Loading...
Certificates of Insurance ISSUE GATE UIIM /00/YYI 11/19/91 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 754TI0V R1N(E NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, UIMII11, °''rl 61 FERO EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER 140 / ATTENTION CERTIFICATE HOLDER If ou have any y questions, KEN W I LL I TS , INC. please contact KATHY SON I ER 1 800 - 226 -3224, P 0 BOB 693960 2601 Cattlemen Road, Sarasota, Fl 34232 -6249 MIAMI, FL 33269 0960 COMPANIES AFFORDING COVERAGE INSURED PEDRO FALCON ELECTRICAL CONTRACT Company Letter A FCCI /SELF INSURERS FUND 1305 WEST INDIES DR Company Letter B: RAMROD KEY, FL 33042 9519 Company Letter C: THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1 INDICATED. NOT WITHSTANDING 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 POLICY POLICY LTR TYPE IN INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION ALL LIMITS IN THOUSANDS DATE (MM /DO /YY) DATE (MM /DO /YY) _ _ 4 GENERAL LIABILITY GENERAL AGGREGATE $ 1 COMMERCIAL GENERAL LIABILITY PRODUCTS -COMP 'OPS AGGREGATE $ g CLAIMS MADE [OCCURRENCE PERSONAL. & ADVERTISING INJURY $ OWNERS • CONUACTO1$ PROTECTIVE EACH OCCURRENCE $ FIRE DAMAGE (ANY ONE FIRE) $ MEDICAL EXPENSE (ARSQ I $ AUTOMOBILE LIABILITY ANY AUTO CSL BODILY f - ALL OWNED AUTOS INJURY .:............... SCHEDULED AUTOS I , PE SON) $ HIRED AUTOS ( IN NON -OWNED AUTOS AC CIDENT) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABI LITY • EACH AGGREGATE OCCURRENCE A OTHER THAN UMBRELLA FORM $ $ • A WORKERS' COMPENSATION STATUTORY AND 718 22226- 001 -001 01/01/92 12/31/92. $ 100 (EACH ACCIDENT► EMPLOYERS' LI $ 500 (DISEASE- POLICY LIMIT) $ 100 (DISEASE -EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS DBA: i z4 • • CERTIFICATE HOLDER LANr~ELEATlA1, MONROE COUNTY PUBLIC WORKS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN CINDY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO SEND 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. P 0 BOB 1029 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIL- KEY WEST, FL 33040 ITV OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE. AUTHORIZED REPRESENTATIVE 1 u 1 1 1 1 1 1 SET TAB STOPS AT ARROWS Of ® CERTIFICATE OF INSURANCE ISSUE 4/10/92 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 POLICIES BELOW. HORAN INSURANCE AGENCY, INC. P.O. BOX 284 COMPANIES AFFORDING COVERAGE SUMMERLANO KEY, FL 33042 COMPANY LETTER A American ProfessionA1 Insurance Co. COMPANY INSURED LETTER B , J Pedro C. Falcon c LETTER NY 1, 1305 West Indies Drive 6 Summerland Key, FL 33042 COMPANY D LETTER ( COMPANY E 1� LETTER COVERAGES THIS IS TO CERTIFY THAT 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 CONDI- TIONS OF SUCH POLICIES. CO POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS LTR TYPE OF INSURANCE POLICY NUMBER DATE (MOONY) DATE (MM /DD YY ) EACH OCCURRENCE AGGREGATE GENERAL LIABILITY BODILY A _x COMPREHENSIVE FORM C9204100140 4/16/92 4/16/93 INJURY $ PREMISES /OPERATIONS PROPERTY UNDERGROUND D COLLAPSE HAZARD DAMAGE $ $ PRODUCTS /COMPLETED OPERATIONS CONTRACTUAL CBI OMBIN 8 PD ED $300 $300 INDEPENDENT CONTRACTORS BROAD FORM PROPERTY DAMAGE PERSONAL INJURY PERSONAL INJURY $ AUTOMOBILE LIABILITY BODLY ANY AUTO INJURY ,PER IPEA PERSONI ALL OWNED AUTOS (PRIV PASS) BODILY OTHAN INJURY ALL OWNED AUTOS ( PRIV HER PATSS) PER ACCIDENT) $ HIRED AUTOS PROPERTY NON -OWNED AUTOS DAMAGE $ GARAGE LIABILITY BI 8 PD COMBINED $ EXCESS LIABILITY UMBRELLA FORM BI & PD COMBINED $ $ OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION STATUTORY AND $ (EACH ACCIDENT) EMPLOYERS' LIABILITY $ (DISEASE - POLICY LIMIT) - s • - $ (DISEASE EACH EMPLOYEE) OTHER Monro ,• • A Additional Insured Same DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION Monroe County c/0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- Monroe County Public Works PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 5100 College Rd. MAIL 10 DAYS W TTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE g LEFT, BUT FAILURE T • AIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Key West, FL 33040 OF ANY KIND UPON , COMPANY, ITS AGENTS OR REPRESENTATIVES. Attn: Wendy AUTHORIZED REPRES7 • ACORD 25 (8184) © IIR /ACORD CORPORATION 1984 . , • CERTIFICATE OF INSURANCE � • STATE FARM FIRE AND CASUALTY COMPANY, v This is to certify that ID STATE Bloomington, Illinois 9 ton R v ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois / / has in force for PEDRO FALCON Name of Policyholder 1305 W. Indies Drive Address of Policyholder Ramrod Key, F1. 33042 -9519 location of operations the following coverages for the periods and limits indicated below. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY (eff. /exp.) ❑ Comprehensive ❑ Dual Limits for: BODILY INJURY General Liability Each Occurrence $ ❑ Manufacturers' and Contractors' Liability Aggregate $ ❑ Owners', Landlords' and PROPERTY DAMAGE Tenants' Liability Each Occurrence $ The above insurance includes (applicable if indicated by ® ) ❑ PRODUCTS- COMPLETED OPERATIONS Aggregate' $ ❑ OWNERS' OR CONTRACTORS' PROTECTIVE LIABILITY ❑ CONTRACTUAL LIABILITY Combined Single Limit for: BODILY INJURY AND El BROAD FORM PROPERTY DAMAGE PROPERTY DAMAGE ❑ BROAD FORM COMPREHENSIVE GENERAL LIABILITY Each Occurrence $ 300,000. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Aggregate $ 300,000. (eff. /exp.) CONTRACTUAL LIABILITY LIMITS 557 9401- A08 -59 Automobile 1/8/92 to (If different than above) BODILY INJURY Insurance 7/8/92 Each Occurrence $ PROPERTY DAMAGE ❑ Each Occurrence $ ❑ Aggregate $ EXCESS LIABILITY ❑ Combined Single Limit for: BODILY INJURY AND PROPERTY DAMAGE ❑ Umbrella ❑ Each Occurrence $ Other Aggregate $ Workers Compensation Part 1 STATUTORY Part 2 BODILY INJURY ❑ and Employers Each Accident $ Liability Disease -Each Employee $ Disease - Policy Limit $ 'Aggregate not applicable if Owners', Landlords' and Tenants' Liability Insurance excludes structural alterations, new construction or demolition. THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. ILL EAU!, AGENT 2105 N. STATE RD. 7 (US 441! HOLLYWOOD, FLORIDA 3302? NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED HOLLYWOOD 987 -0121 MIAMI 624 -3145 MONROE COUNTY • •• 510 0 Junior College Road BA- 170111Mii ! ✓' Ke y West, F1. 33040 C/O Monroe County Public Works Signature of Authorized Representative Agent 1163 Title (5581F6 -994.9 Rev_ 1-86 Printed in U.S.A. * CERTIFICATE QF INSURANCE ISSUE DATE IMM /DD /YY) 12/09/92 Fc .CI FUN) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NPEVS1!ONL�IIR�V� NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, U)MN ltRIDBYFELSCO EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER 140 ATTENTION CERTIFICATE HOLDER: If you have any quest KEN W I LL I TS , INC. please contact KATHY SON