence of the required insurance has been furnished to the County as
specified below.
The OrganizationlIndividual shall maintain the required insurance tly:oughout the entire
term of this lease/rental agreement and any extensions specified in the attached schedules.
Failure to comply with this provision may result in the immediate termination of the
lease/rental agreement and the return of all property owned by the County.
The OrganizationlIndividual shall provide, to the County, as satisfactory evidence of the
required insurance, either: .
.
Certificate of Tnsurance
II
\
cr
· A Certified copy of the actual insurance policy.
The County, at its sole option, has the right to request a certified copy of any or all
insurance policies required by this contract.
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
notificafion is given to the County by the insurer.
The acceptance and/or approval of the Organization/Individual's insurance shall not be
construed as relieving the Organization/Individual from any liability or obligation assumed
under this contract or imposed by law.
7(f .
April 22, 1993
I st Printing
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
. AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient 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 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire tenn of the contract.
Coverage shall be provided by a company or companies authorized to transact business in
the state of Florida and the company or companies must maintain a minimum rating of A-
VI, as assigned by the A.M. Best Company.
If the Contractor has been approved by the Florida's Department of Labor, as an
authorized self-insurer, the County shall 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 of Insurance, providing details on the Contractor's Excess
Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be
required. In addition, the Contractor may be required to submit updated financial
statements from the fund upon request from the County. . .
wel
)
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April 22, 1993
1st Printing
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
)
!
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work govrned by this contract requires the use of vehicles, the
Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance.
Coverage shall be maintained throughout the life of the contract and include, as a
minimum, liability coverage for:
o Owned, Non-Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$lOO~OOO per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
l
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April 22. 1993
1 st Printing
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MOl\TROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the
contract and include, as a minimum:
o Premises Operations .
. 0 Products and Completed Operations
o Blanket Contractual Liability
o Personal Injury Liability
o Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$1,000,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 500,000 per Person
$ 1,000,000 per Occurrence
$ 100,000 Property Damage
An Occurrence Fonn policy is preferred. If coverage is provided on a Claims Made
policy, its provisions should include coverage for claims filed on or after the effective date
of this contract. In addition, the period for which claims may be reported should extend
for a minimum of twelve (12) months following the acceptance of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfY the above requirements.
GL3
SWORN STATEMENT Ul'JDER ORDIN.ANCE NO. 10-199.0
MONROE COUNTY; FLORIDA
ETHICS CLAUSE
151~~eAt!Jp-!i~ 1/5.>";/4';.;" I Bq>Afl warrants that he/it has not employed,
retained or otherwise had act on his/its behalf any former County officer
or employee in violation of Section 2 of Ordinance No. 10-1990 or any
County officer or employee in violation of Section 3 of Ordinance No.
10-1990. For breach or violation of this provision the Coun.ty may, in
its discretion, terminate this contract without liability and may also,
in its discretion, deduct from the contract or purchase price, or
otherwise recover, the full amount of any fee, commission, percentage,
gift, or consideration paid to the former County officer or employee.
1:1iiF~ / (fJes IJe;j
Oate: 0/0/'13
STATE OF
ROIl JA
Jr1V1lke- .
COUNTY OF
Subscribed and sworn to (or affirmed) before
me on Cj 1/1 dfl(ot AuhJ/ /773 (date) by
(name of affiant).
He/She is personally known to me or has produced
j17IlSv0A/lvf (NOW,) fv tf-1C as identification.
(type of identification)
~..,.y '11.-,
+.,.~.~~
.II~ JAMESL WYATT JR
· : My ~ 00287812
.. · Expir.. May 18.1887
~h ~.".
'~~ Of f\"O~
~VJ L~.!CI'f/--
tlOTARY PUBLI C
MCPt4 REV. 2/92
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(.),
ELORIDA STATUTES. ON PUBLIC ENTITY CRIMES
TIllS FORM MlJST BE SIGNED AND SWORN TO IN TIlE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
t. This sworn statement is suhmitted to 111c:J..tl-ce (~(I,,+v Citb 1k. ~d<..s.
