10/25/1991
CONTRACT
THI S AGREEMENT, made
October, 1991, between
LANTIC BUILDERS:
and
Monroe
entered into this :l.S..,..A day of
County, Florida (OWner), and AT-
WIT N E SSE s:
That the parties hereto, for the consideration hereinafter
set forth, mutually agree as follows:
I.
;SCOPE OF THE WORK
The C~:>ntractor shall furnish all labor and equipment to resur-
face, approximately seventy four (74) squares of built up roofing
at the Courthouse Annex Building, 500 Whitehead Street, Key West,
Florida. Repair/replace flashing as required and slope roof to
existing drains. Work will be in accordance with the request for
proposal and the contractor proposal dated October 9, 1991, all
attached hereto and incorporated as part of this contract docu-
ment.
I I . INDEPENDENT CONTRACTOR
At all times and for all purposes under this agreement the
Contractol~ is an independent contractor and not an employee of
the Board of County Conunissioners for Monroe County. No state-
ment contained in this agreement shall be construed so as to find
the contractor or any of his/her employees, contractors, ser-
vants, or agents to be employees of the Board of County Commis-
sioners fc)r Monroe County.
III · ~LSSURANCE AGAINST DISCRIMI'NATION
The Contractor shall not discriminate against any person on
the basis of race, creed, color, national origin, sex, age, 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 or with the provision
of services or goods under this agreement.
IV. ASSIGNMENT
The Contractor shall not assign this agreement, except in
writing and with the prior written approval of the Board of Coun-
ty conunissioners for Monroe County and Contractor, which approval
shall be subject to SUch conditions and provisions as the Board
and contractor may.deem necessary. This agreement shall be incor-
porated bY'1it4~~g~~W any assignment and any assignee shall
comply wi"t:J(1. } a~~ ~~~) ..the provisions of this agreement. Unless
expressly prdvided fo"'tf\f1herein, such approval shall in no manner
or event be deemed to impose any obligation upon the Board in
addition t4~~~~ ~~ abteed-upon price of the services/goods for
the contrC1ctor.
I~JdOJjd dU j tJ31L:J
V.
COMPLIANCE WITH LAW
In providing all services/goods pursuant to this agreement,
the contractor 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 and regulations
shall constitute a material breach of this agreement and shall
enti tIe 'the Board to terminate this contract immediately upon
delivery of written notice of termination to the contractor.
VI . INSURANCE
Upon JB:xecution of this agreement, the Contractor shall fur-
nish the OWner Certificates of Insurance indicating the following
minimum cc:>verage limita,tions:
(~ommercial General Liability including completed opera-
itions and contractual liability, with minimum limits of
$500,000.00 per occurrence.
(:omprehensive Auto Liability with m~n1mum combined sin-
gle limits of $300,000.00 per occurrence.
~~orker's Compensation - as required by Florida Statutes.
Monroe COl.mty is to be named additional insured on both the Gener-
al Liability and Auto Liability Policies. The minimwn coverage
lirnitatioIls must be maintained throughout the contract term.
VII. FIOLD HARMLESS
The Contractor shall defend, indemnify and hold the County,
its offic:ials, employees and agents harmless, from any and all
claims, liabilities, losses and causes of action which may arise
out of the~ performance of the Contract except such claims, liabil-
i ties, lc)sses and causes of action which may arise because of the
County's I'Jlegligent actions or omissions. Compliance wi th the
insurance requirements shall not relieve the Contractor from the
obligations imposed by this article.
VIII.
FtROFESSIONAL RESPONSIBILITY
The Co,ntractor warrants that it is authorized by law to en-
gage in the performance of the activities encompassed by the
project herein described, subject to the terms and conditions set
forth in Florida Statute Chapter 399, which is attached hereto
and incorporated herein as a part of this contract/agreement.
The provider shall at all times exercise independent, profession-
al jUdgement and shall assume professional responsibility for the
services to be provided. Continued funding by the Board is con-
tingent up,on retention of appropriate local, state, and/or feder-
al certifi1cation and/or licensure of contractor.