I ER 1- 800 - 226 -3224, P 0 BOX 693960 2601 Cattlemen Road, Sarasota, Fl 34232 -6249 MIAMI FL 33269 -0960 COMPANIES AFFORDING COVERAGE INSURED PEDRO FALCON ELECTRICAL CONTRACT Company Letter A FCCI /SELF INSURERS FUND 1305 WEST INDIES DR Company Letter B: RAMROD KEY FL 33042 -9519 Company Letter C: COVERAGES TI-IIS IS TO CERTIFY THAT P01 ICIES OF INSIJRAMCE L'STF) BELOW 1-'4. VC BEENI IESLIED TC TI-I5 INSUrIED NAMED ABCVE FOF THE' POLICY PERIOD INDICATED. NOT WITHSTANDING 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 POLICY POLICY LTR TYPE IN INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION ALL LIMITS IN THOUSANDS DATE (MM /DD /YY) DATE (MM /DD /YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP /OPS AGGREGATE $ CLAIMS MADE OCCURRENCE PERSONAL & ADVERTISING INJURY $ OWNERS & CONTRACTORS PROTECTIVE EACH OCCURRENCE $ FIRE DAMAGE (ANY ONE FIRE) $ MEDICAL EXPENSE (ANY ONE $ PERSON) AUTOMOBILE LIABILITY ANY AUTO CSL $ BODILY ALL OWNED AUTOS INJURY gliFT SCHEDULED AUTOS (PER PERSON) BODILY HIRED AUTOS INJURY (PE NON -OWNED AUTOS ACC IDENT) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY OCCURRENCE AGGREGATE $ $ A OTHER THAN UMBRELLA FORM A WORKERS' COMPENSATION �f s� STATUTORY AND 718 - 22226 -00 -001 01/01/93 12/31/93 —l $ 100 (EACH ACCiOEHT) EMPLOYERS' LIABILITY $ 500 (DISEASE- POLICY LIMIT) $ 100 (DISEASE - EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS DBA CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BD OF COUNTY COMMI SS I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO SEND ATTN MONROE COUNTY PUBLIC WORKS 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 5100 COLLEGE RD BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIL- KEY WEST FL 33040 ITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE. AUTHORIZED REPRESENTATIVE 5F� • X609 REv Cafe k ! HOLDER > COPY 4 CERTIFICATE OF INSURANCE This certifies that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ['STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois insures the following policyholder for the coverages indicated below: Name of policyholder PEDRO FALCON ,31 7V( Address of policyholder 1305 W. INDIES DR. 1 RAMROD KEY, FL 33042 -9436 # ' el i 13 11 , 10 Location of operations 1 �' Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date ; Expiration Date (at beginning of policy period) Comprehensive BODILY INJURY AND f Business Liability PROPERTY DAMAGE This insurance includes: ❑ Products - Completed Operations ❑ Contractual Liability ❑ Underground Hazard Coverage Each Occurrence $ ❑ Personal Injury ❑ Advertising Injury General Aggregate $ ❑ Explosion Hazard Coverage Products - Completed ❑ Collapse Hazard Coverage Operations Aggregate $ El General Aggregate Limit applies to each project EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Date ; Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Part 1 STATUTORY I Part 2 BODILY INJURY Workers' Compensation Each Accident $ r and Employers Liability Disease Each Employee $ t Disease - Policy Limit $ POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date ; Expiration Date (at beginning of policy period) 557 9401- A08 -59B Automobile 1/8/93 7/8/93 $300,000.00 Single Limit Received Risk Mgmt. & Loss Cont'a - 3/ � G ? If any of the described policies are canceled before its DATE ..R expiration date, State Farm will try to mail a written notice to the certificate holder days before cancellation. If, JNITTIAL --- a however, we fail to mail such noti.