FY1995 05/16/1995BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
;Dannp 1L. Rotbage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
M E M O R A N D U M
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 952-7145
To: John Carter, Director
Office of Management & Budget
From: Isabel C. DeSantis, Deputy Clerk n C �p
Date: May 25, 1995
At the May 16,"'1995 meeting, the Board granted approval and
authorized execution of Contract between Monroe County and the
Florida Keys Children Shelter, Inc.
Attached hereto is a duplicate original of the subject Agreement
for return to the Provider.
Should you have any questions concerning this matter, please do
not hesitate to contact me.
cc: County Administrator w/o document
County Attorney
Finance
/File
L
FILED FOr' RFCOPD AGREEMENT
'9This(�X�gre�ement?� made and entered into this f �+ day of 1995,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA,
hereinafter referred to as "Board" or "County," and FLORIDA KEYS CHILDREN'S SHELTER,
INC., hereinafter referred to as "Provider."
WHEREAS, it is provided in the Provider's Articles of Incorporation that the purpose of
the Provider is to provide early intervention and prevention programs for youth in crisis and
their families and help in the form of an emergency shelter residential facility for abused,
neglected and runaway children; and
WHEREAS, the Board recognizes a public purpose in reimbursing the Provider for
employee salaries and operating expenses in lieu of providing the public support which
would otherwise be necessary for children in crisis and their families, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is
agreed as follows:
l . AMOUNT OF AGREEMENT. The Board, in consideration of the Provider
substantially and satisfactorily performing and carrying out the duties of the Board as to
providing shelter, and early intervention and prevention programs for youth's and their
families living in Monroe County, Florida, shall pay to the Provider the sum of Twenty Six
Thousand Six Hundred Ninety-five Dollars ($26,695.00) for fiscal year 1994-95.
2. TERM. This Agreement shall commence on June 1, 1995, and terminate
September 30, 1995, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be paid periodically, but no more frequently than
monthly as hereinafter set forth. Reimbursement requests will be submitted to the Board
via the Clerk's Finance Office. The County shall only reimburse, subject to the funded
amounts below, those reimbursable expenses which are reviewed and approved as
complying with Florida Statutes 112.061 and Attachment A - Expense Reimbursement
Requirements. Evidence of payment by the Provider shall be in the form of a letter,
summarizing the expenses, with supporting documentation attached. The letter should
contain a certification statement as well as a notary stamp and signature. An example of
a reimbursement request cover letter is included as Attachment B.
After the Clerk of the Board examines and approves the request for reimbursement,
the Board shall reimburse the Provider. However, the total of said reimbursement expense
payments in the aggregate sum shall not exceed the total amount of $26,695.00 during the
term of this agreement.
4. SCOPE OF SERVICES. The Provider, for the consideration named, covenants
and agrees with the Board to substantially and satisfactorily perform and carry out the
duties of the Board in providing shelter, and early intervention and prevention programs for
youth's and their families living in Monroe County, Florida.
5. RECORDS. The Provider shall maintain appropriate records to insure a
proper accounting of all funds and expenditures, and shall provide a clear financial audit
trail to allow for full accountability of funds received from said Board. Access to these
records shall be provided during weekdays, 8 a.m. to 5 p.m., upon request of the Board,
the State of Florida, or authorized agents and representatives of the Board or State.
The Provider shall be responsible for repayment of any and all audit exceptions
which are identified by the Auditor General of the State of Florida, the Clerk of Court for
Monroe County, an independent auditor, or their agents and representatives. In the event
2
of an audit exception, the current fiscal year contract amount or subsequent fiscal year
contract amounts shall be offset by the amount of the audit exception. In the event this
agreement is not renewed or continued in subsequent years through new or amended
contracts, the Provider shall be billed by the Board for the amount of the audit exception
and the Provider shall promptly repay any audit exception.
6. INDEMNIFICATION AND HOLD HARMLESS. The Provider covenants and
agrees to indemnify and hold harmless Monroe County Board of County Commissioners
from any and all claims for bodily injury (including death), personal injury, and property
damage (including property owned by Monroe County) and any other losses, damages,
and expenses (including attorney's fees) which arise out of, in connection with, or by
reason of services rendered under this agreement by the Provider or any of its agents,
employees, officers, subcontractors, in any tier, occasioned by the negligence or other
wrongful act or omission of the Provider or its subcontractors in any tier, their employees or
agents. The extent of liability is in no way limited to, reduced, or lessened by the insurance
requirements contained elsewhere within this agreement.
