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Certificates of InsuranceAI/III�II. f ATE (MM/ D/YY) fr ISSUED D . 12/01/92 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE THE PORTER ALLEN COMPANY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 513 SOUTHARD STREET POLICIES BELOW. KEY WEST, FLORIDA 33040 COMPANIES AFFORDING COVERAGE COMPANY A LETTER FLORIDA RESTAURANT AS CIAT N (SIF) COMPANY B INSURED LETTER JOHN DEDEK C ETTER"Y RESTAURANT ASSOCIATES OF KEY WEST DBA ^� v L.J.'S BEACHSIDE RESTAUTANT 8 CAFE ETTE NY D 227 DUVAL STREET KEY WEST, FLORIDA 33040 ETrERNY E Covet 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 TYPE OF INSURANCE TR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL & ADV. INJURY $ OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS A AND 895-0784 05/01 /92 05/01 /93 EACH ACCIDENT $ 100, 000. DISEASE —POLICY LIMIT $ 500, 000... EMPLOYERS' LIABILITY DISEASE —EACH EMPLOYEE $ Inn nnn_ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS MONROE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN: PUBLIC WORKS DEPT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL .30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 5100 JUNIOR COLLEGE ROAD STOCK ISLAND LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR KEY WEST, FLORIA 33040 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTAT;r'� ^ _ M The PnideMwl 4D ❑ Please check if additional comments are written on reverse side Prudential Property and Casualty Insurance Company Request For Policy Prudential General Insurance Company Prudential Commercial Insurance Company Change Subsidiaries of The Prudential Insurance Company of America 1 PO ICY PoN fields St3te1D Poycy_N er� O 3 Effe�e Date of C nge Control Date Batch Sours ulian Date S/H Cow i must be c�rompl /i li 2 INSURED Print name exactly as it appears in the Declarations Phone Number 3 0'� [I Change. ❑ Correction �t t K JoHN /✓ �- Jt �N�✓FTt S r Day o29-y,-0:_/ % Evening 3 MAILING House Number/Apt. Number and Street Address County 701 W A D D E� i /l/ a/1 ,�o ❑ Change 13 ❑ Correction City or Town Sta� Zip Code Ternt Tax Town 4 NO Uas List Ages of all unlicensed persons in household e 5 VEHICLE Vehicle No. Year Make el Body Type Vehicle Type Horsepower TO BE ADDED _ RSO use VIN ( Byp. M.C. Purchase Date New/Used Cost Symbol Priv. Gar. 2 V Yes ❑ No Lienhokler ❑ Name VUU \,XdcVtss City County State Zip Code Add. lot, ❑ Cert. of Ins. ❑ 5a Registered Owner Name Address City County State Zip Code VEHICLE Veicle N Year Make Model Body Type Vehicle Type Horsepower DATA TO r}.� BE CHANGED RSO Use VIN Byp. M.C. Purchase Date New/Used Cost Symbol Priv. Gar. Yes ❑ No ❑ Name Address 6014)6 d — ev o 2v7City County State Zi Code Addr WACert. 'Ins. 1Y1.40o e Cv. Rl s K /h 6 �` 3/0 C a i 1 G�/�s 7- of ❑ o Owner Of Name Address City County State Zip Code I 7 VEHICLE TO BEI R80 Vehicle No. Year Make Model Body Type VIN DELETED' r Use 4 8 VEHICLE Vehicle Work I Days I Wkly Mileage to B % Dr. No. Existing Car Dam- Current Date of Estimated USAGE No. I per and from school, Pleasure u Use Farm P/E age (It Yes,* ex- Odometer Reading Annual Mileage DATA week , train, work, etc. S. plain in Remarks.) Reading ADDED VEHICLE RSO Use 9 OTHER VEHICLE I I d 9 LIABILITY Bodily Injury Property Medical UNINSURED MOTORISTS UNDERINSURED MOTORISTS LIMITS Damage Pa Payments Each Person Each occurrencey Bodily Injury Property Damage Bodily Injury Property Damage R80 Each Person Each Accident Each Accident Each Person Each Accident Each Accident 5 10 OPTIONAL Vehicle No. Comprehensive Collision Towing Rental Anti-* Safety COVERAGES ❑ Yes ❑ No ❑ Yes ❑ No Car Theft Device Deductible Stated Value Deductible Stated Value ADDED ❑ Yes ❑ Yes ❑ Yes ❑ Yes VEHICLE ❑ No ❑ No ❑ No ❑ No RSO Uoe ❑ Yes ❑ Yes ❑ Yes ❑ Yes 5 OTHER ❑ No ❑ No ❑ No ❑ No VEHICLES ❑ Yes ❑ Yes ❑Yes El Yes ❑ No ❑ No ❑ No ❑ No 11 � FA�ERAGES Add ❑ P New Jersey only — A completed and signed PAC 3557 Delete ❑ must be submitted with PAC 138 M Use 5 F12 DRIVER Dr. # Name Date of Birth Driver Code Driver's License No. or Permit No. State Ong. date of TO BE ADDED License RSO Use Sex