-, no obligation or liability will be imposed on State Farm or s agents or representa Name and Address of Certificate Holder tives. . s 4 Monore County Board Of County Comfnissioners //) Attn: Monroe County Public Works / / /.' 5100 College Road � B"" � °aAuthorized love Key West, FL 33040 Agent 3/26/93 We Date Agent's al BI LL MARTI, e¢�.;. ank 2105 N. STATE RD, 7 (U.S. 441) HOLLYWOOD, FLORIDA 33021 558-084 a2 Rev. 12 -01 Printed in U.S.A. I MfYfAXC HOLLYWOOD 987 -0121 \ 4 MIAMI 624-3145 \1 E1Idi, iCA ECr!}' - -- ISSUE DATE (MM/DD/YY) 03/26/93 FU ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 1�0 ,'COMPENSATIONWit\CE NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, U)NLNISIERFDBIFEISW EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER 140 ATTENTION CERTIFICATE HOLDER: If you have any questions, KEN W I LL I TS , INC. please contact GERTRUDE MILLER 1 -800- '26-3224, P 0 BOX 693960 2601 Cattlemen Road, Sarasota, Fl 342326249 MIAMI FL 33269 -0960 ` COMPANIES AFFORDING CO ,Er' INSURED Company Letter A FCC) /SELF IN "' R • D • PEDRO FALCON ELECTRICAL CONTRACT 1 C5 1305 WEST INDIES DR Company Letter B: SUMMERLAND KEY FL 33042 - 9519 (J 1 f �J Company Letter C: C©VERAOES THIS IS TO CERTIFv THAT COI )!IFS OF IN UPANJCE _!STED L._ HAVE „E:. ±3LC To INJJRED N,.5 ED ..16(_,vE FUR THE: r'UuCV PER!OL` INDICATED. NOT WITHSTANDING 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. c POLICY POLICY TYPE IN INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION ALL LIMITS IN THOUSANDS DATE (MM /DD /YY) DATE (MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS OPS AGGREGATE $ CLAIMS MADE 71 OCCURRENCE PERSONAL & ADVERTISING INJURY $ OWNERS & CONTRACTORS PROTECTIVE EACH OCCURRENCE $ I FIRE DAMAGE ZANY ONE FIRE) $ MEDICAL EXPENSE (ANY ON) $ AUTOMOBILE LIABILITY _ ANY AUTO CSL $ BODILY ALL OWNED AUTOS INJURY PER _ SCHEDULED AUTOS PERSON) $ HIRED AUTOS ma 14:liiii:1■1J1 BODILY INJURY (PER NON -OWNED AUTOS ACCIDENT) $ GARAGE LIABILITY PROPERTY - DAMAGE $ EXCESS LIABILITY OCCURRENCE AGGREGATE $ STATUTORY $ OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION AND 718-22226-G01-001 01/01/93 12/31/93 —I J 100 EEC:! ACCIDENT) EMPLOYERS' LIABILITY $ 500 ( DISEASE POLICY LIMIT) $ 10 0 (DISEASE-EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS DBA CERTEFRt TE HOLDER CANT Et;LAT10N MONROE COUNTY BD OF COUNTY COMM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO SEND ATTN MONROE COUNTY PUBLIC WORKS 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 5100 COLLEGE RD BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIL - KEY WEST FL 33040 ITV OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE. AUTHORIZED REPRESENTATIVE 5 67‘-41.44-'. • 2809 , REV: 10191 HOLIER COPY AS riao® CERTIFICATE OF INSURANCE ISSUE DATE (MM /DD /YY 4 26 93 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 HORAN INSURANCE AGENCY, INC. POLICIES BELOW. P.D. BOX 284 COMPANIES AFFORDING COVE , GE SUMMERLAND KEY, FL 33042 COMPANY LETTER A Old Dominion Insurance s:. COMPANY B 1 P INSURED LETTER J am( Pedro Falcon Electrical Contractor 1 0 J 1305 West Indies Dr. LETTER 4 Sunmerland Key, FL 33042 COMPANY D I, f „k ' . LETTER 1 11 ° COMPANY E LETTER COVERAGES d a 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM /DD /YY) DATE (MM /DD /YY) • GENERAL LIABILITY BODILY