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03/28/1990 AgreenentCONTRACT THIS AGREEMENT, made and entered into this 28th day of March, 1990, A.D., by and between Monroe County, Florida, party of the first part (hereinafter sometimes called the "Owner"), and D-N-G, Incorporated, party of the second part (hereinafter sometimes called the "Contractor"). WITNESSETH: That the parties hereto, for the consideration hereinafter set forth, mutually agree as follows: 1.01 SCOPE OF THE WORK The Contractor shall furnish all permits and permit fees; labor, materials, equipment, machinery, tools, apparatus, transportation and dump fees; and perform all of the work described in the Request for Proposal dated February 15, 1990 and entitled: EXTERIOR PUBLIC RESTROOM REHABILITATION MONROE COUNTY COURTHOUSE 500 WHITEHEAD STREET KEY WEST MONROE COUNTY, FLORIDA and shall do everything required by this Contract and other Contract Documents. 1.02 THE CONTRACT SUM A. The Owner shall pay to the Contractor for the faithful performance of the Contract, in lawful money of the United States, as follows: B. Based upon the price shown in the Proposal Number 1156 dated March 20, 3.990 heretofore submitted to the Owner by the Contractor, a copy of said Proposal being a part of these Contract Documents, the aggregate amount of this Contract is the sum of Eighteen Thousand Dollars ($18,000.00) 1.03 COMMENCEMENT AND COMPLETION OF WORK A. The Contractor shall commence work within 10 calendar days after date of Notice to Proceed.. B. The Contractor shall prosecute the work with faithful- ness and diligence and shall complete the work not later than forty-five ( 45 ) calendar days after date of Notice to Proceed. 1 1.04 CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. The Contractor hereby agrees that he has carefully examined the sites and has made investigations to fully satisfy himself that such sites are correct and suitable ones for this work and he assumes full responsibility therefore. The provisions of the Contract shall control any inconsistent provisions contained in the specifications. All Specifications have been read and carefully considered by the Contractor, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Contract be more strongly construed against the Owner than against the Contractor and his Surety. B. Any ambiguity or uncertainty in the Specifications shall be interpreted and construed by the Owner, and his decision shall be final and binding upon all parties. C. It is understood and agreed that the passing, approval, and/or acceptance of any part of the work or material by the Owner shall not operate as a waiver by the Owner of strict compliance with the terms of this Contract, and Specifications covering said work; and the Owner may require the Contractor and/or his surety to repair, replace, restore, and/or make to comply strictly and in all things with the Contract and Specifications any and all of said work and/or materials which within a period of one year from and after the date of the passing, approval, and/or acceptance of any such work or materi- al, are found to be defective or to fail in any way to comply with this Contract or with the Specifications. This provision shall not apply to materials or equipment normally expected to deteriorate or wear out and become subject to normal repair and replacement before their condition is discovered. Failure on the part of the Contractor and/or his Surety, immediately after Notice to either, to repair or replace any such defective materials and workmanship shall entitle the Owner, if it sees fit, to replace or repair the same and recover the reasonable cost of such replacement and/or repair from the Contractor and/or his surety, who shall in any event be jointly and severally liable to the Owner for all damage, loss, and expense caused to the Owner by reason of the Contractor's breach of this Contract and/or his failure to comply strictly and in all things with this Contract and with the Specifications. 