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Certificates of Insurance
FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS ASSOCIATION, INC. RSA SELF INSURERS FUND P.O. BOX 4907 • WINTER PARK, FL 32793 • (407) 671 -FRSA 1- 800 - 767 -3772 • FAX (407) 671 -2520 CERTIFICATE OF INSURANCE ISSUED TO: Marathon Airport Bob Nilson & Company, Inc. 9400 Overseas Hwy, Ste 200 10460 SW 187 Terrace Marathon FL 33050 Miami FL 33157 ATTN:To Whom it may concern This is to certify that Bob Hi lson & Company, Inc. 10460 SW 187 Terrace Miami FL 33157 being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of compensation by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS ASSOCIATION SELF INSURERS FUND. COVERAGE NUMBER: 870 008328 LIMITS Workers' Compensation Statutory - State of Florida EFFECTIVE DATE: 01/01/98 0 /01 /99 Employers' Liability $100,000 - Each Accident EXPIRATION DATE: $100,000 - Disease, Each Employee $500,000 - Disease, Policy Limit REMARKS: Non - cancelable without 30 days prior written notice. Additional location insured: 300 Atlantic Drive Key Largo, FL 33037 Qualifiers: Mark A. Zehnal- CCC041344,CBC 038910, Robert B. Nilson - CC CO17513, Gonzalo C. Arostegui - CG C013930 Bradley R. Farinelli- CCCO57397, Tibor Torok- CCCO57388 This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be constructed as extending coverage not afforded by the policy(ies) shown above or as affording insurance to any insured not named above. DATE: 111/ ?2/9A By: Tom e, Admin istrator FRSA -SIF ri "'R V. P • SK . " ` w 11 l�_ By: ZO .¢. (�j Debbie Kemmerer - SI Accounts Representative DATE _ i v FRSA -SIF P WAIVER: ,A, -::',: - 1 -'," :::::*::: ‹,- ,;., -,:"%.,,,,,' . r:..::..::: Immiquimmim __ Gamoom ;:.,,$. k . .12 1 121:::: ,, k . •.„ :.:. % .,.. : .,,. :,•:....• .. • . .. c Sc...........x.x.x..,,wm..w.,:... PA PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CORPORATE RISK MANAOEMENT HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P . O . Box 788 L • V - c . . • I = I • :• •y • = • , Melbourne FL 3480= 4788 COMPANIES AFFORDING COVERAGE COMPANY A Assurance Co. of America INSURED COMPANY tlob Moon & Company, buo B 10480 8.W. 187th Terrace COMPANY Wand, EL 33117 C COMPANY D THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF 14&MANCE POLY NUMBER POLICY EFFECTIVE POUCY EXPIRATION LMTS LTA DATE wawa) DATE IMWDDtr0 A GENERA walurr ECA20609203 10/01/98 10/01/99 GENERAL AGGREGATE $ 2,000,000 X CoMMEflCIAL GENERA LUBLm PRODUCTS - COMP/OP AGO 8 2,000,000 was MADE © occim PERSONAL & ADY INJURY $ 1,000,000 — OWENS & CONTRACTORS PROT EACH OCCURRENCE $ 1,000,000 FiE DANAGE (My an. nn) 8 300 000 MED DP (Any one parson) $ 10,000 A AUTOMOBILE LIAeuTY EC88717624 10/01/98 10/01/99 comma) MOLE UNIT $ 1,000,000 X ANY AUTO ALL OWED AUTOS BOOLY INJURY SCHEDULED AUTOS (Par psis* 8 X HIED AUTOS BODILY INJURY X NON AUTOS (Per accident) $ i KM' D RY RI <r • FA PROPERTY DAHIAtE 8 �� u 0 10 . WAGE LIABLIIY , . AUTO ONLY - EA ACCIDENT 8 _ MIY AUTO I ��_ ,� �� nEr OD TW W AUTO ONLY: EACH ACCIDENT $ R: k.'3 /,'f AGGREGATE $ EXCESS LUBLITY – EACH OCCURRENCE $ UMBRELLA FOAM AGGREGATE 8 ODER THAN UMBRELLA FOAM 8 T11 1 WORKERS COMPENSATION AND I m S I l '< >>s>>» ?