Mar. St. Occupation Vehicle # % Use Vehicle # % Use Vehicle # % Use S Driv. Trng. Good Stud. Def. Driv. Date Dr. at School I Locationm of road miles from home Cust. Child Assigned Risk ❑ Yes ❑ No I ffFmok— RESPONSIBILITY: Is Driver required, Date Orig. Filed State % Surch. Reason to mwmfln. Rap`. §1W O YES ❑ NO Mo. Day Yr. U Yes, ottatptete the fo8owing: 13 DRIVER Dr. # Name Date of Birth Driver Code Driver's License No. or Permit No. State Ong. Date of TO BE License CHANGIEW ❑ DELETED' ❑ Sex Mar. St. Occupation Vehicle # % Use Vehicle # % Use Vehicle # % Use RIO Ua 4 Driv. Trng. Good Stud. Def. Driv. Date Dr. at School I Location/# of road miles from home Cust. Child Assigned Risk ❑ Yes ❑ No I Is Driver rerm'Ared I Date Odg. Filed State % Surch: Reason to meM Fin. gyp.OW ❑ YES ❑ ¢O Mo. Day I Yr. 14 ALTERNATE GARAGRiG Is place of principal garaging of any car other than that indicated in line 3? ❑ Yes ❑ No If Yes, indicate Vehicle # and location. Provide reason(s) in REMARKS section. Vehicle # Location Zip Code Vehicle # Location Zip Code is micy Effective Date of Cancel Proof of other insurance attached ❑ Yes ❑ No C)LIMI ATION" Reason for Cancellation This is to acknowledge that the changes shown above are correct as indicated. Insured's Signature Date �ATAIVEZED Co ract / �I �-4fo RMO 0 e Code �' ! A ency # or Init. r Bypass CAIF ❑ Inspec. CPC Code Und. Flags RO Code C1 / ❑ ❑ RBE r ice/ f r. T�f/�: s.� ,� fr:>'c It x C'c:!�a�•� ` �3a7/S/ Wrilling Representative's Name (Print) Title Writing Representative's Signature Telephone Number Date *Explain In remarks on reverse side of RSO Copy. **Must provide Inured': Signature PAC 138 Ed. 11/89 IAICI IQCII'C nnov ISSUE DATE (MM/DD/YY) 12/01/92 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE THE PORTER ALLEN COMPANY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 513 SOUTHARD STREET POLICIES BELOW. KEY WEST, FLORIDA 33040 COMPANIES AFFORDING COVERAGE (305) 294-2542 COMPANY A LETTER COLONIA INSURAN OMPAN INSURED JOHN DEDEK COMPANY LETTER 8 RESTAUANT ASSOCIATES OF KEY WEST COMPANY 1� C t LETTER DBA L.J.'S BEACHSIDE RESTAURANT 9 CAFE - 227 DUVAL STREET COMPANY 1 , LETTER D KEY WEST, FLORIDA 33040 _ COMPANY E LETTER 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 TYPE OF INSURANCE POLICY NUMBER LTR POLICY EFFECTIVEPOLICY EXPIRATION LIMITS DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 500.9000. A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 500,-000. CLAIMS MADE X OCCUR. CGL 134761 1 2/09/92 12/09/93 PERSONAL & ADV. INJURY $ 500, 000. OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 5QOZ 000. FIRE DAMAGE (Any one fire) $ 500000. - - MED. EXPENSE (Any one person)' $ AUTOMOBILE LIABILITY : COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS EACH ACCIDENT $ AND DISEASE —POLICY LIMIT $ EMPLOYERS' LIABILITY DISEASE —EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS MONROE COUNTY IS LISTED AS ADDITIONAL INSURED 30 DAY NOTICE OF CANCELLATION, EXECPT FOR NON -PAY, THEN 10 DAY NOTICE OF CANCELLATION. I CANCELl OlN MONROE COUNTS/ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN: PUBLIC WORKS DEPT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 5100 JUNIOR COLLEGE ROAD MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE STOCK ISLAND LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR KEY WEST, FLORIDA 33040 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. MIKE LAWN AUTHORIZED REPRESENTATIVE Prudential Property and Casualty Insurance Company CERTIFICATE Prudential General Insurance Company OF INSURANCE Prudential Commercial Insurance Company Subsidiaries of The Prudential Insurance Company of America Policy Number: 394AS05503 Named DEDEK, JOHN N & JEANNETTE S Insured 701 WADDELL and P.O. KEY WEST FL 33040 Address This policy period Covers 0 6 months. Loss ® Received From 11 / 0 3 / 9 2 payee Additional interest Risk Mgmt. & Loss Control to 0 5 / 0 3 / 9 3 , 12:01 A.M. at place MONROE CO RISK MOT DATE--- �� 9 3 of garaging. 