2 1.05 1.06 1.07 A. LIQUIDATED DAMAGES A. It is mutually agreed time is of the essence of this Contract and should the Contractor fail to complete the emergency repairs within the specified time, or any authorized extension thereof, there shall be deducted from the compensation otherwise to be paid to the Contractor, and the Owner will retain the amount of. Fifty Dollars ($5O.O0) per calendar day as fixed, calendar day as fixed, agreed, and liquidated damages for each calendar day elapsing beyond the specified time for completion or any authorized extension thereof, which sum shall represent the actual damages which the Owner will have sustained by failure of the Contractor to complete the work within the specified time; it being further agreed that said sum is not a penalty, but is the stipulated amount of damages sustained by the Owner in the event of such default by the Contractor. B. For the purposes of this Article, the day of final acceptance of the work shall be considered a day scheduled for production. PARTIAL AND FINAL PAYMENTS In accordance with the provisions fully set forth in the General Conditions, and subject to additions and deductions as provided, the Owner shall pay the Contractor as follows: One (1) partial payment of fifty percent (50%) of contract amount upon inspection and approval of the work completed. One (1) final, payment of one -hundred percent (100%) of contract amount less any previous partial payments shall be paid in full upon one -hundred percent (100%) completion and acceptance of the work. CONTRACT DOCUMENTS The Contract Documents attached hereto, are as fully a part of this Contract as if herein repeated. 3 IN WITNESS WHEREOF the parties hereto have executed this Agreement on the day and date first above written in four (4) counterparts, each of which shall, without proof or accounting for the other counterparts, be deemed an original Contract* MPROV1DAS TI FORS, AND LEGAL SUFFICIENCG BY �4 -- Attor ey's C'%fire Signed, Sealed and Witnessed in the presence of:** . ��. E 80. .� ' "Y MONROE C TY, FLORIDA Party o e F' st Part By: AttestAN L, % C ,1 -;!,� ,4 al) Party of the Second Part By: Title Attest: (Seal) (*) In the event that the Contractor is a Corporation, there shall be attached to each counterpart a certified copy of a resolution of the Board of Directors of the Corporation, authorizing the officer who signs the Contract to do so in its behalf. (**) Two witnesses are required when Contractor is sole ownership or partnership. 4 D-N-G, INC.3 r DBA DAVID ELECTRIC 1803 ATLANTIC BLVD. KEY WEST, FL 33040 (305) 294-6361 PrODosal iSPECIFICATIONS AND ESTIMATE No.* 1156 Page No. of Pages PROPOSAL SUBMITTED TO PHONE DATE Monroe County Public Works 294-8417 20 Mar 90 STREET JOB NAME P. O. Box 1029 Public Bathroom Remodel CITY, STATE AND ZIP CODE JOB LOCATION Key West, Fla 33040 Justice Building ARCHITECT DATE OF PLANS JOB PHONE .