(tint name of the public entity)
hy ~ei+t.. G'.. ~I'\C.S _ (Pr~s~J-et,d- - <B.PA.A.
------F (print individual', name and fttle)
for 13" CR;le A:Ft:Je-f,~ Ass()C,;J/~ ·
(print name of entity !lubmitting !lworn !ltafement)
whose husiness address is
~~ g77
~/" cPJ;'\e k'~ I FL 330'"3
and (if applicable) its Federal Employer Identification Number (FEIN) is
~
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
stat.ement:
1~1- ~';t. 3l.f~ 9
.)
2. I understand that a "public entity crime" AS defined in Paragraph 287.1JJ(1)(g), Florida Statutes. means a
violation of any state or federal law by a person with respect to and directly related to the transaetlon of business
with any public entity or with an Agency or political subdivision of any other state or of the United States, including,
but not limited to, any bid or cont.ract for goods or services to be provided to any public entity or an agency or
political subdivision 9f Any other state or of the United States SInd involving antitrust, fraul, theft, bribery,
collusion, racketeerint, ~onspiracy, or material misrepresentation.
J. I understand that"convicted" or "conviction" IS defined in Pllragraph 287.IJJ(.t)(b), Florida St.tutes, means a
finding of guilt or a conviction of a puhlic entity crime, with or without an adjudication of guilt, in any federal or
state triAl court of record relating to chArges brought by indictment or information Arter July t, 1989, as . result
of I jury verdict, nonjury trial, or entry of 8 plelt of guilty or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph 287.133(I)(a), Florida Statutes, means:
1. A predecessor or successor of a person convicted of a public entity crime; or
2. An entity under the control of any natural person who is active in the management of the entity and who has
been convicted of a public entity crime. The term "affiliate" includes those officers, directors, e:xecutives, partners,
shareholders, employees, members, and agents who are active in the management of an affin.te. The ownership
by one person of shares constituting a controlling interest in another person, or pooling of equipment or income
among persons when not for fair market value under an arm's length agreement, shall be . prima facie else that
one person controls another person. A person who knowingly enters into I Joint venture with . per~on who has
been convicted of a public entity crime in Florida during the preceding 36 months shan be considered an .ffiliate.
5. I understand that a "person" as defined in Paragnph 287.133(I)(e), Florida Statutes, meanslny nltural person
or entity organized under the 'aws of any state or of the United States with the 'ega' power to enter into a binding
contract and which bids or applies to hid on contrlllcts for the provision of goods or services 'et by I puhlic entity,
or which otherwise transacts or applies to trAnSAct business with a public entity. The term "person" Includes those
officers, directors, executives, partners, shareholders, employees, members, Ind agents who Ire Ictive in
management of an entity.
6. Based on informAtion And belief, the statement which I have mArked below is trlle in relation to the entity
submitting this sworn statement. (Indicate which statement applies.)
~ Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners,
shareholders, employees, members, or Agents who Are Active in the management of the entity, nor any .ffiliate of
the entity has been chArged with And convicted of I public entity crime subsequent to July I, 1989.
- The entity submitting this sworn stateme!!~, nor any of its officers, directors, exectutives, partners,
shareholders, employees, member~, or ARents who are acfive in the manSlRemenf of the entity, nor an .ffiliate of
the enfity has been charged with and convicted of. public entity crime subsequent to July I, 1989.
_ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the m8nagement of the entity, or an .ffiliate of
the entity has been charged with And convicted of a public entity crime subsequent to July I, 1989. However, there
has been a subsequent proceeding before a HeRring Officer of the State of Florida, Division of Administrative
Hearings and the Final Order entered by the llearing Officer determined that it was not in the public interest to
place the entity submitting this sworn statement on the convicted vendor list. (attach. copy of the final order)
I UNDERSTAND TIIA TTHE SUBMISSION OF TillS FORM TO TIlE CONTRACTING OFFICER FOR THE PUBLIC
ENTITV IDENTIFIED ON P ARAGRAPII I (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONL V AND, TUA T THiS
FORM IS VALID TIIROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO
UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRA<.,T IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDAST A TUTES
FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
U}tP<;;,' 6'I,j
~fA .A.