2
IX. NOTICE REQUIREMENT
Any notice required or permitted under this agreement shall
be in writing and hand delivered or mailed, postage prepaid, to
the other party by certified mail, returned receipt requested, to
the follo'wing:
FOR C10UNTY
Monroe Co'unty Public Works
P. O. Box 1029
Key West, FL 33041
ATTN: Mi:k.e Lawn
FOR CONTRACTOR
ATLANTIC BUILDERS
P. O. Box 4464
Key West, Fl. 33040
X. PAYMENT
The County shall pay to the Contractor in full, upon final
acceptanc4~ by the owner, Twenty Eight Thousand Dollars
($28,000.00).
In witness whereof, the parties hereto have executed this agree-
ment the clay and year first above written,
COUNTY OF MONROE, STATE OF
FLORIDA
By ~~;:~;~~ ~ ~
Attest: DJrnNY L. KOLHAGE, Clerk
ATLANTIC BUILDERS
By ~,/~~
Pres1- err
Attest:
,,~
WITNESS
By
3
OK~~~~: ~R~~~2E
(305) 294-4641 ·
BOARD OF COUNTY COMMISSIONERS
Mayor Pro Tern Wilhelmina Harvey. District 1
Gene Lytton. District 2 ".
Douglas Jones. District 3
Mike Puto. District 4
MAYOR John Stormont. District 5
~QUEST FOR PROPOSAL
TO: ATLANTIC BUILDERS.
Please quote the best prices you offer on
P.O~Box 4.~64
the items listed below. Note Delivery Re-
Kev West, Fl. 33040
quirements, and state firm Delivery Date.
(305) 294.-2726
DATE REPLY DUE BY I DELIVERY REQUIRED BY~ M.C. SALES TAX EXEMPT #
-- 03-00021-03-54
- QTY UN I ~r DESCRIPTION . UNIT PRICE AMOUNT
1 74 sase JPS Elastomeric membrane $ 28,000.00
Re-surface existing roof
,
SPECIAL NOTES: ~-1 0, 1 ~ II insulation board un/perlayment over exi st ing roof
I \
surface, single-ply ~embrane to surface.
VENDOR: PLEASE (:OMPLETE TIllS INFORMATION
1. Delivery Promised: ASAP
We offer to sell yoti the above items
2. F.D.B. Point:
nt the prices indicated:
Vendor Name: Atlantic Builders
ByRobert W. Svetlik,contractor
(Title)
Lic. # RC0056192
3. Terms: PaYmE~nt on completion.
4. Date of Proposal: October 9,1991
5. Date quoted prices will expire:
January 1 () 19 91
ADDRESS REPLY TO:
Monroe County Purchasing
5100 Jr. College Road, West
Key West, Florida 33040
PHONE (305)292-4464 or 292-4465
FAX (305)292-4401
'rnpll!iul
Page No.
of
Page~
ATLANTIC BUILDERS
. General & Roofing Contractor
Llc. #CG C037715 RC0056192
P.O. Box 4464
KEY WEST, FLORIDA 33040
(305) 294.2726
. . .
PROPOSAL SUBMITTED oTO
Monroe County
STREET 0
Office of Director of Purchasing
CITY, STATE AND ZIP CODE
Key West, Fl. 33040
ARCHITECT
PHONE
292-4431
DATE
October 9, 1991
JOB NAME
Courthouse Annex ROOf-Key West
'JOB LOCA nON
500 Whitehead Street~ Key West.
n/a/
DATE OF PLANS
JOB PHONE
We hereby submit specificatioJns and e.stimates for:.
approximately 74 squares membrane roof.
1. Remove all standing water on roof.
W'2H~wi~'~t'~iiwi~';';"r'igidwb'oar(iH""i'n'suia'tIon;"mechaiiIcaiiy'fasteriedfo"r'oofw'Cfeck~'ww,
Wj~'Hi~~t~iiwwJi;sWH;;Hi:'Tuii';;'H'me'mbi:an'eH'srngieH.wpiy"wmaterliiY"me'charilciiIIy"'fa'sfe'nedw,
..w.wwt.Qw.rQQ.f.....,.g.e..~K.~..wM.9Ht..~.,J;.~..9.!..w..t...Qw....l.?.~...w~.hJ.~.~.W..:r.:H~H~.:!H~..c;.~!.y.~..H..!..~.......~.c::>.!.c::>.:r:...~.H..W.H.W.WW..HHHW.H.W.....H.W.WW.H..