INJURY OCC. $500 COMPREHENSIVE FORM BODILY INJURY AGG. $500 A X PREMISES /OPERATIONS GLM204819 2/16/93 2/16/94 PROPERTY DAMAGE OCC. $500,000 UNDERGROUD EXPLOSION & N COLLAPSE HAZARD 000 PROPERTY DAMAGE AGG. $ 50O X PRODUCTS /COMPLETED OPER. BI & PD COMBINED OCC. $ CONTRACTUAL BI & PD COMBINED AGG. $ INDEPENDENT CONTRACTORS PERSONAL INJURY AGG. $ BROAD FORM PROPERTY DAMAGE X PERSONAL INJURY AUTOMOBILE LIABILITY BODILY INJURY $ ANY AUTO (Per person) ALL OWNED AUTOS ( Priv. Pass. ) BODILY INJURY Other Than ) (Per accident) $ ALL OWNED AUTOS ( Priv. Pass. HIRED AUTOS PROPERTY DAMAGE $ NON -OWNED AUTOS GARAGE LIABILITY BODILY INJURY & 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 Monroe County as Additional Inourcd Same Same DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION Monroe Cty Bd, of Cty Commiss SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE M.C. Public Works EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 5100 College Rd. MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Key West, FL 33040 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN, ' ON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE • I ACORD 25 (7/90) ( ACORD CORPORATION 1990 • 6037E_9 CERTIFICATE OF INSURANCE This is to Certify that: C c r El State Farm Mutual Automobile Insurance Company, or State Farm Fire and Casualty Company of Bloomington, Illinois has coverage in force as shown below for the named insured. If ti coverage is changed or terminated we will give 10 days written notice to: Monroe County Board of County Commissioners Monroe County Risk Management 5100 Colle :e Load Key West, FL 33040 LIABILITY COVERAGE A Description of Vehicle Bodily Injury Property Damage Liability Limits Liability Limits 1982 GMC Van 300, 000. "e�dcha cident S each accident $ each accide This Certificate of Insurance does not change the coverage provided by the described policy Named Insured Pedro Falcon Received Policy number 557 9401A08 Risk Mgmt. & Loss Control July 8 1993 • DATE /3 i�3 Effective date — — , - -�� � . INITIAL 12:01 A.M. Standard Time President ADD BY omit MANAGEmrto SO(` Countersigned Sept . 7 , , 19 93 BY DATE g ■t 3 l 9 3 Gi;t; WAIVER N Authorized Representative J 7 . , ; uu,„ BILL MUM V NOLL • 7 U� MOIL " .STATE FARM ® ® WILLIAM A. MARTI, 31 YEAR AGENT INSURANCE Auto - Life - Health -Home and Business 2105 NORTH STATE ROAD 7, HOLLYWOOD, FL 33021 -3898 PHONE (305) 987 -0121 MIAMI (305) 624 -3145) September 8, 1993 C V � S Monroe Cty Commissioners Attn: Kay 5100 College Road Key West, FL 33040 Dear sirs: Enclosed is a certificate of Insurance for Mr. Pedro Falcon. It is not State Farms's policy to add as additional insureds any city, or their advisory boards. We will furnish you with a certificate each year as required for Mr. Falcon. Sincerely, / William A. Marti Agent CERTIFICATE OF INSURANCE ISSUE DATE IMM /DD /YY) 01/14/94 FccIFJI�D THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS U f,051PEVS4TIQSI\StR4� NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, 11)INSERThB1FEIS €O EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER 140 ATTENTION CERTIFICATE HOLDER: If you have any questions, KEN W I LL I TS , INC . please contact GERT MILLER 1 -800- 226 -3224, PO BOX 693960 2601 Cattlemen Road, Sarasota, Fl 34232 -6249 MIAMI FL 33269 -0960 COMPANIES AFFORDING COVERAGE INSURED PEDRO FALCON ELECTR I CAL CONTRACT