7. INDEPENDENT CONTRACTOR. At all and for all purposes hereunder, the
Provider is an independent contractor and not an employee of the Board. No statement
contained in this agreement shall be construed so as to find the Provider or any of its
employees, contractors, servants or agents to be employees of the Board.
8. COMPLIANCE WITH LAW. In providing all services pursuant to this
agreement, the Provider shall abide by all statutes, ordinances, rules and regulations
pertaining to or regulating the provision of such services, including those now in effect and
hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall
3
constitute a material breach of this agreement and shall entitle the Board to terminate this
contract immediately upon delivery of written notice of termination to the Provider.
9. PROFESSIONAL RESPONSIBILITY AND LICENSING. The Provider shall assure
that all professionals have current and appropriate professional licenses and professional
liability insurance coverage. Funding by the Board is contingent upon retention of
appropriate local, state and/or federal certification and/or licensure of the Provider's
program and staff.
10. INSURANCE. The Provider shall obtain, prior to the commencement of work
governed by this agreement, at Provider's own expense, that insurance specified in the
insurance schedules attached hereto and incorporated herein by reference. The Provider
will also insure that all subcontractors, in any tier, have obtained the insurance as specified
in the attached schedules. The Provider will not be reimbursed for any work commenced
prior to coverage with required insurance. The Provider will not be reimbursed for any
services governed by this contract until satisfactory evidence of the required insurance has
been furnished to the Board via either Monroe County's certificate of insurance or a
certified copy of the actual insurance policy. Delays in the commencement of work,
resulting from the failure of Provider to provide satisfactory evidence of the required
insurance, shall not extend deadlines specified in this agreement. The Provider shall
maintain the required insurance throughout the entire term of this agreement. Failure to
comply with this provision may result in the immediate termination of reimbursement.
The Board, at its sole option, has the right to request a certified copy of any or all
insurance policies required by this agreement. If a certificate of insurance is provided, the
County -prepared form must be used. "Accord Forms" are not acceptable.
4
All insurance policies must specify that they are not subject to cancellation, non -
renewal, material change, or reduction in coverage unless a minimum of thirty (30) days
prior notification is given to the Board by the insurer. The standard language of "endeavor
to provide notification" is insufficient. The acceptance and/or approval of the Provider's
insurance shall not be construed as relieving the Provider from any liability or obligation
assumed under this agreement or imposed by law.
Monroe County, Monroe County Board of County Commissioners, its employees
and officials shall be included as "additional insureds" on all policies, except for worker's
compensation.
Any deviations from these general insurance requirements must be requested in
writing on the County -prepared form entitled "Request for Waiver or Modification of
Insurance Requirements" and approved by Monroe County's Risk Manager.
11. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the
services and/or reimbursement of services shall be amended by an agreement
amendment, which must be approved in writing by the Board.
12. NO ASSIGNMENT. The Provider shall not assign this agreement except in
writing and with the prior written approval of the Board, which approval shall be subject to
such conditions and provisions as the Board may deem necessary. This agreement shall be
incorporated by reference into any assignment and any assignee shall comply with all of
the provisions herein. Unless expressly provided for therein, such approval shall in no
manner or event be deemed to impose any obligation upon the Board in addition to the
total agreed upon reimbursement amount for the services of the Provider.
5
13. NON-DISCRIMINATION. The Provider shall not discriminate against any
person on the basis race, creed, color, national origin, sex or sexual orientation, age,
physical handicap, 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. At all times, the Provider shall comply with all applicable laws and regulations
with regard to employing the most qualified person(s) for positions under this agreement.
The Provider shall not discriminate against any person on the basis of race, creed, color,
national origin, sex or sexual orientation, age, physical handicap, financial status or any
characteristic or aspect in its providing of services.
14. AUTHORIZED SIGNATURES. The signatory for the Provider below, certifies and
warrants that:
(a) The Provider's name in this agreement is the full name as designated in its
corporate charter, if a corporation, or the full name under which the Provider is authorized
to do business in the State of Florida.
(b) He or she is empowered to act and contract for the Provider; and
(c) This agreement has been approved by the Board of Directors of the Provider
if the Provider is a corporation.
15. NOTICE. Any notice required or permitted under this agreement shall be
in writing and hand -delivered or mailed, postage pre -paid, by certified mail, return receipt
requested, to the other party as follows:
For Board: Louis LaTorre
Monroe County Social Services Director
Public Service Building
5100 College Road
Key West, Florida 33040
and
R
Monroe County Attorney
310 Fleming Street, upstairs
Key West, Florida 33040
For Provider: Janet Peterson
Interim Executive Director
Florida Keys Children's Shelter, Inc.