Sworn to and subscribed before me this clT0 day of Av c.'V..s -r
,19 ? .~
Personally known '77.) M <- {jL~
J~
W '1ct tI
V
-q- L-A
OR Produced identification
Notary Public - State of
My Commission expires
(Type of identificAtion)
(TINt tAl y All
(Printed typed or stamped
commissioned name of not.ry public)
~".Y "u~
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JAMES L WYATT JR
My CommiMion CCa7812
ExJair..Uay 18,1GOi
Form PUR 7068 (Rev. 06/11/92)
A.__lilt.
CERTIFICATE OF INSURANCE
ISSUE DATE (MM/DD/YY)
: PRODUCER
8/11/93
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Ar:fo- ------
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
Regan Insurance Agency, Inc.
90144 Overseas Highway
Tavernier, Fl 33070
f~T~~~NY A
Nautilus Ins. Co.
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- :)/ J., -,.- L Iv
C~ I ~C/ '.1' .. ~/ (-1 {j)
c( J I ·
COMPANIES AFFORDING COVERAGE
INSURED
f~T~~NY B
Big Pine Athletic Association
PO Box 89
Big Pine Key, Fl 33043
f~:r~~NY c
f~i'i~~NY 0
I f~~~~NY E \(\./ \i,
tcovERAGES '-...' '--... '.....
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 CONDITfONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAiMS.
ICO
iLTR
I
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DA TE (MM/DDIYY) DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
;A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROTo
NS 020187
6/29/93
6/29/94
GENERAL AGGREGATE $ 1 ,000,000
PRODUCTS-COMP/OP AGG. $ 1,000,000
PERSONAL & ADV. INJURY $ excluded
EACH OCCURRENCE $ 1, 000 , 000
FIRE DAMAGE (Anyone fire) $ excluded
MED. EXPENSE (Anyone person) $ exclude.d__
COMBINED SINGLE
LIMIT
$
-...
I -
I '
I .. ili .
I ,...
AUTOMOBILE liABiliTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
DATE
f<ecelv~
lusk Mgmt. & Loss Control
~ -/~~
~ D/~
BODIL Y INJURY $
(Per person)
BODIL Y INJURY $
(Per accident)
PROPERTY DAMAGE $
EACH OCCURRENCE $
AGGREGATE $
ST A TUTORY LIMITS
EACH ACCIDENT $
DISEASE-POLICY LIMIT $
DISEASE-EACH EMPLOYEE $
INmAL
EXCESS liABILITY
UMBRELLA FORM
f J'
I -....
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
;.-
OTHER
: DESCRIPTION OF OPERA TIONS/lOCA TIONS/VEHIClES/SPECIAl ITEMS
Athletic_Association
Watson Field, Blue Heron Park & facilities at Sugarloaf Club, St. Peter's Catholic Church
I and Srmshine Key Camping Resort
, CERTIFICATE HOLDER CANCELLATION
Monroe County Board of County
Commissioners, Additional Insured
At t : Risk Management
5825 Jr. College Rd
Key West, Fl 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL --lO- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTIC.~HALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIN U N THE CaMP yllTS AGENTS OR REPRESENTATIVES.
4t /
- {'
,"-
AUTHORIZED REPRESE
I
LA~C?_RD 25-8 (7/90)
@ACORD CORPORATION 1990
.\plll 22. 19<).1
I ~l Pritlllllg
M()NI{()[ (~()lJN'r"~ FL()I{IDA
({cqucst For \\-'aiver
of
Insurance I{cqu~rcnlcnts
Contract for:
It is requcsted that the i Ilsurance requi relnenls. as spcci ficd in the ('Ollllly's Schedule of I nSlIf:l nee
Rcquirenacnts.. be \vaivcd or l110dificd olllhc follo\ving contracl.