5100 COLLEGE RD RqMAL ` KEY WEST FL 33040 Vehicle Data: Veh. Year Make Model Body Type 2 89 PONTIAC GRANDPRIX COUPE Coverage Data: Bodily Property Injury Damage $1009000/ $509000 $3009000 Uninsured Motorists #100,000/ $300,000 Transaction Effective Date: 12 / 01 / 9 2 Underinsured Motorists Messages: LOSS PAYABLE COVERAGE AFFORDED Vehicle Identification # 1GZWJ14W1KF278941 Collision Deductible 250D THIS POLICY IS SERVICED BY. SOUTHEASTERN REGIONAL SERVICE OFFICE P.D. BOX 2627 JACKSONVILLE9 FL 32232 Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Clause and/or the Additional Interest Clause shown on the reverse. Comprehensive Deductible 2500 PAC 187 Ed. 4188 INS -A Prudential Property and Casualty Insurance Company CERTIFICATE Prudential General Insurance Company OF INSURANCE Prudential Commercial Insurance Company Subsidiaries of The Prudential Insurance Company of America Policy Number: 394A805503 Named DEDEK, JOHN N & JEANNETTE S Insured 701 WADDELL and P.O. KEY WEST FL 33040 Address This policy period Covers 0 b months. Loss ® Deceived From 11103192 payee Additional interest to 0/03/93, Risk Mgmt. & Loss Control 12:01 A.M. at place MONROE CO RISK MGT DATE-3`as— of garaging. 5100 COLLEGE RD� KEY WEST FL 33040'`�� Vehicle Data: Veh. Year Make Model Body Type Vehicle Identification # 1 89 DODGE CARAVANSE WAGON 284FK45J1KR274438 Coverage Data: Bodily Property Uninsured Underinsured Collision Comprehensive Injury Damage Motorists Motorists Deductible Deductible $1009000/ $509000 $1009000/ 2500 2500 $3009000 $3009000 Transaction Effective Date: 12 / 01 / 9 2 Messages: LIENHOLDER DATA CORRECTED THIS POLICY IS SERVICED BY: SOUTHEASTERN REGIONAL SERVICE OFFICE P.O. BOX 262T JACKSONVILLE, FL 32232 Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Clause and/or the Additional Interest Clause shown on the reverse. PAC 187 Ed. 4/88 INS -A t SENT BY:FOBARTY 1875 HOUSE ....araPrudential Property and Casualty - p 'ThePru wp► Insurance Company IIIIiIlllimampnu�■,...____ A Subsidiary of The Prudential Insurance P. 0. Box 627 company of America Car Policy Renewal Declarations Jacksonvill , FL 32232 Policy Number: 39 4A805503 1-800-43 —5556 Agency Data: 000000 5 CGAB 043 Dedek, John N S Jeannette S ad Insured ]01 Waddell P.O. Address Key West FL 33040 This policy period coves 6 months, from 11/03/92 to 05/03/93, 12:01 A.M. at place of garaging. Listed below are names and birth dates of licensed drivers resident in your household. 1 Dedek John Norman 01/18/33 2 Dedek Jeannette S 02/18/35 Listed lelow are the cars covered by your policy. i CAR YE R MAKE. MODEL BODY TYPE VEHICLE ID NUMBER TERRITORY SYMBOL CLASS CODEI 1 19 9 Dodge Caravanse Wagon 284FK45JIKR274438 036 7 841220 1 2 19 9 Pontiac Grandprix Coupe 1G2WJ14W1KF278941 036 J 841320 Listed elow are your policy coverages, limits and premiums. if a premium charge does not app ar, that coverage is not provided. COVERAG S LIMITS PREMIUMS Bodily njury Each arson $ 100,000 Each ccident $ 300,000 Propert Damage Each ccident $ 50,000 Uninsur d Motorists Bodil Injury Eac Person $ 100,000 Eac Accident $ 300,000 Persona Injury Protection Collisi n Deduc ible - $ 250 Compreh naive Deduc ible - $ 250 Rental ar Coverage TOTAL P EMIUM PER CAR TOTAL POLICY PREMIUM lyt l 1 ,�vr✓J Car 1 Car 2 $ 99 $ 108 $ 40 $ 45 $ 51 $ 51 $ 39 $ 64 S 18 $ 5 $ 316 $ 40 $ 90 $ 30 $ 5 $ 369 $ 685 PAC 681I ED. 1/90 PAGE 1 AE11-011377, ThePrudentialM InsurancelCompany and Casualty II�IIIIIIIIIII�IIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII A Subsidiary of The Prudenlial Insurance Certificate of Insurance P. O. Box 2627 Company of America Jacksonville, FL 32232 1-800-437-5556 Policy Number: 39 4A805503 MONROE CO RISK MGT Lienholder Name 5100 COLLEGE RD and P.O. Address KEY WEST FL 33040-4364 11111161111 111lll111111111 III l l r l l l rll l 111 lla 1 1 llll D Loss Payee N Additional Interest Dedek, John N & Jeannette S 701 Waddell Key West FL 33040 Vehicle Data: Veh. Year Make Model 89 Dodge Caravanse Coverage Data: Bodily Property Uninsured Injury Damage Motorists 100,000/ 50,000 100,000/ 300,000 300,000 Transaction Effective Date: 05/t4/93 Messages: VEHICLE DELETED Body Type Wagon Policy effective From 05/03/93 Until Terminated Received -)!.q Control Vehicle Identification # 2B4FK45J1KR274438 