.........4.J.........C.Q.'U.n.t.e..r.:::.f..l..9:..:;?h.......~..l..l.......P.?l.~. ~ pet e d g e san d pen e t rat ion sin roo f sur f ace wit h
sam e mat e r i 4:11 . . .. . ..... ................................ ......................................... .......................................................................................................................................................................................................
..............................................................................................................................>.............
5. Sea 1 and c a 11 1 k a 11 seamS'an'd"edg'es'ii's"'per'miinuf'iiCfii:r'er'is"s"i>ecsP~"P'
...............T.E.N.......Y.E.AR......UNt~.I.l~ff.T.Etj......MA.TEl~.I.AL......WARRAN.T.Y..~..........................................................................
TWO YEAR UNLIMITED LABOR WARRANTY.
........................................,........................................................................
..... ...... .....15. r"f ..c.e.......l.iic.i..ii"cfe.~i.......r.6.6..f.. i.Iig......p. e'rmI"t"~"""'"'''''''''''''''''''''''''''''''' .... ...................... ........................................ .................................... ........... .................. ...
.............................................................................................
Dr 'rnpnsr hereby to furnjsh material and labor - complete in accordance with above specifications. for the sum of:
TWENTY EIGHT THOUSAND DOLLARS
Payment to be made as follows.:
Pa ment on co m letion.
dollars ($ 28, 000 . 00
).
All material is guaranteed to be as, specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above $pecifica.
tions involving extra costs will be l!xecuted only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and 9ther necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance.
Authorized
Signature
Note: This proposal may be
withdrawn by us if not accepted within
days.
PRODUCT 118.3 !NE:8s.4lnc.. Gtoton. M4~ OWL To Order PHONETOU fREE 1 + 800.225.6380
Atttptatttt nf 'rnpnsal- The above prices. specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
~
MONROE COUNTY PUBLI C WORKS
BOARD OF COUNTY COMMISSIONERS
MONROE COUNTY, FLORIDA
REQUEST FOR PROPOSAL
September 6, 1991
PROJECT:
Roofing repairs to Courthouse Annex Build-
ing, 500 Whitehead Street, Key West FL.
SCOPE:
Resurface approximately 74 squares of built
up roofing, repair/replace flashing as
required. Slope roof to existing drains.
Provide ten year guarantee for all work. Must
be able to withstand wind strength to 115 mph.
DOCUMENTS:
All work specified herein shall be performed
in accordance with the Standard Building Code,
the National Electric Code, and all State,
County, and Local Ordinances.
EXECUTION:
Proposals to be considered shall be submitted
to Monroe County PurChasing Department, Wing
II, Public Service Building, Stock Island, no
later than 10:00 AM on 10 October, 1991. Work
shall be completed within sixty (60) days of
proposal acceptance and issuance of Notice to
Proceed.
PERMITS ANJD
LICENSES:
Prior to the commencement of the work, the
Contractor shall obtain all required permits.
The Contractor shall furnish copies of all
current licenses as a part of this proposal.
INSURANCE:
Contractor shall furnish all insurances as
required by Monroe County Code, Monroe County
Public Works Manual, and all State and Federal
Statutes.
The Contractor shall furnish the Owner with
Certificates of Insurance indicating current
coverage in the minimum amounts herein stated.
Minimum limitations of required insurances
are:
Commercial General Liability/
Combined Single Limit
Commercial Auto/
Combined Single Limit
Workman's Compensation
$500,000.00
$300,000.00
As required by law
PUBLIC
ENTITY
CRIMES:
NON - CaLL U~; I ON
AFFIDAVIT
INDEMNIFIC~ATION
AND HOLD
HARMLESS
CONDITIONS:
(
The Contractor shall furnish the attached
statement, fully complete and notarized, as
required by law, as a part of his propos-
al.
Any person SUbmitting a bid or proposal in
response to this invitation must execute the
enclosed NON-COLLUSION AFFIDAVIT. If it is
discovered that collusion exists among. the
bidders, the bid or proposals of all partici-
pants in such collusion will be rejected, and
no participants in such collusion will be
considered in future proposals for the same
work.
The Contractor shall defend, indemnify, and
hold harmless the County, its officials,
employees and agents, from any and all
claims, liabilities, losses and causes of
action which may arise out of the performance
of the Contract except such claims, liabili-
ties, losses and causes of action which may
arise because of the County's negligent ac-
tions or omissions. Compliance with the insur-
ance requirements shall not relieve the Con-
tractor from the obligations imposed by this
article.