•c nmeuy yropuse ru iurmsn marenars ana moor necessary ror me compieoon or: The remodel as described in plans and specifications. SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted with Bid, Proposal or Contract No. for 2. This sworn statement is submitted by ,AC�a,,, s - G,M. `moo, V;d E Iec-4 ;c (name of entity submitting sworn statement) whose business address is 3 31 q ay b C 4 �\s+ o e °D C; u c 16 A KP.i UJ &s } P I a and (if applicable') its Federal Employer Identification Number (FEIN) is - to 0 3 R q t„ (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: 3. My name is `1b e„ I s 5q A (�gr.^ ,s (please print name of individual signing) entity named above is 4. 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 agency or political subdivision of any other state or with 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. 5. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(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. 6. 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 entityunder 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 management of an affiliate. The ownership by one person of shares constituting a controlling interest 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 considered an affiliate. 7. I.understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes means 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 management of an entity. 8. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (please indicate which statement applies.) V Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, nor any affiliate of the entity have 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 the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in 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, AND (Please indicate which additional statement applies.) There has been a proceeding concerning the conviction before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer did not place the person or affiliate on the convicted vendor list. (Please attach a copy of the final order.) The person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. (Please attach a copy of the final order) The person or affiliate has not been placed on the convicted vendor list. (Please describe any action taken by or pending with the Department of General Services.) (signature) Date: QL( f\ a .r 9 0 STATE OF T7L,-) iu1)4 COUNTY OF f ,QiJ ftf— PERSONALLY APPEARED BEFORE ME, the undersigned authority, �NtIk,5 who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this 5 day of 111 =1 , 196)0. NOTARY PUBLI My commission expires: ST A rt ,I• Ft c )WIt A �ry,TThn,•tti al profrss,on.Tl I r,i;Tl:TlT,ni t! . L TL C3'1T C.T'_'?> L?C JLJTL?ED CAL C(?'.T-.�t;TCR,� - - T :. ;3 It I'ffI•: f'ItOVIsII•' ('I I:\f'I f:!t '3 �I 11•:.\ftl;\f'lltl:\C; �'J'�t. 7f:� 1 (,U:�T -r:T ALL LOCAL CC"� T� ,CY = %Ui q H�-'N ir)E?, 1:T'"I'�I•) ATLn'vTIC -�LVD. KEY WEST FL 33',' T ALLA, He k. DISMAY IN A CONSt'ICUO,,, PLACE ATE DEPARTMENT OFTPROF OFESSIOA NAL REGULATION CONSTRUCTIGN INDUSTRY LICENSING BOARD 05/24/89 RG 0026605 THE REGISTER_D GENERAL CONTRACTOR NAMED BELOW HAS REGISTERED UNDER THE 'IZOVISI 11493 EXPIRING JUNt 30, 1991CH(PTERMUST M�4E9aT FS.. FOR THE YEAR L AL LICNSIN REBUIREMEhTS PRIOR TO CONTRACIINGCIN ANYEAREA) HERNANDEZ♦ ANTONIO INC 3314 �NORTHSIDE DR STE 11A KEY WEST FL 33040 O"ATIONREZ1z OVE o DISPLAY IN A CONSPICUOUS PLACEouNOR z Ez SECRETARY, D.P.R. STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION CONSTRUCTICN INDUSTRY LICENSINC 80ARD 05/24/.