Underinsured Collision Comprehensive Motorists Deductible Deductible 250 250 Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest (which includes a Leasing Company) under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Clause and/or the Additional Interest Clause shown on the reverse. PAC 187 Ed. 4/93 LA32-002810 CERTIFICATE OFINSURANCE ISSUE DATE (MMIDDIVY) PRODUCER THE PORTER ALLEN COMPANY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 513 SOUTHARD STREET KEY WEST FLORIDA 33040 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A LETTER CIGNA FIRE UNDERWRIyV&jWWRANCE COMPANY COMPANY B RPP LETTER INSURED RESTAURANT ASSOCIATES OF KEY WEST INC. DB,A L.J. BEACHSIDE RESTAURANT AND CAFE ETTERNY `. COMPANY D �5...►--- LETTER 227 DUVAL STREET KEY WEST FLORIDA 33040 COMPANY E LETTER ,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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/VY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS GENERAL LIABILITY BODILY INJURY OCC. $ A COMPREHENSIVE FORM X BODILY INJURY AGG. $ PREMISES/OPERATIONS D2 45 98 67 6 12/09/93 12/09/94 X PROPERTY DAMAGE OCC. $ UNDERGROUND EXPLOSION & COLLAPSE HAZARD PROPERTY DAMAGE AGG. $ BI & PD COMBINED OCC. $ 500,000. PRODUCTS/COMPLETED OPER. BI & PD COMBINED AGG. $ 1 , 000 , 000 . CONTRACTUAL CONTRACTORS PERSONAL INJURY AGG. $ ,500, 000. NINDEPENDENT BROAD FORM PROPERTY DAMAGE PERSONAL INJURY X AUTOMOBILE LIABILITY ANY AUTO L tCE'iVtC: BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS ( Priv. Pass. ) ALL OWNED AUTOS ( Other Than HIRED AUTOS Priv. Pass.DATE .C,Sk —C/ Mgrr, °Z ±. & Loss ContOI —/ — I NON -OWNED AUTOS {�,^�;;,4j- i'w h PROPERTY DAMAGE $ BODILY INJURY & GARAGE LIABILITY PROPERTY DAMAGE $ COMBINED EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS EACH ACCIDENT $ AND DISEASE —POLICY LIMIT $ EMPLOYERS' LIABILITY DISEASE —EACH EMPLOYEE $ OTHER 7— DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS MONROE COUNTY AND MONROE COUNTY COMMISSIONERS ADDITIONAL INSURED MONROE COUNTY AND ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY COMMISSIONERS 5100 JUNIOR COLLEGE ROAD RATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE KEY WEST FLORIDA 33040 , BUT FAILURE TO M�IH NOTIC SH LL IMPOSE NO OBLIGATION OR [AUTHORIZED LITY OF ANY KIND UCO , ITS AGENTS OR REPRESENTATIVES. REPRESENTATID W. FREE Restaurant Associates of Key West Inc DBA L.J. Beachside Restaurant & Cafe 12/9/93-94 POLICY NUMBER: D2 45 98 67 6 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION RECEIVED This endorsement modifies insurance provided under the following: JAN 14 1994 COMMERCIAL GENERAL LIABILITY COVERAGE PART. COUNTY ADMINISTRATOR SCHEDULE Name of Person or Organization: Monroe County and Monroe County Commissioners 5100 Junior College Rd Key West F1 33040 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. Received P"sk MSTnt. Loss Control DATE Cl INITIAL Porter Allen Company Inc Key West Fl 12/15/93pm CG 20 26 1185 Copyright, Insurance Services Office, Inc., 1984 Al Prudential Property and Casualty Insurance Company Prude�al General Insurance Company Prudential Commercial Insurance Company Subsidiaries of The Prudential Insurance Company of America Named Insured John N & Jeannette S Dedek and P.O. Address 701 Waddell Key West FL 33040 F1 Loss payee Additional interest Monroe County RIK Management 5100 College Rd Key West FL 33040 Vehicle Data: CERTIFICATE OF INSURANCE Policy Number: 394A805503 AM"11 E1-D Sy R1 K MANAGEMENT _ ` Q BY U g This policy period GATE Covers 6 months. WAIVER: Y —" From 5-3-94 toll-3-94 12:01 A.M. at place of garaging. Veh. Year Make Model Body Type Vehicle Identification # 1 93 GMC Sierra 150 42 Truck 2GTEC19H7P1523008 Coverage Data: Bodily Property Uninsured Underinsured Collision Comprehensive Injury Damage Motorists Motorists Deductible Deductible 100/300 50 100/30C 250 250 Transaction Effective Date: Messages: 8-2-94 Received Risk NMgmt. & Loss Control DATE MIAL Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Clause and/or the Additional Interest Clause shown on the reverse. PAC 187 Ed, 4/88 CG (N /"tea - Z�K2�*z rsuaelaand