Contractors will provide details of proposed
methods and materials to be used in this re-
pair. All work will be scheduled and per-
formed so as not to adversely affect the opera-
tions of the Courts or the Jail, and will in
no way diminish the security of the prison-
ers. References of work performed in a simi-
lar manner will be provided to this Department
upon request. Inspection of the job site may
be made through arrangements with the Facili-
ties Maintenance Department, Public Works
Division, 5100 Junior College Road, Key West,
(305) 292-4431, during normal working hours.
Unscheduled visits will not be permitted.
Work will include the main roof area, the
roofs of the two elevator penthouses, and the
roof over the loggia.
All inquiries will be directed to the Opera-
tions Superintendent, Walter Stachowicz, at
(305) 292-4530.
WI
,
1
,
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(0),
FLORIDA STATUTES. ON PUBUC ENTI1Y CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR
OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This swomstatementis submitted to County of Monroe, Florida
[print name of the public entity]
~ Robert W. Svetlik. owner president of corporation.
[print individual's name and title]
for :[arth Star Enterpri ses. Tnr... / dhri ArrT,ANrrT~ RTTTT,DRRS
[print name of entity submitting sworn statement]
whose business address is *@cP Ter ry Lane, P .0 . Box 4464, Key Wes t, Fl.
and (if applicable) its Federal Employer Identification Number (FEIN) is. 65-0013414
statemlent:
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
369-44-6814
.)
2. I understand that a .public entity crime- as defined in Paragraph 287.133(1)(g), Florida Statutes.
means a violation of ~any state or federal law by a person with respect to and directly related to
the transaction of business with any public entity or with an agen"}' or political subdivision of any
other state or of the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any other state
or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
3. I understand that "convicted- or "conviction" as defined in Paragraph 287.133(l)(b), Florida Statutes.
means a finding of guilt or a conviction of a public 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 after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty
or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph 287.133(1)(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, executives, partners, shareholders, employees, members, and agents who are active in the
manag(~ment of an affiliate. The ownership by one person of shares constituting a controlling
interes:t in another person, or a pooling of equipment or income among persons when not for fair
market value under an arm's length agreement, shall be a prima facie case that one person controls
another person. A person who knowingly enters into a joint venture with a person who has been
convicted of a public entity crime in Florida during the preceding 36 months shall be con.,idered
an alfiUa tee
5. I unde.rstand that a .person. as defined in Paragraph 287.133(1)(e), Florida Statutes. means any
~ . natural person or entity organized under the laws of any state or of the United States with the legal .
power to enter into a binding contract and which bids or applies to bid on contracts for the provision
of goods or services let by a public 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, and agents who are active in ~n.agemen~Of an'>ent,~~
:JC .ii;:-... ..t.., ,;
6. Basc:d on information and belief, the statement which I have marked below is true in relation to
the entity submitting this sworn statement. [Indicate whlcb statement appUes.]
. .
~_ 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 affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, 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 management of the
entity, or an affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, 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 management of the
entity, or an affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing
. Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by
the Hearing Officer determined that it was not in the public interest to place the entity submitting
this sworn statement on the convicted vendor list. [attach a copy or the final order]
I UNDERST.t\ND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACl1NG OFFICER FOR
THE PUBUC ENTIlY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBUC ENTITY
ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN
WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBUC
ENTIlY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT
PROVIDED IN SECl10N 287.017, FLORIDA STATUTES FOR CATEGORY lWO OF ANY CHANGE IN
THE INFORMATION CONTAINED IN THIS FORM.
~ (?~
\. ~~<:P~ :n' .
~ [signature]
STATE OF
COUNTY O:F
Florida
Monroe
August 15, 1991
[date]
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
a..f)b~,d '^~ S'" e +1 i K who, after first being sworn by me, affixed his/her signature
[nome of individual signing]
in the space provided above on this
, '5 f'1"\- day of ~ 19 q J .
.~~~
NOTARY PUBLIC
My commission expires:
_TMY PUlLIC STATE 8F FLORIDA
NY C_SSIO. EX'. OCT. 16, 1"3
-- 'fit" ..1Al INS. UNO.
