Certificate of Insurance I i NvOR . s ,,,, 4 " = ISSUE
DATE (MM/DD/
T
�3. �b':w #. r �.. �-A:k E f" r13.. 2+ R rc � °�r 'S " .TM Poo- � � �' � r - /
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Rollins Hudig Hall NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND
of Illinois, Inc. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO
123 North Wacker Drive COMPANIES AFFORDING COVERAGE
Chicago, Illinois 60606
Attn: Patricia DeLeonardis COMPANY
A
(312) 701 -4434 L Royal. Surplus Lines Insurance Company
COMPANY B
INSURED LETTER Planet Insurance Company
Emergency One, Inc . COMPANY
C
LE T TER
1601 S.W. 37th Avenue Royal. Indemnity Company
Ocala, FL 34474 APPROVED BY RISK MAMMON D
0290 (��f7 Transamerica Insurance Company
0290 B y 0 _l i "` `✓ fj C OMPANY =
(f Le "" Reliance Insurance Company
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY F�MEIVAERM R Or ITION OF ANY CONTRACT OR OTHER DOCUMENT W RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, T )) f�FrvrtutLTBY THE POLICIES DESCRIBED HEREIN IS S 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 POLICY EFFECTIVE POLICY EXPIRATION
.TR DATE (MM /DD /YY) DATE (MM /DD /YY) ALL LIMITS IN THOUSANDS
GENERAL LIABILITY GENERAL AGGREGATE $
2,000,
X COMMERCIAL GENERAL LIABILITY KHA005823 11/01/92 11/0.1/93 : PRODUCTS - COMP /OPSAGGREGATE $ 4,000,
A CLAIMS MADE X OCCUR. PERSONAL & ADVERTISING INJURY $ 1 ,
OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 1,000 , t
FIRE DAMAGE (Any one fire) $
(
MEDICAL EXPENSE (Any one person) $
AUTOMOBILE LIABILITY COMBINED )
SINGLE $
X ANY AUTO LIMIT 1,000 ,
B ALL OWNED AUTOS NKA149- 75__3107 11/01/92 11/01/93 I NJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY t
NON -OWNED AUTOS INJURY $
'(Per accident) ..
GARAGE LIABILITY i
PROPERTY
DAMAGE $
EXCESS LIABILITY EACH AGGREGATE
OCCURRENCE
C X RHN005824 .11/0.1/92 11/01/93 $ 5,000, $ 5,000,
OTHER THAN UMBRELLA FORM `-
Excess STATUTORY i,
WORKER'S COMPENSATION
D AND W- 1.4172.5C -FL 11/01/92 11 $ 500 (EACH ACCIDENT) a '
EMPLOYERS' LIABILITY $ 500 (DISEASE— POLICY LIMIT)
Retention-500,000 $ 500 (DISEASE —EACH EMPLOYEE)
OTHER
E Excess Liability NEAl2.53263 11/01/92 11/01/93 $5,000,000 excess
$5,000,000
)ESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS Received
Risk Mgmt. & Loss Control
(
DATE -1 -73 ,/j
CERT AIE ER` !CANCELLATION: UIfl1Ai. O ----
MONROE CO. BOARD OF COMMISSIONERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
5100 COLLEGE ROAD EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
PUBLIC SERVICE BLDG ROOM 002 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
KEY WEST, FLORIDA 33040 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KI UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED TATIVE .
A
,254 - isf 0ACOIit3, CORPORATION 1988
.lg /28-9011.CER