Casualty ThePruderdiale InrncComnY IIIIIIIIIIIIIINIIIIIIIIIUIIIIIIIIIN111IIoil 11111111111111111111111111111111111111111 P. 0. Box 2627 Jacksonville, FL 32232 ECE3302021 Client Services 904-391-5252 Lienholder Name and P.O. Address n Loss Payee A Subsidiary of The Prudential Insurance Company of America Certificate of Insurance Policy Number: 39 4A805503 Received Mgmt. & Loss Control MONROE COUNTY DATE Attn: ISK MNGMT 5100 COLLEGE RD iN1T1AL ---- KEY WEST,FL 33040-4364 Irrll�rrllrllrrr�lr�lll��rrlr�lr�llrrll�rrlr�lllrrrll�r�rrll�l N Additional Interest Dedek, John N 5 Jeannette S 701 Waddell Key West FL 33040 Policy effective From 1 1 /03/94 APPROVED B" RISK MANAGE M ENT Until Terminated BY DATE 7 f WAIVER: N/A YES Vehicle Data: Veh. Year Make Model Body Type Vehicle Identification # 93 GMC Sierra150 Pkp 4X2 2GTEC19H7P1523008 Coverage Data: Bodily Property Uninsured Underinsured Collision Comprehensive Injury Damage Motorists Motorists Deductible Deductible 1001000/ 50,000 1001000/ 250 250 300,000 300,000 Transaction Effective Date: 02/28/95 Messages: LOSS PAYEE/ADDITIONAL INTEREST DATA CHANGED Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest (which includes a Leasing Company) under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Cl�pse and/or the Additional Interest Clause shown on the reverse. PAC 187 Ed 4193 / LA33-002022 Prudential lay and CasualtyThePrudential A Insurance Company II'IIIIIIIIIII1IIIIIIIIIIIIIIIIIHill IIIIIIIIIIIIIIIIIIIIHill IIIIIHill IIIIIIIIIII1IIIIIIIIII P. O. Box 2627 Jacksonville, FL 32232 EJ83202211 Client Services 904-391-5252 Lienholder Name and P.O. Address D Loss Payee A Subsidiary of The Prudential Insurance Company of America Certificate of Insurance Policy Number: 39 4A805503 Received MONROE COUNTY Risk Mgmt. & Loss Control -� Attn: ISK MN G MT DATE -� gam_ 5100 COLLEGE RD INITIAL KEY WEST,FL 33040-4364 III III I1111ll11Bell III loll& Itell 1lll111ll11rr1ll11 1X1 Additional Interest Dedek, John N & Jeannette S 701 Waddell Key West FL 33040 Vehicle Data: Policy effective From 11 /03/94 Until Terminated Ai FkD`dED BY RISK MANA Ev_ a2iG DATE VYA;VFR: N/A YES Veh. Year Make Model Body Type Vehicle Identification # 93 GMC Sierral50 Pkp 4X2 21STEC191-171`1523008 Coverage Data: Bodily Property Uninsured Underinsured Injury Damage Motorists Motorists 100,000/ 50,000 1001000/ 300,000 300,000 Transaction Effective Date: 03/21/95 Messages: POLICY TERMINATED - NON PAYMENT OF PREMIUM Collision Comprehensive Deductible Deductible 250 250 Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest (which includes a Leasing Company) under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Clause and/or Additional Interest Clause shown on the reverse. aar 187 Ed 4193 LA32-002213 Prudential Property and Casualty Th@Prudential Yi Insurance Company NEW000001 A Subsidiary of The Prudential Insurance Company of America Car Policy Renewal Declarations P. sox Policy Number: 39 4A805503 Jacksonville, FFL L 32232 Agency Data: 000000 5 CGAB 043 Client Services 1-800-437-5556 APPROVED B" Rl� Claims 1-800-437-3535 BY Dedek, John N & Jeannette S _Ir �S and P.O. Address Named Insured 701 Waddell DATE 15 / Key West FL 33040-4728 WAIVER: N/A ✓ YES This policy period covers 6 months, from 05/03/95 to 11/03/95, 12:01 A.M. at place of garaging. Listed below are names and birth dates of licensed drivers resident in your household. 1 Dedek John Norman 01/18/33 2 Dedek Jeannette S 02/18/35 Listed below are the cars covered by your policy. CAR YEAR MAKE MODEL BODY TYPE VEHICLE ID NUMBER TERRITORY SYMBOL CLASS CODE 1 1993 GMC Sierra150 Pkp 4X2 2GTECl9H7P1523008 036 8 851420 2 1988 Ford Taurus Lx Wagon 4D 1FABP58UOJA143265 036 J 851320 Listed below are your policy coverages, limits and premiums. If a premium charge does not appear, that coverage is not provided. COVERAGES LIMITS PREMIUMS Car 1 Car 2 Bodily Injury $ 121 $ 114 Each Person $ 100,000 Each Accident $ 300,000 Property Damage $ 50 $ 48 Each Accident $ 50,000 Uninsured Motorists $- 76 $ 76 Bodily Injury Each Person $ 100,000 Each Accident $ 300,000 Personal Injury Protection $ 47 $ 45 Collision Deductible - $ 