Form PUR 7068 (Rev. 04/10/91)
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY I FLORIDA
ETHICS CL}\USE
--Rob.ert___H-.__SVRtlik._________________.___________._______.__warrants that he/i t has not employed,
retained or otherwise had act'on his/its behalf any former County officer
or employee in voliation 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 County 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 form ~~e~
(signatllre)
Date: August 15, 1991
STATE OF
Florida
COUNTY OF Monroe
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
---Q.n.,~r:J:_1A1_~tf--~J<___ ....._
who, after first being sworn by me,
affixed his/her signature (name of individllal signing) in the space
provided above on this ____\.<Q.~____day of
4'^'b L-V:~-_., 19~_ ·
NOTARY PUBLIC
My commission expires:
_TMY ,,,,Ie STAT[ OF FLORIDA
IIY ClllUSSlOll EX'. OCT. 11. '"3
-. TMIU .IIEMl INS. _.
MCPi4 REV. 6/91
NON-COLLUSION AFFIDAVIT
I Robert W. Svetlik
I
, of the city
of Ke}r West, Fl.
according to law on my oath, and
under penalty of perjury, depose and say that;
1) I am the owner of ATLANTIC BUILDERS, , the bidder
making the Proposal for the project described as follows:
Re-Roofing Courthouse Annex Building, 500 Whitehe~d Street,
Key West, Fl. Material to b~ used is JPS Elatome~lCs Corp.
"Hi-Tuff" white membrane, which carries a full fIfteen year
warran2~-. the prices in this bid have been arrived at independently
without: collusion, consultation, communication or agreement for the
purpose of restricting competition, as to any matter relating to such
prices with any other bidder or with any competitor;
3) unless otherwise required by law, the prices which have been
quoted in this bid have not been knowingly disclosed by the bidder
and will not knowingly be disclosed by the bidder prior to bid
opening, directly or indirectly, to any other bidder or to any
competi,tor; and
4) no attempt has been made or will be made by the bidder to
induce .~ny other person, partnership or corporation to submit, or not
to submit, a bid for the purpose of restricting competition;
5) the statements contained in this affidavit are true and
correct, and made-with full knowledge that Monroe County relies upon
the truth of the statements contained in this affidavit in awarding
contracts for said project.
COUNTY OF
Monroe
~:t>k~
(Signature 0 -Bi er)
!~ /6/, J?C//_
,: DATE.I' .
STATE OF
Florida
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Robert W. Svetlik
(name of individual signing)
who, after first being sworn by me,
affixed his/her signature in the space provided above on this
~M- day of ~rf-'
My commis:sioll expires:
FORM MCP#l REV. 1/91
..TAlty "'IC STATE OF FLOIJDA
MY COMISSIOff EX'. OCT. 1'. 1.3
_D THlU IENERAL IllS. WID.
STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY.LICENSING BOARD
. . .
DATE
'[Ij:t~~:I~[1
:f..:lltil:INI
07/20/91< RI :~. 0050962 00091f ".
THE RE6:ISTERED R'ESIDiN'TI'AJi,:) CONTRA,CTOR;
NAMED BELOW HA S ; REGISTER!'D .' .
UNDER THE: PROVISION.S OF CHAPTER 489 ... F.S., FOR THE YEAR
EXPIRING AU6 31, .1993 (MUST MEET AL:t L:'OCAl LICENSING _
:REQUIREMENTS PRIOR.'xTO CONTRACTING IN ANY.ARE.A)
SVETLIK,.. ROBER'T<.V (t)
INDIVIDUAL:
826 TERRY' CANE
POBOX .4464~.
KEY WEST fLt 33040
4rd4
LAWTON CHILES
GOVERNOR
DISPLAY IN A CONSPICUOUS PLACE
1--'---.-'
STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD.
DATE
.[tiI:t~I-~:I~['
:'.'ltil:INI
II-
07/20/91 RC!0656192 0009t
THE REGISTERED ROOFING CONTRACTOR
NAMED BE:LOW HAS REGIST'E:REO
UNDER T~-IE PROVISIONS OF CHAPTER 489. F.S., FOR THE YEAR
EXPIRING AU6 31, 1993 ("UST "EEl. ALt:l;,iLOCAL1LICENSIN6
REQUIREMENTS PRIOR1TO.CONTRACTING IN AMY AREA)
--
SVETLIK, ROBERr'W~
ATLANTIC 8UI....}j)ERS CO
826 T E RRY"LJA,MEi}
P 0 BOX4464~ ..
