Certificates of Insurance
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Attachment No. 1
~ERTIFICATE OF INSURANCE
(1) FIREMAN'S FUND INSURANCE COMPANY
THIS IS, '!'() CER~rIFY. THAT THE (2) CENTRAL NATIONAL INSURANCE COMPANY
Insurance Company
(1) 3434 PEACHTREE ROAD, N.E.
Address (2) C/O CRAVENS, DARGAN & COMPANY, 211 PERIMETER CENTER PKWY, STE. 550
of ATLANTA, GEORGIA
has issued policies of insurance, as described below and identified
by a policy nunber, to the insured named below; and to certify that
such policies are in full force and effect at this time. It is
agreed that none of these policies will be cancelled or changed so
as to a f fee t: the in t ere s t ( s ) 0 f the MONROE COUNTY
(hereinafter sometimes called the Owner) until forty-five (45) days
after written notice of such cancellation or change has been
delivered to the Owner's Engineer;
Insurecl TI-E BREWER COMPANY OF FLORIDA, INC.
9800 N.W. 106TH STREET, MIAMI, FLORIDA 33178
Address
Status of Insured ~Corporation ___Partnership
Individual
Location of Operations Insured
STATE OF FLORIDA
Description of Work
PAVING AND DRAINAGE IMPROVEMENTS
SECOND AVENUE, STOCK ISLAND, FLORIDA; PROJECT H106-800-4-01
INSURANCE POLICIES IN FORCE
Forms of Coveraqe
*Worker's Compensation/Employers'
Liability
Policy. Number
Expiration Date
( 1 ) +Comprehensive Automobile Liabi 1 i ty. LA2897779 6-1-81
( 1 ) Comprehensive General Liability LA2897779 6-1-81
( 1 ) Contractural Liability LA2897779 6-1-81
(2) +Excess Liabj:,,,li ty CNU036382 6-1-81
Other (Please specify type)
POLICY INCLUDES COVERAGE FOR:
1. *Liability under the United States Lonshoremen's and
Harbor Workers' Compensation Act.
2. +All owned, hired, or nonowned automotive equipment
used in connection with work done for the Owner.
YES
~JO
x
Attachment No. 1
Page 1 of 2
POLICY INCLUDES~COVERAGE POR: - (continued)
3. Damage caused by explosion, E~~~~X~~X~~~~
OR ~i~xx~ damage to underground utilities.
4. Products/Completed Operations
5. Owners and Contractors Protective Liability
6. Liability assumed in the Contract
7. Personal Injury Liability
8. Excess Liability applies excess of:
(a) Employers' Liability
(b) Comprehensive General Liability
(c) Comprehensive Automobile Liability
(d) Contractural Liability
...,;;;,""'....~.;...;;li"'
YES NO
X
X
X
X
X
X
X-
X-
X-
FORM O]~ COVERAGE
BODILY INJURY
LIMITS OF LIABILITY
PROPERTY D~.J.l\L~GE
Worker's Compensation
Statutory
xxxxxxxxxxxxxxx
Each Accident XXXXXXXXXXXXXXX
Each occurence -
Combined Sinqle Limit BI/PD
Each occurence -
Combined Sinqle Limit BI/PD
$ 500 , 000 . AGGREGATE
Each Occurence -
Combined Sinqle Limit BI/PD
Emplovers' Liability $
Comprehensive
AutomobhLe Liability $
Comprehensive
GeJJE~ra.l Liabi 1 i tv
~ctural
Liabilitv
500,000.
$ 500,000.
Excess Liability
Other (please
specify tvpe)
$ 2 , 000 , 000 .
The Insurance Company hereby agrees to deliver, within ten (10) days,
two (2) copies of the above policies to the Ownerls Engineer when so
requested.
,
NOTE: Entries on this certificate are limited to the Authorized
Agent or Insurance Company Representative.
Date
4/8/81
(S EAL)
Issued at
ATLANTA, GEORGIA
Send Oriqinal to:
Superintendent - Monroe County
Road and Bridge Department
Wing II-B
Public Service Building
stock Island
Key West, Florida 33040
Attachment No. 1
Page 2 of 2
~/
r sentative
RISK MANAGEMENT SERVICES, INC.
P. O. BOX 20654
ORLANDO, FLORIDA 32814
TELEPHONE: 894-2031
CERTIFICA TE,OF INSURANCE
ISSUED TO:
lSuperintendent - Monroe County ~
Road & Bridge Dept., Wing II-B
Public Service Bldg.
~tock Island, Key West, Florida 3304~
This is to certify that THE BREWER COMPANY OF FLORIDA~ INC.
9800 N. W. 106th Street
M; am;.. Fl or; da 33166 , being subject to the provisions
of the Florida Workmen's Compensation Act, has secured the payment of compensation by
insuring their risk with the
FLORIDA TRANSPORTATION BUILDERS ASSOCIATION SELF-INSURER'S FUND
EFFECTIVE DATE:
8-90-001
2/1/81
2/1/82
Statutory - State of Florida
COVERAGE NUMBER:
EXPIRATION DATE:
$100,000 Employers Liability
REMARKS:
This certificate is not a policy and of itself does not afford any insurance. Nothing con-
tained in this certificate shall be construed as extending coverage not afforded by the
policy (ies) shown above or as affording insurance to any insured not named above.
DATE: 4-14-81
BY: Zd. If. ~.
W. R. Dorminy, President
Risk Management Services, Inc.