250 $ 77 $ 68 Comprehensive Deductible - $ 250 $ 55 $ 33 Rental Car Coverage $ 5 $ 5 TOTAL PREMIUM PER CAR $ 431 $ 389 TOTAL POLICY PREMIUM $ 820 cc : O)e2tAy Key-13oXrox) F/&-= PAC 681 ED.. 1/90 AL PAGE 1 suuz-uuuubl IF II ThePrudential � Insurance Company and Casualty IIIIIIIIIIIIIIIiII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII A Subsidiary of The Prudential Insurance P. O. Box 2627 Company of America Jacksonville, FL 32232 NIE3301587 Certificate of Insurance Policy Number: 39 4A805503 Client Services 904-391-5252 MONROE COUNTY Attn: ISK MNGMT Lienholder Name 5100 COLLEGE RD and P.O. Address KEY WEST, FL 33040-4319 III III III IIII III IIIII{IItoll Il„IIIIIIIIIII IIIIIII III IIIJIII u Loss Payee r� Additional Interest Dedek, John N & Jeannette S 701 Waddell Key West FL 33040 Vehicle Data: Veh. Year Make Model 93 GMC Sierral50 Coverage Data: Received Risk Mgmt. & Loss Control DATE !7—& 7 INITIAL Policy effective From 05/03/95 Until Terminated Body Type Vehicle Identification # Pkp 4X2 2GTEC19H7P1523008 Bodily Property Uninsured Underinsured Collision Comprehensive Injury Damage Motorists Motorists Deductible Deductible 100,000/ 50,000 1001000/ 250 250 300,000 300,000 Transaction Effective Date: 06/26/95 Messages: REINSTATE POLICY WITH LAPSE AFFROVED BY RISK MANAUMENT BY �_ o.PiG DATE Z2- /7 VIP11I.TP, n, `,, _,e:::�'—YES Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest (which includes a Leasing Company) under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Clause and/or the Additional Interest Clause shown on the reverse. PAC 187 Ed 4/93 O- LA33-001588 Prudential Property and Casualty ThePrudential � Insurance Company 000002 A Subsidiary of The Prudential Insurance Company of America Car Policy Amended Declarations P. 0. Box 2627 Policy Number: 39 4A805503 Jacksonville, FL 32232 Agency Data: 000000 5 CGAB 043 Client Services 1-800-437-5556 Claims 1-800-437-3535 Dedek, John N & Jeannette S Named Insured 701 Waddell and P.O. Address Key West FL 33040-4728 This policy period covers 6 months, from 05/03/95 to 11/03/95, 12:01 A.M. The Effective Date of this Policy Change is 06/26/95 at place of garaging. Listed below are names and birth dates of licensed drivers resident in your household. 1 Dedek John Norman 01/18/33 2 Dedek Jeannette S 02/18/35 Listed below are the cars covered by your policy. CAR YEAR MAKE MODEL BODY TYPE VEHICLE ID NUMBER TERRITORY SYMBOL CLASS CODE 1 1993 GMC Sierra150 Pkp 4X2 2GTEC19H7P1523008 036 8 851420 2 1988 Ford Taurus Lx Wagon 4D 1FABP58UOJA143265 036 J 851320 Listed below are your policy coverages, limits and premiums. If a premium charge does not appear, that coverage is not provided. COVERAGES LIMITS PREMIUMS Car 1 Car 2 Bodily Injury $ 121 $ 114 Each Person $ 100,000 Each Accident $ 300,000 Property Damage $ 50 $ 48 Each Accident $ 50,000 Uninsured Motorists $ 76 $ 76 Bodily Injury Each Person $ 100,000 Each Accident $ 300,000 Personal Injury Protection Collision pppROVEDBYRISK4GE C2lGc� 47 $ 45 Deductible $ 250 _ $ 77 $ 68 Comprehensive Deductible - $ 250 $ 55 $ 33 Rental Car Coverage -4. N/.4 ✓ vcS $ 5 $ 5 TOTAL PREMIUM PER CAR $ 431 $ 389 PREMIUM DIFFERENCE FOR REMAINDER OF TERM $ 581 TOTAL POLICY PREMIUM $ 820 CC .' 6 =t -H L-,-- 7-0 — p it) PAC 681 ED. 1/90 AL PAGE 1 SD02-000066 Policy Number 39 4A8o5503 Your policy is made up of your application, your most recent Declarations, and the forms and endorsements listed below. Forms and endorsements being made part of your policy with this transaction are provided in separate booklets or are indexed and reproduced on pages which follow. FORM EDITION NUMBER DATE POLICY FORMS AND MANDATORY ENDORSEMENTS PAC 186 4/86 Car Policy, Parts 1, 2, and 3 Applicable policy parts are those for which a premium charge is shown in the Declarations. PAC 226/FL 05/92 Florida Special State Provisions PAC 190/FL 4/87 Car Policy, Parts 4, 6, and 7 Applicable policy parts are those for which a premium charge is shown in the Declarations. OTHER CHARGES & CREDITS The Deluxe Package Discount applies to your policy. The Multi -Car Discount applies to your policy. An Anti -Lock Brake