73 High Point Road
Tavernier, Florida 33070
16. CONSENT TO JURISDICTION. This agreement shall be construed by and
governed under the laws of the State of Florida and venue for any action arising under this
agreement shall be in Monroe County, Florida.
17. NON -WAIVER. Any waiver of any breach of covenants herein contained to
be kept and performed by the Provider shall not be deemed or considered as a
continuing waiver and shall not operate to bar or prevent the Board from declaring a
forfeiture for any succeeding breach, either of the same conditions or covenants or
otherwise.
18. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be
continued at a level sufficient to allow for continued reimbursement of expenditures for
services specified herein, this agreement may be terminated immediately at the option of
the Board by written notice of termination delivered to the Provider. The Board shall not be
obligated to pay for any services or goods provided by the Provider after the Provider has
received written notice of termination, unless otherwise required by law.
19. PURCHASE OF PROPERTY. All property, whether real or personal, purchased
with funds provided under this agreement, shall become the property of Monroe County
and shall be accounted for pursuant to statutory requirements.
7
20. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the Provider and the Board.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be
executed as of the day and year first written above.
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
By: C . aef- i�
Deputy CIA
Witness
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By.
Ma r/Chairman
FLORIDA KEYS CHILDREN'S
SHELTER, INC.
(Federal ID No.59-J606s S6 )
y<
Witness Executive Director(�,��,
i
WCONS/shelter.doc
8
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
s oouNrr�
c
J�4 JM'CUipfi\G
.i
090E COUNTY, fed'
wannp 3L. Rotbage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
Dear Human Service Organizations,
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
In an effort to streamline the expense reimbursement process,
please note the change of address for submitting your requests.
Effective with your fiscal year 1995 contracts (October 1, 1994
thru September 30, 1995), all reimbursement requests should be
mailed to:
Clerk of the Court
500 Whitehead Street
Key West, FL 33040
Attn: Finance Department
You will also find several attachments to the contract. One is a
document titled "Expense Reimbursement Requirements." This was
prepared in an attempt to eliminate any confusion regarding
required supporting documentation.
A "prototype cover sheet" has been provided in an effort to assist
you in packaging your request, as well as to facilitate the review
process in our office. Please let me know if you want blank copies
of the cover sheet for your reimbursement requests.
Please contact me at 292-3528 with any questions or comments
regarding this change.
Sincerely,
wt�o
Stephanie Griffiths
Chief Accountant
ATTACHMENT A
Expense Reimbursement Requirements
This document is intended to provide "basic" guidelines to Human
Service Organizations, county travellers, and contractual parties
who have reimbursable expenses associated with Monroe County
business. These guidelines, as they relate to travel, are
interpreted from Florida Statute 112.061, which is attached for
reference.
A cover letter summarizing the major line items on the reimbursable
expense request should also contain a certified statement such as:
I certify that the attached expenses are accurate and in
agreement with the records of this organization. Furthermore,
these expenses are in compliance with this organization's
contract with the Monroe County Board of County Commissioners.
Invoices should be billed to the contracting agency. Third party
payments will not be considered for reimbursement. Remember, the
expense should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the
level of detail in the contract. This document should not be
considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis.
Any questions regarding these guidelines should be directed to
Stephanie Griffiths at 305-292-3528.
Payroll:
A certified statement verifying the accuracy and authenticity of
the payroll expenses.
If a Payroll Journal is provided, it should include:
Payroll Journal dates
employee name, salary, or hourly rate
hours worked during the payroll journal dates
withholdings where appropriate
check number and check amount
If a Payroll Journal is not provided the following must be listed:
check number, date, payee, check amount
support for applicable payroll taxes
Original vendor invoices must be submitted for Worker's
Compensation and liability insurance coverage.
Telephone expenses:
A user log of pertinent information must be remitted: th���? aIrty
called, the caller, the telephone number, the date, and the purpose
of the call must be identified.
Telefax, fax, etc.:
A fax log is required. The log must define the sender, the
intended recipient, the date, the number called, and the reason for
sending the fax.
supplies, services, etc.:
For supplies or services ordered the County requires the original
vendor invoice.
Rents, leases, etc.:
A copy of the rental agreement or lease is required. Deposits and
advance payments will not be allowable expenses.
Postage, overnight deliveries, courier, etc.:
A log of all postage expenses as it relates to the County contract
is required for reimbursement. For overnight or express
deliveries, the original vendor invoice must be included.
Reproductions, copies, etc.:
A log of copy expenses as it relates to the County contract is
required for reimbursement. The log must define the date, number
of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor
services, the original vendor invoice is required and a sample of
the finished product.