% o, RF U038425 11535 THE REGISTERED PLUMBING CONTRACTOR NAMED BELOW HAS REGISTERED UNDER THE PROVISIONS OF CHAPTER 439 F.S. FOR THE YEAR EXPIRING JUN_ 30, 1991 (MUST MEET ALL LOCAL LICENSING RE-1UIREMENTS PRIOR TO CONTRACTING IN ANY AREA) H:RNANDEZ. ANTONIO D—w—G INC 3314 NORTHSIDE DR SUITE #16—A K=Y WEST FL 33040 Z04cKs COUNTY OCCUPATIONAL LICEQNSE 198Q9-1,1, 9yp0 MONROE �ffiT ETAT`JUiF10fYUTAX THIS LICENSE EXPIRES S E COST AND 4 PENALTY UMfJiW OF EMPLOYEES: 10NTEIt CURRENT NbR OF EMPLOYEES HERE: TRANSFER FEE TOTAL DUE ATE CERTIFICATE NUMBER ' HAk2Y F_ KNt6HTpCFC TAX COLLECTOR 294-8403 P.O.«lox 1129 KEY WEST. FL Sj041-1129 PLEASE SEE BACK OF FORM THE A•+OVE LICENSEE IS HEREBY LICENSED TO ENGAGE IN THE BUSINESS PRu#;ESSIJN Oa OCCUPATION OF 6ENEgAL CONTRACTOR 6C 200A ACCOUNT NUMdEk IS O4688 K 10/02/89 LOCATION: LANTId815 AT1cPAIDSHARRY F.K�1*� &gf 18.00 D—N-6— INC DEIA DAVID ELECTRIC HERNANDEZ LUPE PRES TONY HERNANDEZ VP 13C3 ATLANTIC 3LVD XcY WEST FL 33040 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED BY RECEIPTING MACHINE SHOVqNP 19*O1+IK12*011"v*DT_ww DATE AND AMOUNT PAID. _ C k k T I F I C A T E Up"If"®MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS © COUNTY OCCUPATIONAL LICENSE 1989-1 990 �IjiO COUNTY -STATE OF FLORIDA TAX THIS LICrON IRES SE PTEMBER 30P 1990 COSTAND 301-11 i-12 PENALTY NUMBik- OF EMPLOYEES: ENTER CUkAENT NSR OF EMPLOYEES HERE: TRANSFER FEE _ STATE CERTIFICATE NUMBER TOTAL DUE �To ' HA441Y F. KNIGHT.CFC TAX COLLECTO9 294-8403 P_O_dJX 1119 KEY WEST. FL IJ041-1129 PLEASE SEE BACK OF FORM D—N-6 INC DBA DAVID C-LECTRIC THt AeOVt LICENSEE IS HEREBY HERNANDEZ LUPE PRIES LICFNSIED TO ENGAGE IN THE BUSINESS HERNANDEZ TJNY V P PNUFCSSION 04 UCCUPATIONOF 1803 ATLANTICC 3LVD_ PLUMdIN6 CONTRACTOR PC 3J9 KEY WEST FL 3304-1 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED BY RECEIPTING ACC O N,��� ,µ,�,� R I S 5� 8K 10/02/89 19SOCT12ltfM h v(ft f ffTION NUMBER. DATE, AND AMOUNT PAID (PAID#HARMT 1w11F�Kt*f 03 ATLI��II'IC 8LVD C E k T I F I C A T E R E41U OD MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS COUNTY OCCUPATIONAL LICENSE 1989-1 99 0 M O N R O E COUNTY -STATE OF FLORIDA TAX THIS LICENSE EXPIRES S t I) T EM 6 E Q 3V ♦ 1990 COST AND SU1 -11 i-1 S NUMbeik - OF EMPLOYEES: PENALTY ENTER CURRENT NOR OF EMPLOYEES HERE: TRANSFER FEE STATE CERTIFICATE NUMBER ;.«,. o"�' .o"�`' HARiiY f_ KNI6NTPCf[ TAX COLLECTOR 294-8403 P_o.dux 1129 KEY WtST. FL 33041-1129 PLEASE SEE BACK OF FORM THE ArtUVE LICENSEE IS HEREBY LICIENbED TO ENGAGE IN THE BUSINESS PKOFkSSIUN Uri OCCUPATION OF : p ELcCINICAI. CONTRACTOR EC 108 0 AIMARRY F.KNIGHT*** 18.00 CK 10/02/89 ACCOUNT QUAdfA IS 00267 LUCATIUN: 1603 ATLANTIC dLVD TOTAL DUE D m v 18.00 D—N—G INC DSA DAVID ELECTRIC HERNANDEZ LUPE PRIES TONY HERNANDEZ V P I i(J3 ATLANTIC 3LVD . MI y �cY WEST FL 33040 19T�CT � JRJ4 ONLY WHEN VALIDATED BY RECEIPT.'. I G T C I N NUMBER DATE AND AMOUNT PAID C E R T I F I C A T E R Pl*lr"IDMUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS li R ISSUE DATE (MKVDD/YY) IM:18/89 EST INSURAN(—[. TNC. Fl_AGL..E.fi AVENUE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. fl^&AnALIICQ ACCi�nnihi!l f+/1VCr%A^► YWEST FL_ 33040 .,.,,... ,,,..�.. �, , ..,....,.w .,.,.�....�� COMPANY A C'A %LJ!'fl_ Y 1NDr-l:.fV4 Y EXCHANGE LETTER COMPANY } LETTER B INSURED )AVID ELECTRICALCOMPANY C � 'pNTkACTUFS INC. LETTER COMPANY D --- — 5.314 NUhTH8 [DE DR. #i:I. f,A KEY WEST, f"L_ 33040 LETTER COMPANY E LETTER • THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTrgTNSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY N NSIJED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI- TIONS OF SUCH POLICIES. CO POLICY EFFECTNE� PoIC` E1F; r" LIABILITY LIMITS IN THOUSANDS TYPE OF INSURANCE POLICY NUMBER L DATE IMM�D,"�'�'� -A'E i6�!,,�,�.rr. EACR OCCURRENCE AGGREGATE 1 GENERAL LIABILITY [3 L.. 0 3 4 21. 