Discount applies to Car(s) 1. Listed below are the Loss Payees/Additional Interests present on the policy. CAR 1 Monroe County/Risk Mngmt 5100 College Rd Key West,FL 33040 Listed below are Important Messages about your policy. Personal Injury Protection Option H Your policy is free of any accident, conviction or inexperiencpd driver surcharge. IMPORTANT: Your policy premium may have changed due to rating by make and model of your car. Please check the vehicle description shown. The "Stacking" referred to in PAC 4/FL, UNINSURED MOTORISTS, applies to all cars listed on the policy. Rental Car Coverage, referred to under "Our Obligations to You (Part 3)" of your policy, applies for Car (s) 1 , 2. THE COMPANY MUST RECEIVE YOUR PREMIUM PAYMENT BY THE EFFECTIVE DATE OF YOUR RENEWAL FOR COVERAGE TO CONTINUE. YOUR CHECK OR MONEY -ORDER WILL NOT BE DEEMED PAYMENT UNLESS HONORED BY YOUR BANK. H L BRIDGES CLUCHFC MANAGER pnr ARi rn i/on ei DAr[ , r Prudential Property and Casualty ThePrudential AV Insurance Company and Affiliated 000002 '"MW Companies Subsidiaries of The Prudential Insurance Received Billing Statement Company of America g P. 0. Box 2627 Risk Mgmt. & Loss Contr(gar Policy Jacksonville, FL 32232 DATE SIT 7'S�: Policy Number 394A805503-2 INITIAL Paymenf Due Date 07/28/95 Bill To: Dedek, John N & Jeannette S 701 Waddell Key West FL 33040-4728 07/10/95 1 583.00 0.00 1 583.00 207.00 376.00 We are pleased to tell You that your policy has been reinstated for the remainder of the term, subject to your timely payment of any additional premium that may be due. If your payment Is less than the amount due, it will be returned to you. To make changes to your policy or obtain billing information, call: Your local Prudential Office at...................1-305-670-0o88 or Client Services at ....... 1-800-437-5556 To report a claim, call............ 1-800-437-3535 APPROVED BY RISK MANAGEMENT BY. DATE Look for other messages on the reverse. Detach here. ThePrudential Imp When making payment, please: Be sure we receive your payment by the due date, since there is no grace period. Make your check payable to Prudential. Include your policy number on the check. Note that payment by check is subject to its being honored and paid. Four Payment Plan Selected Payment Amount Due 2 30.00 Remaining Installments 1 Installments including service charge of $ 1 147.00 Next Bill to be sent 07/20/95 To Pay in Full 376.00 Thank you for insuring with The Prudential. Detach here. Full Minimum Payment Payment 376.00 230.00 Payment is due at the address below by: 07/28/95 Prudential Dedek, John N & J Account Processing Center 394A8o55o3-2 Holmdel, N.J. 07777 /0394180550320002300007289509 AL SD02-00006 THE QUICKEST AND SUREST WAY OF HAVING YOUR PAYMENT CREDITED IS 5 TO RETURN THIS PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE. PAC 29726 Ed. 8/93 039418055032 01OD23000003760000230000728955 ERTIFICATE +�1" INSUR NCE THE 0057g' ISSUE DATE (MM/DD/YY) Fl 09/18/95 PRODUCER 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 EY WEST INSURANCE INC. POLICIES BELOW. .0. BOX 9108 COMPANIES AFFORDING COVERAGE KEY WEST FL 33041-9108 COMPANY A PROGRAM UNDERWRITERS LETTER COMPANY B Annn.r„Fri C4 PI"1k. !�t.A 1 E ,NT INSURED LETTER a ITTLE JOHN' S COMPANY C PV Dig !G EACHSIDE CAFE LETTER EST ASSOC OF KW COMPANY 27 DUVAL STREET LETTER KEY WEST , FL 33040 COMPANY E r YES LETTER 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 POLIG`IES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. O POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS TR DATE (MM/DD/M DATE (MM/DD/YY) GENERAL LIABILITY PU 8 0 4 2 7 7/ 2 7/ 9 5 7/ 2 7/ 9 6 GENERAL AGGREGATE $ 1 0 0 0 0 0 MMERCIAL GENERAL LIABILITY PRODUCTS—COMP/OP AGG. $ 1 0 0 0 0 0 LAIMS MADE OCCUR. PERSONAL & ADV. INJURY $ 1 0 0 0 0 0 OWNER'S & CONTRACTOR'S PROT, EACH OCCURRENCE $ 1,000,00( FIRE DAMAGE (Any one fire) $ 50,00( MED.EXP. (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ BODILY INJURY HIRED AUTOS NON —OWNED AUTOS (Per accidenq $ GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM STAMORY LIMITS WORKER'S COMPENSATION EACH ACCIDENT � AND