Travel expenses: please refer to Florida Statute 112.061.
Travel expenses must be submitted on a State of Florida Voucher for
Reimbursement of Travel Expenses. Credit card statements are not
acceptable documentation for reimbursement.
Airfare reimbursement requires the original passenger receipt
portion of the airline ticket. A travel itinerary is appreciated
to facilitate the audit trail.
Auto rental reimbursement requires the original vendor invoice.
Fuel purchases should be documented with original paid receipts.
Original taxi receipts should be provided. However, reasonable
fares will be reimbursed without receipts. Taxis are 'tot
reimbursed if taken to arrive at a departure point: for example,
taking a taxi from one's residence to the airport for a business
trip is not reimbursable.
Original toll receipts should be provided. However, reasonable
tolls will be reimbursed without receipts.
Parking is considered a reimbursable travel expense at the
destination. Airport parking during a business trip is not.
Lodging reimbursement requires a detail listing of charges. The
original lodging invoice must be submitted. The County will only
reimburse the actual room and related bed tax. Room service,
movies, and personal telephone calls (see previous guidelines) are
not allowable expenses. Per diem lodging expenses may apply.
Again, refer to Florida Statute 112.061.
Meal reimbursement is breakfast at $3.00, lunch at $6.00, and
dinner at $12.00. Meal guidelines are that travel must begin prior
to 6 am for breakfast reimbursement, before noon and end after 2pm
for lunch reimbursement, and before 6pm and end after 8 pm for
dinner reimbursement.
Mileage reimbursement is calculated at 20 cents per mile for
personal auto mileage while on county business. Effective October
1, 1994, mileage will be reimbursed at 25 cents per mile. An
odometer reading must be included on the state travel voucher for
vicinity travel. A mileage map is attached for reference to
allowable miles from various Florida destinations.
Mileage is not allowed from a residence or office to a point of
departure: for example, driving from one's home to the airport for
a business trip is not a reimbursable expense.
Data processing, PC time, etc.:
The original vendor invoice is required for reimbursement.
Intercompany allocations are not considered reimbursable
expenditures unless appropriate payroll journals for the charging
department (see Payroll above) are attached and certified.
The following expenses are not allowable for reimbursement:
penalties and fines
non -sufficient check charges
fundraising
contributions
capital outlay expenditures
the contract)
(unless specifically included in
depreciation expenses (unless specifically included in the
contract)
SGRIFFITHS
WP51\PROCEDUR\EXP REIM
ATTACHMENT B
HUMAN SERVICE ORGANIZATION LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, Florida 33040
November 4, 1994
The following is a summary of the expenses for (Human Service
Organization name) for the time period of to
Check # Payee
F27UNTM�it•_�
101
A Company
rent
$xxxx.xx
102
B Company
utilities
$xxxx.xx
103
D Company
phones
$xxxx.xx
104
Person A
payroll
$xxxx.xx
105
Person B
payroll
$xxxx.xx
(A) Total S xx. xx
(B) Total prior payments $xxxx.xx
(C) Total requested and paid (A + B) $xxxx.xx
(D) Total contract amount $xxxx.xx
Balance of contract (D - C) SXLCNK.KX
I certify that the above checks have been submitted to the vendors
as noted and that the expenses are accurate and in agreement with
the records of this organization. Furthermore, these expenses are
in compliance with this organization's contract with the Monroe
County Board of County Commissioners and will not be submitted for
reimbursement to any other funding source.
Executive Director
Attachments (supporting documentation)
Sworn and subscribed before me this day of 19449'.