0 9/ 1 0/ 8 9 0 9/ 1. 0/ 9 0 BODALY r "� COMPREHENSIVE FORM uav $ $. y PREMISESIOPERATIONS MRGROUND + PROPERTY DAMAGE $ EXPLOSION 33 COLLAPSE HAZARD y i PROOUCTSICOMPLETED OPERATIONS CONTRACTUALB F P $ ,_� U 3()) ' $ C �(=Cr.16�yEC WEPIENDENT CONTRACTORS KM FORM PROPERTY DAMAGE PERSONAL INJURY I PERSONAL INJURY i $ AUTOMOBILE LIABILITY ---- --- ANY AUTO -; i xc x=x. $ ALL OWNED AUTOS (PRIV. PASS.)ALL OWNED AUTOS (OTHER THAN PRIV. PASS. HIRED AUTOS -- ---r— - NON -OWNED AUTOS uAMA;E GARAGE LIABILITY - + -- g3 8 PC EXCESS LIABILITY UMBRELLA FORM Bi a PO COM&NED $ $ OTHER THAN UMBRELLA FORM1-- i STATUTORY WORKERS' COMPENSATION— EACH ACCIDENT) AND EMPLOYERS' LABILITY $— (DISEASE -POLICY LIMIT) I IDiSEASE-EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS L_ECTkzCAL_ CON'rItACTOR 19 MONROE COUNTY E'L_DO DEFT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- 5825 COL.I._E(.`s ROAD PIRAT fj,[�1 DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO .JR . MAIL CI DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE STOCK ISLAND LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY KEY k1E87 F L_ ..§U4U OF AN KIND UPON THE COMPANY, ITS A NTS OR REPRESENTATIVES. ALIT REPRESENTATIVE ✓ -' 7 / ISSUE DATE (MMIDO/YY) 03/13/90 THIS'CERnFICArE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RORIDfRS OOMP�M110N RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT ARMA M 1DM11157i]�D BY FIEW TEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER 469 ATTENTION CERTIFICATE HOLDER: If you have an y ny questions, THE PORTER ALLEN CO- INC. PleadconesKATHY YOUSSE at1-800-ZM3224, 513 S O U T H AR D S T H E T 2601 Cattlemen Road, Sarasota, FL 34232 KEY WEST. FL 3J040 0000 COMPANIES AFFORDING COVERAGE INSURED Company Letter A FCCUSELF INSURERS FUND DAVID ELECTRIC Company Letter B: 3314 NORTHS I0E OR SU ITc. 10-A SLY NEST* FL 33040 0000 Company Letter C: THIS IS TO CERTIFY THAT POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IfDCXWrED. NOT WTTIISTANDM ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI- TIONS OF SUCH POLICIES. LR TYPE IN INSURANCE POLICY NUMBER POLLY EFFECTIVE DATE (NM/DDNY) POLKY EXPIRATION DATE (INUDD/YY) ALL LIMITS IN THOUSANDS GENERAL LIABILITY GENERAL AGGREGATE i COMMERCIAL GENERAL LIABILITY AGGREGATE i CAM MADE ❑ OCCURRENCE PERSONAL 3 ADVERTISING INJURY i OWNER'S & CONTRACIDRS PROTECIIVE EACH OCCURRENCE i RRE DAMAGE (ANY ONE RRE) i MEDICAL EXPENSE (ANY ONE PERSON) IS AUTOMOBILE LIABILITY ANY AUTO WL i ALL OWNED AUTOS OWLY SCHEDULED AUTOSRRSONI INJURY i HIRED AUTOS SWILY NON -OWNED AUTOS INJURY i GARAGE LIABILITY PROPERry DAMAGe i EXCESS LIABILITY EACH AGGREGATE OCCURRENCE OTHER THAN UMBRELLA FORM A WORKERS' COMPENSATION SlATUMRY AND 71,j-2077c-0C; 1-uu i 01/01/v0 i (EACH ACCIDENT) $ 3 J 0 (DISEASE-POUCY LIMIT) EMPLOYERS' LIABILITY i 1 CJ 0 (DISEASE -EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMSDd A: D A V I D QzLE C T ►R I C r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE A V N R G c COUNTY EXPIRATION DATE THEREOF, THE ISSUEING COMPANY WILL ENDEAVOR TO SEND �i U I L J 1 w G 2: L J N I 'i v J L P T 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 4 1 v 0 1 I STUCK 1 .� L A rd J BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY E S T, r L 3 3 v 4 v J J C U OF ANY KIND UPON THE COMP TS ITS AGENEPRESENTATIVE. AUTHORIZED REPRESENTATIVE 77 �,;r