Recei« $ DISEASE —POLICY LIMIT $ EMPLOYERS' LIABILITY jgillL. _ontrol DISEASE —EACH EMPLOYEE $ OTHER DATE , --- —_ iNIT1AL -"�'�— DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ERTIFICATE HOLDER IS LANDLORD AND ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION _. .N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MONROE COUNTY MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE RISK MANAGEMENT LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ATTN : KAY MILLER LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 5100 COLLEGE ROAD KEY WEST FL 33040 AUTHORIZED R PRESENTATIVE to—�-}- Ct,�,Q ACORD �25 5 (7/") G C : c { u1 OACORD CORPORATION 100 01 ThePrudential A NEW P. O. Box 2627 Jacksonville FL 32222 XJE0105090 Client Services 904-391-5252 Lienholder Name and P.O. Address I- Loss Payee Prudential Property and Casualty III�IINIIII�II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIII'IIII�II Insurance Company A Subsidiary of The Prudential Insurance Company of America Certificate of Insurance Policy Number: 39 4A805503 Recelveo fc sk-,Mgmt, & Loss Control MONROE COUNTY D rr_ Attn: ISK MNGMT 5100 COLLEGE RD INITIAL. -� KEY WEST,FL 33040-4319 K Additional Interest Dedek, John N & Jeannette S 701 Waddell Key West FL 33040 Vehicle Data: Veh. Year Make Model 93 GMC Sierral50 Coverage Data: Policy effective From 11 /03/95 APPP,'Vlc,? Pv FIST; Until Terminated PY_ DA.2 - WAIVER: N/A _,Z YES Body Type Vehicle Identification # Pkp 4X2 2GTEC19H7P1523008 Bodily Property Uninsured Underinsured Collision Comprehensive Injury Damage Motorists Motorists Deductible Deductible 1001000/ 50,000 1001000/ 250 250 300,000 300,000 Transaction Effective Date: 11/03/95 Messages: RENEWAL REFUSED BY INSURED Certificate of Insurance - The Company states that it has issued to the insured named on this certificate a policy which includes the coverage(s) shown. The Loss Payee's interest or the Additional Insured's interest (which includes a Leasing Company) under the Certificate of Insurance will continue in force until terminated. Notice of termination will be mailed to the Loss Payee or the Additional Interest at least 10 days before the effective date of the termination. A Loss Payee or an Additional Interest should review the Loss Payee and Additional Interest Clause and/or the Additional Interest Clause shown on the reverse. PAC 187 Ed. 4193 LNF 1-005093 PRODUCER ISSUEDATE(MMiODNY) THE PORTER ALLEN COMPANY 513 SOUTHARD STREET Received KEY WEST, FL 33040 Ri.,k Mgmt. & Loss DATE 6 CODE SI9L'AC INSURED CJ RESTAURANT ASSOC. OF KEY WEST L.J.'S BEACHSIDE RESTAURANT 227 DUVAL STREET KEY WEST, FL 33040 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. .o1 COMPANIES AFFORDING COVERAGE APPROVED R� RICK �JlaruerrMENT COMPANY A O LETTER BY t"MPANY B DATE LETTER COMPANY C V!ATFR: N/A YES LETTER COMPANY D LETTER Florida Restaurant Assoc. SZF COMPANY E LETTER 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. TWITH RESPECT TO WHICH THIS HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT C ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE_ TPOLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DO/YY) I DATE (MM/DO/YY) ALL LIMITS IN THOUSANDS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILII CLAIMS MADEF OCCUR. OWNER'S a CONTRACTOR'S PRC 8 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS I HIRED AUTOS NON -OWNED AUTOS rl GARAGE LIABILITY c L EXCESS LIABILITY OTHER THAN UMBR. FORM D WORKERS' COMPENSATION AND 895-3468 1/13/95 EMPLOYERS" LIABILITY OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS 30 DAYS NOTIC3! or cANCSLLATioH is PXQUnUn ON WOPJ=S C014PERSATIOH MONROE COUNTY 5100 COLLEGE ROAD KEY WEST, FL 33040 ATTN: RISK MANAGEMENT GENERAL AGGREGATE EACl/ OCCURRENCE COMBINED SINGLE LIMIT BODILY INJURY INJURY _ (PR. ACC.) PROPERTY DAMAGE EACH AGGREGATE OCCURRENC STATUTORY 1 / 1 / 96 100,00 (EACH ACCIDENT) 500,000 (DISEASE-POL. LIM.) 100,000 (DISEASE -EA. EMPL.) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL lD OAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 13UT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE (?,/C� //��