Certificates of Insurance
THE BREWER COMPANY OF FLORIDA1 INC.
9800 N. W. 106 STREET - MIAMI, FLORIDA 33178
Phone: Area Code 305-
885-2463
LETTER OF TRANSMITTAL
TO:
Monroe County Public Works
500 Whitehead Street
DATE: December 18, 1990
Summerland Key Roads II
Key West, Florida
JOB:
Project # 04-009.01
33040
A TTN;
Mr. Danny Kolhage
GENTLEMEN:
WE ARE SENDING YOU
x
HEREWITH
UNDER SEPARATE COVER
COpy OF lETTER _CHANGE ORDER _SHOP DRAWINGS _PlANS
PRINTS _SPECIFICATIONS
OTHER:
WITH REFERENCE TO YOUR LETTER DATED:
COPIES
_SETS _SUMMARY OF MATERIALS
Please find enclosed a co of the Certificate of Insurance for Workers Com ensation.
The original Certificate was mailed out on November 8, 1990. The expiration date for
this policy is January 1, 1991, but the agent is in the process of changing over to
new forms and we should be receiving our new blanket Certificates before the end
of this month. Once we have these certificates, one will be mailed out for this
project covering the riod from Januar 1, 1991 throu h Januar 1, 1992.
THESE ARE TRANSMITTED as checked below-
FOR APPROVAL ~ FOR YOUR USE --1L-AS REQUESTED _ FOR REVIEW
FOR BIDS DUE
19_ _PRINTS RETURNED AFTER lOANS TO US
REMARKS:
COpy SENT TO: Mr. Charles Dent Pierce
Mr. H.A.V. Parker, III, P.E.
. ~
~},j ) ( .~:! )
SIGNEri:~:t21l/!t-) . rL/lp~LL1'
v
Debra A. Brown
TITLE: Contracts Secreta:r:y
DA TE;
December 18, 1990
ASSOCIATED GENERAL CONTRACTORS
SELF INSURERS FUND
P.O.BOX 10409, TALLAHASSEE, FLORIDA 32302
CERTIFICATE OF SELF INSURANCE
ISSUED TO:
t1clllroe C"llnty Public Work,s DeJ;~rttnerlt
500 ~Jllitf~hea.d Strget
K€y t~]e~t I 1:'lor.i.cla 33()4t)
This is to certify that .
'J "U~: x:~f~:E:WE:J~ C~C) + (Jr" Fl.. (JF~ I DA t 1 NC~. l'
(.;)E~():t. t..l ~ ~J ~ :1. Ol) ~31' f;~I:::f:::'r
t1.t AM I ~ Fl.. :3:3 :l'7{3
being subject to the provisions of the Florida Worker's Compensation Act, has secured the payment of
compensation by becoming a member of the Associated General Contractors Self Insurers Fund.
COVERAGE NUMBER: t:~....r1()""O:L ::~(y()
EFFECTIVE DATE:
j. / ():.I. /~:)()
Statutory - State of Florida
"lll) -, -' (:~ " $ ") ()(l (~ f)i) ')
EXPIRATION DATE: . .. .1./ T.. . .<... . , J t · , \.. Em.p,IQyers. .~ic!'Qi!ity
C () M 1-:1 J N I:~.r.l ~;) J rH:J I... F.:. L. .I. (.1.i. r
REMARKS Additipnal Insur~: Monroe County Public ~~ork.s Depar-trocnt
fr?ject Ne~: Rollavray Irnprc"rlernents of SllImrarla.lld !{e:f Roads II
i 04-009.01
Should any of the above described policies be cancelled before the expiration date thereof, the issuing
company will endeavor to mail 30 days written notice to the certificate holder named above, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company, its agents or
representatives. ~ _ . ~
DATE: Uov'~moor Of 1990 BY: ~S
Vice President CRIMS, Inc.
............
. . ........
~,......
P. O. Box 144022
Orlando, Florida 32814-4022
Combined Risk and Insurance Management Services
3300 University Blvd. · Suite 140 · Winter Park, Florida 32792 . 407/657-6005 . FAX 407/657-0068