~~/',e A1l,kt,c A~SH,j~
t\4t1dl~'1 of kqectf,~c.(? Qlk:l>tfh.. <; c-t-t CJ!lfe Jtet~ (jj,.k
(!~(PAA
Contractor:
Addrcss of Contractor:
Phonc:
Scopc of Work:
4
Reason for Waivcr:
.e'f.:t?~d-t;~ -Cae.. ~ ~ ~~.
~ S~~~~~~.
'//;
Signature of Contractor:
/~~
Approved I / ~ Not Approved
9r.;\jV~--t'~~r;r6J -k .~
~/ ,;)-t, I CD ./ . ·
cr~> ,de~ -~AA
:c ~Je. ~:>e
l/OA(t-e ~ ~e5.
~
'. 1r'"
Risk Managclllenl
Date
C'ollnty Ad.ninislrator appeal:
Approved:
Not Approved:
Date:
Uoard of County ('ol1l1llissioncrs appeal:
Approved:
Not Approved: __
Mcel i ng Dale:
\VAIVER
;if --t~ $Cf A A !-t.e=_ rtvr.t- (~~~ 'c-~~~1 cl~~ e') t1rC-n-- ~ 5
'1:.0 0--<~v0~ ~-<-') dt..Cl-?- ~ ~/ ~ <.;:r(~>'-. ct".S<:. cjl~
~~ 5r;;r CciYt/)7 .~ <-2 L<tVl~ (>-6 f;-\4-?~}~ ~~ ~~ r-~ri) ~.
~ ~ rrC\0- (L~'L~ v-~~ ~~~~ ~ :yX~1~~ ~
/1~.1 ) ll,r(. L'''~ .~ a. v..el~.Ce o--~-/x f\tA. "'-c/---rr-2-€ h~~(J
U 'J'
4 ~f~~€- .
-....
4
~:.f
~
l?!'(?~k p(JAA
f
" *""
A.....
U M A I N NL Y AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
PRODUCER
Ray Hampson & Assoc.
P. O. Box 1617
Big Pine Key, Fl. 33043
COMPANIES AFFORDING COVERAGE
~~T~~~NY A
Lumbermans Mutual tv
~_ .ft" -,___ ~~'"~", /' ~ JI))~p-r"<
~ . ~J. L.t~ L.
('. ,/~ l j -l \J - r
rf-~( ./ q I i I C{.~ - f.)/, : ~
o~tt ;{-~ I~C
. , f.\J - l
,",'V{1t ,.,. ~ .
INSURED
~~T~~~NY B
Big Pine Athletic Assoc., Inc.
P. O. Box 89
Big Pine Key, Fl. 33043
f~T~~~NY C
COMPANY D
LETTER
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
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.
OWNER'S & CONTRACTOR'S PROTo
- ...
GENERAL AGGREGATE $
PRODUCTS.COMP/OP AGG. $
PERSONAL & ADV. INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MED. EXPENSE (Anyone person) $
4
AUTOMOBILE LlAIILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREO AUTOS
NON-OWNEO AUTOS
GARAGE LIABILITY
;:
~~;
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
A
WORKEFI'S COMPENSATION
AND
EMPLOYERS' LIABILITY
Binder #
091564493239003861
8/24/93
8/24/94
STATUTORY LIMITS
EACH ACCIDENT $ 1 0 0
DISEASE-POLICY LIMIT $ 5 00
DISEASE-EACH EMPLOYEE $ 1 00
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONS/VEHICLES/SPECIAL ITEMS
Athletic Association
CEftTIFICA TI HOLDER
ACOIIID .... (7/1e)
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.
AUTHORIZED REPRESENTATIVE j
'---I
Tim Hampson //
'~ ....
,r\
,;~~"_<"IIO
Monroe County, Risk Management
Attn: Donna Perez
5100 College Rd., Wing 2, Rm. 207
Key West, Florida 33040