Company Letter A FCCI /SELF INSURERS FUND RR 1 BOX 694B Company Letter B: APPROVED BY RISK MANAGEMENT BIG PINE KEY FL 33043 -9639 Company Letter C: BY w 9 k / 4 £OVERAGE& not J-- '® THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT ER �M WI RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE P01 -I SCRIE E „_ ._, '8!ET.. O ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. CO POLICY POLICY LTR TYPE IN INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION ALL LIMITS IN THOUSANDS DATE IMM /DD /YY) DATE IMM /DD /YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP OPS AGGREGATE $ CLAIMS MADE [ (OCCURRENCE PERSONAL & ADVERTISING INJURY $ OWNERS & CONTRACTORS PROTECTIVE EACH OCCURRENCE $ FIRE DAMAGE (ANY ONE FIRE) $ MEDICAL EXPENSE (ANY ESO ) $ AUTOMOBILE LIABILITY ANY AUTO CSL BODILY ALL OWNED AUTOS INJURY SCHEDULED AUTOS FCC1[ BO (PER $ PERSON) HIRED AUTOS BODILY INJURY PER ; NON -OWNED AUTOS ACCIDENT) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY OCCURRENCE AGGREGATE OTHER THAN UMBRELLA FORM $ $ A STATUTORY WORKERS' COMPENSATION AND 718 -22225 -001 -001 01/01/94 12/31/94 $ 1000" ACCIDENT) EMPLOYERS' LIABILITY $ 500 ID)SEAoE- POLICY LIMIT) $ 100 (DISEASE -EACH EMPLOYEE) OTHER Received DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS DBA : Risk Mgmt. & Loss Control DATE / •"?‘ INITIAL Q�L CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO SEND DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. MONROE COUNTY BD OF COUNTY COMM BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIL- ATTN MONROE COUNTY PUBLIC WORKS g-6 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE. 5100 COLLEGE RD AUTHORIZED REPRESENTATIVE KEY WEST FL 33040 -4364 2609, REV 10/91 HOLDER COPY Cc CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This certifies that: 1 x 1 STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, or El STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois has coverage in force for the following Named Insured as shown below: Named Insured Pedro Falcon Address of Named Insured RR1 Box 694B Big Pine Key, FL 33043 -9639 POLICY NUMBER 622 7841 Al2 59 EFFECTIVE DATE OF POLICY Jan. 12, 1996 DESCRIPTION OF 1994 Dodge B250 VEHICLE g LIABILITY COVERAGE IX 1 YES In NO I 1 YES n NO n YES I I NO n YES n NO LIMITS OF LIABILITY a. Bodily Injury 750,000 Single limit Received Each Person Risk Mgmt. & Loss Gi11.101 Each Accident DA 1 r /..-/ G r 7r Od/ G ti b. Property Damage Each Accident INITIAL PL c. Bodily Injury & Property Damage Single Limit Each Accident PHYSICAL DAMAGE IX I YES 1 I NO n YES I 1 NO n YES n NO 1 I YES 1 I NO COVERAGES (� a. Comprehensive $ 25° . O 9eductible $ Deductible $ Deductible $ Deductible Ix 1 YES Q NO I I YES I I NO n YES n NO I I YES n NO b. Collision $ 2 9 0 . 0 Aeductible $ Deductible $ Deductible $ Deductible EMPLOYER'S NON- OWNERSHIP 1 1 YES 1 I NO I 1 YES I I NO 1 1 YES 1 I NO 1 I YES n NO COVERAGE HIRED CAR C' ERAGE fn YES n NO I 1 YES n NO n YES 1 1 NO I 1 YES n NO . . .. .. . _re_ Air' ,..._ Agent 1/12/96 Signature of Authorized Repr-senta ive Title Agent's Code Number Date Name and Address of Certificate Holder Name and Address of Agent Monroe Cty Bd of Commissioners William A. Marti Monroe County Risk Management State Farm Insurance • 5090 College Rd. 2105 N. State Rd 7 Key West, FL 33040 Hollywood, FL 33021 cc . Cm.A y S414,y L f c;G J L J CERTIFICATE HOLDER COPY '