KEY,WEST~ FL!. 33040
40U
LAWTON CHILES
GOVERNOFC
DISPLAY IN A CONSPICUOUS PLACE
.' ' 11.;nk('.,~SI",~~(""" . In~~r~~~~"COmp8ny
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'tJWn e" C;lfv
POLICY EFFECTIVe.
DAlE AND
TIME
TrnM
· It MONTHS
I o1Cw:J013O (300 minimum)
, ~122J2~2 (300 minimum)
F.l Vf MONTHS
I' 40130I3O (300 rrllMnUft',
~' 2 ~612& (300 mfnlmuI1IJ
P8y.~ down CSOO min,mw",
. 1 0 Ply.2O% down (..000 m,'ur, litn 'i
t'AVMLNl
OP1 tONS
, :. . '-:.
V N
Y N
V N
... --....---.................
\ ' .. ,\'l.: .
- ----.....
., .~. ~.'l r ~
- - . ..---.-.- ; .. '1(/. . ~ _':-A .-. --
OfN r OeVELOPMENT - Ixp','n !!! lcord.n.., I~Udln;ftOt*,iUlt IOCldent..
r 1/ II. .. 00IIl/ Uf
.. ~, ~~r~~~ .~~'!'!. :~..
'n..t , .
CII,L~\...~ ~.''\I ,.,,117
. , '.',
~. '.ft;: ," :
.~
. ,..~
, ~.j
'. ~&'
I VES-
NO
VES
NO
... ...--.. ,.-... - --........ ........ ...... .
YES
I NO
l VII
L. NO
f. VII
t. NO
50 CSiL
100 CSl
10/20 rJ 1001300 L1100 CSl
25/50 ( , j 250/500 Q ~ CSL
501100 :.: 50 CSL Ll 500 CSl
6" 'Non..Steck~d.JJM '$ 8elec~ed. E'k~~~!"
of Non-Stacked Coverage (Page 6)
~...! be legned 8nd checked.
1000
2000
5000
i.J 10.000
.' . ,:,1 "llJ~.' ("JI"$I;:':~I .lIld '. 'Il
':,' .'I",~'IC!:"{' I .....,~~
~'P with Worksrs' Compensation
=":.IC:"~I~~T~ .M drlVerl 'rl~ comOll :=~=
, 1 PIP wllhout Worker,' Compensation
(ChooM thfs option when .,1 <<'tWet. a,. not Cov.'.d under a
...... Work.". Compo poI~.t
~~:~f~~1 ,
i 00l3oo/50
: '5(l/~OO/1 00
\ """",,!\ ,..,... I
... ..UV ,,~'-
500 CSl
{~'..~Ue:~~ OnJy
wUh FlIP)
"J T
ON.H K
TOWING
."'\~'
(Por Occurrenco)
10.000
?5.000
~(l. 000
~ liable on'y on BOdy
''''5 88, 89. 90 and 91.
, ~,:;,<w,;,;""."""""'~' "'~';'("'~"'~_j'. .;,.
, . . .1. ~. ~.' "1",. "7. .... , .; . ~t\'~,~ " ' . ,
' .. .. >,'" ~':. . "'/-'."""'~l .
."'\~\~;"~~~. .1 ~ · '..: ...~ .~:.r.~..1~~~...
}1t4/.'~:~:,1~,'J~~~~~4~~',:~{~~,_: ;r..
. I .
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":~'f'''' 'f':~. . \-. J '
t "
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It ""~
~ ,~ ,"
., 1-'.,
. 1
i
j
COMP'ItNlil ""OftDING -xwIflAGIEI
'J:'h. ~ro1.\n5on8 I'f\.~ltU:.8l1ee A"ancy
r. 0., Hox 2346
l~;lrf;.~:hon Shores ~ !{[.' 3305~-'2-3/.6
c; 0""""''' v A
u rr{l~
t:'JMPJlMV B
~~"': :;
t'OM~"r..v C
..UH =t
l:rjW~~rn 0
AcceptnUCQ Insur~nce CompAny
~AIlII( Allt) ,l.c.uMIS GI IN~~P.[D-.'