` 3 >i <!; >[<x B. EACH ACCIDENT s DE PROPREfORI NCL a DISEASE - POUCY UNIT 8 MIDERSE ECUTNE – OFFICERS ARE EX L B. DISEASE - M EMPLOYE _ 8 OTHER • DEPT p� �1o�L0G CIAL REMS Issued 10/ 95 Board OOsSissianers for Monroe County is named as Additional Insured with respect to General Liability and Auto Liability only. Additional Insured applies only to operations performed by the insured. Revised COl: 11/12/98 :;4'I Eva ,'.x, a "EIV.22{ 2 : : v: Ry ry¢r : Z ,h ig R .2 ESERMI .}• SHOULD ANY OF TTE ABOVE DESCRIBED POLICES BE CANCELLED BEOAE THE Marathon Airport EXPIRATION DATE THBEOF, THE ISSUING COMPANY WLL DNDEAVOR TO MAL Aunt 0400 Overseas Huy. 4200 10 DAYS mum NOTICE TO THE a3TTFICATE HIOI.0 AIMED TO THE NUT Marathon PL 33050 BUT FANM S TO MM. SUCH • 1 ■ SMALL IMPOSE NO 08UGATIOILOR LIABILITY OF ANY KIND UPON THE • • 7 . ITS AGENTS OR A =- AUTHORS= - -- := Cindy Brown , , ttl .;• {.};fi 2:11;•• } >:••.•.'t: {t; ;�r:•:r•:ft�'f45:• ::v� +: }`.2i: :;:: :::; %r:: ;• ;+c •ttt { { { � f a. ::,t•.. `j :"R� ':fP,: ;.:• } •• •• }:•:•: t 7 r •:. • :: }tt:: tt {t{:::< ; ;i }3'i, <iu: r•;: ::.••: •: f. . 3:. K ..: C. .. . :.:• '' . l ; ',f.v. : . �..:t t?�H I.{ : ...:.:. :: :. �. s. <}, ;':'a t• {:{;r._:;:•::t_tt:••:} t• tL '?n: f:3::ti:•?t:n < #2,�, a: s' : y •: b 1 . . . . 2 , FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS ASSOCIATION, INC. RSA SELF INSURERS FUND P.O. BOX 4907 • WINTER PARK, FL 32793 • (407) 671 -FRSA 1- 800 - 767 -3772 • FAX (407) 671 -2520 CERTIFICATE OF INSURANCE ISSUED TO: Monroe County Florida Bob Nilson & Company, Inc. 1500 College Road 10460 SW 187 Terrace Key West FL 33040 Miami FL 33157 M600E iriiIT'; CaisTP" r'T" ' c v 77 T T DEC 071998 This is to certify that Bob Hi lson & Company, Inc. ' TIME.: • 201. 10460 SW 187 Terrace RECEIVED BY: Fig Miami FL 33157 being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of compensation by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS ASSOCIATION SELF INSURERS FUND. COVERAGE NUMBER: 870 008328 LIMITS EFFECTIVE DATE: 01/01/99 Workers' Compensation Statutory - State of Florida 0 /01 /00 Employers' Liability $100,000 - Each Accident EXPIRATION DATE: $100,000 - Disease, Each Employee $500,000 - Disease, Policy Limit REMARKS: Non - cancelable without 30 days prior written notice. Additional location insured: 300 Atlantic Drive Key Largo, FL 33037 Qualifiers: Mark A. Zehnal- CCC041344,CBC 038910, Robert B. Hilson - CC C017513, Gonzalo C. Arostegui - CG C013930 Bradley R. Farinelli- CCCO57397, Tibor Torok- CCCO57388 This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be constructed as extending coverage not afforded by the policy(ies) shown above or as affording insurance to any insured not named above. DATE: 12/02/9F1 By: i/ / - — Tom - e, Administrator FRSA -SIF By: 1 tvr• n.P/1. Debbie Kemmerer- S Accounts Representative DATE ``-- FRSA -SIF WATER: ,r. 7 "FS . Oa? e CC ' 01144/ cr4 . PlenPitt— 010J2.