MiscellaneousC
UNTY SROE
ON
KEV WEST,RIDA 33040
(305) 294-4641
BOARD OF COUNTY COMMISSIONERS
- Wilhelmina Harvey, District 1
Ed Swift, District 2
Jerry Hernandez, District 3
_ Mayor Pro tern Alison Fahrer, District 4
Mayor Ken Sorensen, District 5
M E M O R A N D U M
DATE: October 15, 1984
TO: Danny L. Kolhage
Clerk of the Circuit Court
FROM: Sheri Smallwood
Asst. County Attorney
RE: Agreement between MSTD 1-D
and Fishermen's Hospital
Enclosed herewith please find the original and three copies
of the above -referenced agreement which the Commission approved
at their September 21, 1984 meeting. Upon complete execution of
said agreement, please forward to this office a copy of the same.
S E I LLW S OOc�Q�,.�
Asst. County Attorney
SS/brp
Enclosures
r
BOARD OF COUNTY COMMISSIONERS
O U N TYIF!NAN ROE ^ WSwifina Harvey, District ,
Ed Swift, District 2
KEY WEST, 33040 Jerry Hernandez, District 3
(305) 294-4641 ' Mayor Pro tern Alison Fahrer, District 4
OFFICE OF: E MENCY SERVICES :! Mayor Ken Sorensen, District 5
3131 0/S HWY.
MARATHON, FL. 33050
i
October 25, 1984
TO: Danny Kolhage, Clerk of thqefirc,
't Court
FRCM: James R. Paros, Director\.
Monroe County Emergency z2s
RE: Executed Agreement
Please find attached the original and one copy of the executed
agreement between MSTD 1-D and Fishermen's Hospital for the
operation of an advanced life support ambulance service.
JRP/me
Attachments (2)
TO Clerk of Courrtss, - Attn: Rosalee DEP'T
FROM Stacy DeVaneqHss . Coordinator DEP'T Ehergency Services
SUBJECT Attache-d Insurance Binders DATE November 21, 1984
Please find attached the insurance binders adding the two Big Pine ambulances
onto the insurance policy for Fishermen's Hospital.
Please attach to your copy of the agreement recently entered into between
District 1-D (Big Pine Key) and Fishermen's Hospital.
attachment
TOPS ® FORM 3397 LITHO W USA
INSURANCE BINDER Nov 1 0 1984
Binder No.
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT 0 r.>
• • • TO THE CONDITIONS SHOWN ON i I lk fIEVI f,SL: SIDE OF THIS FORM. F- 1.J11 ;X J M
E AND ADDRESS OF AGENCY COMPANY 11ULL COMPANIES
PAUL L ANDRE INC Effective12; 01am March 31 19 S_4
5701 OVERSEAS 11WY ##£3 Expires 12:01 am March 31 19 SS
MARAT11ON FL 33050 This binder is issued to extend coverage in the above named
company per expiring policy # L-IA313�.-44
( except as notes below
E AND MAILING ADDRESS OF INSURED Description of Operation/Vehicles/Property
C/AUTO 73 DODGE AMBULANCE ;;L,3 CtF 3X1�'303�
FISHERMANS 1-10SPITAL INC I C,'AU'TO 30 FORD AMBULANCE #E3"7L1-1Ji17S7
3301 OVERSEAS 11WY
MARAT11ON FL. 33050
Type and Location of Property
Coverage/Perils/Forms o"
Amt of Insurance Ded. ,o
T V Limits of Liability
Type of Insurance Co�esrage/forms
_ Eachoccurrence Aggregate
JScheduled Form Comprehensive Form Bodily Injury $ $
Premises/Operations Property
Products/Completed Operations Damage $ $
Contractual Bodily Injury &
Other (specify below) Property Damage
Med. Pay. $ Per $ Per Combined $
Person Accident
Personal Injury []A B C Personal Injury $
Liability Non -owned
Hired
Comprehensive -Deductible
$
Collision- Deductible
$
Medical Payments
$
Uninsured Motorist
$10, U00
No Fault (specify): PIP
Other (specify):
JWUKKtKS GUMFLNSAI IUN — Statutory Limits (specify statos below)
CIAL CONDITIONS/OTHER COVERAGES
ENDORSEMENT RECIUES-PED EFFECTIVE~ 111118A
ENDORSEMENT WILL FOLLOW SHORTL.Y.....
E AND ADDRESS OFOMORTGAGEE 0 LOSS PAYEE ADO t INSURED
LOAN Ni,M,[it ,
Bodily Injury (Each Person) $ bO AOO
BoCluy Injury (Each Accident) $1 r 00Property Damage $ 10
Bodily Injury & Property Damage
Combined $
EMPLOYERS' LIABILITY — Limit $
,n 7s (.i->>)
Si. - ature of Authorized
Date
INSURANCE BINDER Gov 1 o w4
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT
Binder No.
F-l0l..lr..1....-7
TO THE CONDITIONS SHOWN ON -THE
REVERSE SIDE OF THIS FORM.
VAME AND ADDRESS OF AGENCY
COMPANY 11ULL COMPANIES
PAUL L ANDRE INC
Effective12:01am March 31 19 Uri
5701 OVERSEAS HWY #8
Expires 12:01 am March 31 19 OS
MARAT11ON FL 33050
This binder is issued to extend coverage in the above named
company per expiring policy #f 7351
(except as no below )
VAME AND MAILING ADDRESS OF INSURED
Description of Operation/Vehicles/Property
C/AUTO ` DODGE AMBULANCE ffB35BF3X12303u
FISHERMANS HOSPITAL INC
C/AUTO � FORD AMBULANCE #E37L11JJ'1757
3301 OVERSEAS HWY
MARATHON FL 33050
Type and Location of Property
Coverage/Perils/Forms
Amt of Insurance
Ded,
co%s
P
R
P
E
�
R
r
f
Type of Insurance
Coverage/Forms
Limits of Liabilit
Each Occurrence
Aggregate
L
I
OScheduled Form Comprehensive Form
Bodily Injury
$
$
3
Premises/Operations
Property
I
Products/Completed Operations
Damage
$
$
L
Contractual
Bodily Injury &
I
Other (specify below)
Property Damage
r
Med. Pay. $ Per $ Per
Person
Combined
$
Personal Injury $
Limits of Liability
Acc,dent
Personal Injury
1 rY
OA 0 B nC
4
J
Liability Non -owned Hired
Bodily Injury (Each Person) $
r
Comprehensive -Deductible $ 1 Y 000
Bodily Injury (Each Accident) $
Collision -Deductible $ 11,000
Medical Payments Y $
Property Damage $
3
Uninsured Motorist $
Bodily Injury & Property Damage
I
No Fault (specify):
L
Other (specify):
Combined $
c
WORKERS' COMPENSATION — Statutory Limits (specify states below) EMPLOYERS' LIABILITY — Limit $
SPECIAL CONDITIONS/OTHER COVERAGES
ENDORSEMENT REQUESTED EFFECTIVE 11/1/0-4
ENDORSEMENT TO FOLLOW SlIORTLY. „ . o a a , o
NAME AND ADDRESS OF❑MORTGAGEE D LOSS PAYEE ADD'I INSURED
LOAN NUtsHLR
I
Nov u, ii'GiIT
v-----�
Si ature of Authorized R- tative Date
ORM 75 (11-77)