E,~rt:h Sts-r l!nt.f.\rrrt"1ses J Inc..
dbaAtlantic .8uildc~:ts
'P. ()~. "Box l~!~ 61~
Key l~eat:1' :uL ':;3041
T~ PI: or IN1U"AN1~(
PeJUf.;Y Nt,JPa1ftt((
~)llC~;" .
[X~IRA'fI(~ ., I\T t
GIN,tiiA'L1 f A Sf LIT'"
o CO~!~lIt"E ~!tt~ rOHM
(iJ ~P~""~ n -cpr,.,.. T 'o~~ t
8.,(:\(1"0$1.1'" "NO COL~Ag,~
H"IZAPO
\lNQ~RGROIJ~O tIAlAR:>
~~Kit{J~J'~UEO
LXJ~o;.'~f~~"k$ ~~I~~t1
o (;('~fr~.I(Tu'~\ H~S~~.\'~f
D.I!I~j~' ;o~ '~Ir(N"';
D~:"(.I0 t
8 l~orP(fiottif eON1 RAe ro~,,;
"'€~iOk"~ (l'fJvllitv
t'tc't(~Ir. y .t..Juq-v
PR(l~t~h 04'~A.'4~
otA'.154'6JS,
4/2t.I9~
BC'Oll v (~.R:~ } ~C>
FROF[FUV I)~M,iC.1 '500
~eMe ~(O
1,500
~E R'!.("'1,t\l. iI'lJUC/'(
10" 0' OPlItt"T~CXA.riQNs......t..UCL[3
Effe.ct1...,~' Da te: 4/22/91
(~~~Zd~~i~J
~P(FTl O^"'~I
rK.D)~.'" .,.. Jv..... j,.c r
r~cr cPT ( Ci_~.i"~( ~,
c=v~ ~to. I
AUTO'MOttl' ~1.e'LtTY
8 cc~:~W'(.,("t~.vt tOFlM
OJ'tNro
H~:O
o N~ ow,..<<o
~.. i)ll" It" Jt.,""
:1 ~~ l ("~fj.L
IX4~-'$$ l1~8IltiY-"
'0 Uuti::;hLA rtm~
CJ OT"I[A nlAN ~"'..C~~),
rOt:iM
WORKERS. COMPE~SATtON
..,~
IMPI.OYEJt"ltAllltTY
OTHIA
a,;.c,~ ~ "t..'Jlh .c.Nn
PRc);tER.,.t, ~~"'''~J~
<:OM8IhEO
C~)Ut~TY OJ? MONROE:I f4'I. IS .o.N .ADj)lTION.A.L I~t~un.t~n. .
C.nc.U.tI4~": Sh6utd any 01 the abo". de'~tb~d POik:j~5 be cancelled be~cre the e)Cp;ratio~) (J~H" ther'~()f. thf! iSlulns tOm..
~:Jny w!)1 end9tJ'/or to m~il ......Q..... da,,~ Yi'ftten r~oUce to th~ belQw r,am@d etrtifitete hotder, but fa HUll to
rnail Sf,J(h not~~~ sha~\ irnpo$e nQ obt~ ~at; ~" (;I r I\~hh,ty of any kind UDt" th(t (onlpilny.
N^MI ANP "'c.t~C1i (' ': ~ 'i'f " K:'~,l( ....r,t.f,lJ>-;;...
Nonroa County M~intenan~~
J.ttni \ialt Sto.chowit~
.Junior Co1.1eg~ Road
Key W(~tlt J FL I '~30!rO
g~ I~~
.. ~...- ........ - ......--~
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1i
cC1E1
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T 6.......13C)....... T T
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ftCOUCU
,.
.t,;;~;~~~"mC~~9E:::.!~(_~:::':::' . gel.D~: ~M~
TBJS CERMCATE IS tSSUED AS" MAnta OF INFORMATION ONLY A.'4\
CONrIU NO RIGHTS UPON TIlE Cn11FlCATE BOLOD. THIS C Eltn PICA TE
DOli NOT AMEND. IXTEND 01 AL TEA mE COVERAGE AFFORDUD IY TH[
THE JOHNSONS INS AGCY
PO BOX 234&
MARATHON S.HORESFL 33052
COMPANIES .\FFORDING COVERAGE
~,.,,"I .,.....,.................".,.,._...... '.......f..".Ill.,..,............ ,..,.. .,.... .......1.;" .. .~........... .11................... ..1...........