Notary Public
Notary Stamp
MILEAGE CHART
KEY WEST TO:
Bay Point
15
Big Coppitt
10
Big Pine
31
Big Torch Key
29
Clearwater Beach
399
Coco Beach
350
Conch Key
55
Cudjoe Key
22
Dania
180
Daytona Beach
416
Duck Key
62
R. Lauderdale
183
Ft. Myers
275
Gainesville
476
Grassy Key
56
Hollywood
175
Homestead
127
Islamorada
83
Jacksonville
505
Key Colony Beach
53
Key Largo
101
Lakeland
365
Layton
70
Little Torch Key
28
Long Key
70
Lower Matecumbe Key
75
Marathon
48
Marathon Shores
53
Marco Island
221
Miami
155
Miami Beach
170
Middle Torch Key
26
Naples
236
Ocean Reef
118
Opa Locka
180
Orlando
378
Palm Beach
223
Palm Beach Gardens
238
Panama City
702
Plantation Key
87
Ramrod Key
27
Rock Harbor
100
Stock Island
05
Sugarloaf Key
17
Summerland Key
24
W. Summerland Key
31
Sunshine Key
39
Tallahassee
606
Tampa
391
Tavernier
92
Vacation Village
84
MARATHON TO:
Big Pine Key
17
Conch Key
12
Islamorada
35
Key Largo
50
Long Key
22
Miami
110
Plantation Key
39
Summerland Key
24
Sunshine Key
09
Tavernier
45
BOOT KEY TO:
Long Key 20
Middle Torch 22
HOMESTEAD TO:
Key West
127
Plantation
42
Tavernier
35
KEY LARGO
TO•
Big Pine Key
70
Homestead
27
Islamorada
36
Long Key
40
Marathon
50
Miami
57
Ocean Reef
17
Plantation
14
LONG KEY TO:
Boot Key
20
Cudjoe Key
47
Homestead
61
Islamorada
16
Marathon
22
Miami
109
Middle Torch
43
Plantation Key
20
MIAMI TO:
Islamorada
72
Key Largo
54
Marathon
110
PLANTATION TO:
Big Pine
56
Duck Key
26
Homestead
42
Key Largo
14
Key West
87
Layton
17
Marathon
39
Miami
67
Sunshine Key
48
MONROE COUNTY, FLORIDA
INSURANCE GUIDE
TO
CONTRACT ADMINISTRATION
Indemnification and Hold Harmless
for
Human Service Organizations
The Organization covenants and agrees to indemnify and hold harmless Monroe County Board of County
Commissioners from any and all claims for bodily injury (including death), personal injury, and property
damage (including property owned by Monroe County) and any other losses, damages, and expenses
(including attorney's fees) which arise out of, in connection with, or by reason of services provided by the
Organization occasioned by the negligence, errors, or other wrongful act or omission of the
Organization's employees, agents or volunteers.
HHI 2
•, R fl:
..�1 � 1 �R'7� ....:.; CSR': BD DATEIMMIDD/YY)
FLKEYSC :: 03/13/95
PRooucER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Greg Roe Insurance, Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5006-208 Trouble Creek Road
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
New Port Richey FL 34652
COMPANIES AFFORDING COVERAGE
Barbara R. Davis
813-842-6263 m
Received COMPANY
mt. & Loss COnt Ol A National Union Fire Ins. Co.
INSURED
DATE-B
G •�
COMPANY
Florida United Business SIF
Florida Keys Children, dNITIAL
Shelter, Inc.
MPANY APPROVED f` °' .N ( %1ENT 0,e 16
C CC�RI�
73 Highpoint Road
Tavernier FL 33070
COMPANY UT
D
CQVRAGES:>
.....
..... ,. ..... ....... .... ........ ...._.:.
THIS IS TO �URERTIFY THAT THE POLICIS OF INSURANE LISTED BELOW HAVE BEEN R THE CY PER OD
rV
NOTW NOTWITHSTANDING ANYEREQUIREMENT,CTERM OR CONDITION OF ANY CONTRATCTR OTEREDOCUMENT �yOVE F�OCT TOLWHICH THIS
INDICATED,
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
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
s3,000,000
X
PRODUCTS - COMP/OPAGG
s3,000,000
A
COMMERCIAL GENERAL LIABILITY
MLP2083320
09/15/94
09/15/95
CLAIMS MADE Ix OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
$ 50,000
MED EXP (Any one person)
$ 51000
A
AUTOMOBILE
LIABILITY
ANY AUTO
MLA2038875
09/15/94
09/15/95
COMBINED SINGLE LIMIT
9 500,000
X
BODILY INJURY
(Per person)
s
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY.
`
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
B
WORKERS COMPENSATION AND
X FSTATUTORY LIMITS
B
EMPLOYERS' LIABILITY
EACH ACCIDENT
$ 500, 000
THE PROPRIETOR/ X INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
15116
15116
01/01/95
01/01/95
01/01/96
01/01/96
DISEASE- POLICY LIMIT
$ 500, 000
DISEASE -EACH EMPLOYEE
$500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
WORKERS COMPENSATION APPLIES TO FLORIDA OPERATIONS ONLY.
CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED UNDER GENERAL LIABILITY
COVERAGE.
CER7IFICAT6HOCDER
CANCELLATION ''
MONRO01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
MONROE COUNTY
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: RISK MANAGEMENT
5100 COLLEGE RD.
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
KEY WEST FL 33 040 -43 99
OF ANY KIND UPON THE COMPANY S AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE &Wmk4
Barbara R. Davis
ACORD 25 5 (3/93) [ tj/Yj
eACl7RD CORPORATION 1993<?