~A
.,....
.' ................= flVaNfr B
:. .,..............,.".,..............,.'..,... ....,......... .... .... . ........ .. . .... . . '.- .......'.... ',j
ATLANTIC BIUILDERS
P.o. 80X 4464
KEY WEST FL 33041
:COMPAlfYC
. ,.,.
: c;oNJtANY D
:....~.......,.........~~y:~~~~.~. ...~.~.~...~9... ........ .."".... . ........ , ,. .... .....".. .... .. ..
;~YE
.~g~l"}~;.:; :!~:i~\;:~/;~ ;:'::: .;::; >". . '.::.: .';):: ::. <:' ;;':~"~' '; .;.:;' /: ~\'.~~:\::: .: '; .): :~:~:~::. ,+,;; ::~\ \:::: ;::'):':'.\'.':; :;r.:U}<J?~\.fo.~.,}(j:;:: -=f~\:~/'> \: :.~~..:; ::~,i:,,:~ ":'<';: " :.':~:~.~.::.:.':; .': : ': :~ ~:}.'/;;. :i:\: ~:~;<~\'. : .~ ;. ....
TRD IS ro CIImt'Y 1HAT 'J'KB POucms 0' INSUJWlCS lJSTBD BILOVI HAVB mer ISSl1ED TO THllNStJRBD HAMED ABO\-& FOR 1M' fOU~\' PJ\k,(IP
D!l)JCAE), .)f~1TH'TANDINO -AHY .RP.QUlRmGHT..1BRW.QR CONDmON OP ~'fY -OONTRACT OJt ~ntER-DOC't~ "'mI IUlSPSCT TO \\'CCH TE::!!
CBITIJIICATI MAY BB ISS\''lJ) 01 ).fAy PERTAIN. THE INSUJANCE AfPJIU>;m) IY THE POUCtBS DbCP.18~ HBRl'lN IS ItJ81Bt7 TO AU. n~E ~f/~.
IXCWSlOHI AND CONDmOHS 0' SUCK PO.LlClES. UMrTS SHOWN MAY HAVS BDN UDVCP'J> BY PAID CtA.tMS.
00 :
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nftO'I~
POLICY HUN'"
. poucy arncrrn ; POLIC'r &U1unOff
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, . COMMII~.fo.l OIHDAL IJAlIUTY
ff2I~Jf.'.".'.'.'." j CLAM MAnI 00C\1I. .
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AOOUOATI ,
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2{09{91 -42-/09 /92 X~...~:~;~~~~~-.~..'.,~.,......_~
EAC't(ACClODtr ' 1100 I qo C
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ann
IDCI&IIT1OfI 0' OPUATJO~TJONNaKICLUIIPaaAL IT....
CONTRACTOR I ROOFING
~~;1?l~~T~:p().~~~
~
~c.~~ r~~~:<< ..... '.',,' ~ ~. ..
:.,:., SHOULD AMY OF THB ABOVE DBSCJU1lBD R1UCI&t WI CANCEJ..Z..l!I> '.U':Jll! nt:s 1
;~:F I5XPflATION DAiI 11I1i.1lIOP. THE ISSUINO COWPMY V.1I.J. E~l[;ftI-.":-:~~ ~'I) I
~~,~;; MAJI...A9- DAYS W1aTTEH HonCE TO 'tkJ! CElnf1CA11I H\)lJ)!3t StU.~~ T{.~ ';!f!=. ~
<; LaPr. WT PAlWJtS TO WAlL SUCH NOnCB :'HALL IMPOS! ~O OBUaA'~~:'", ,if '
~j:::, UABlllrY OF M~ KIND U N 1HE l."OA!P~Y. ITS AOENTS OJ: l~p)lli3r::T.~ 1 '.'~;; l
....
CITY OF KEY 'WE~
P.O. BOX 140i
KBY WEST
FL 33041
AVf'IIOUZID .....IM" A nn
LINDA HOLMES
- ! t" n!! !'~ ~ ~.. ~ _''''-~~
.~------~-~'C!!~~')~ ~"^r~c ~'.?~.~.~ '\'~,..
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