Certificates of Insurance CERTIFICATE INSURANCE ISSUE DATE (MM /DD /YY)
1/04/94
PRODUCLAt 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.
THE JOHNSONS INS AGCY COMPANIES AFFORDING COVERAGE
PO BOX 2346
MARATHON SHORES FL 33052 COMPANY
LEITER A
LETTER
COMPANY B AP"'POVED BY RISK MANAGEMENT
INSURED STATE FARM
COMPANY c Ry � »\
LETTER E.G.A. INC. rn
� /
■
PO BOX 1575 COMPANY D DATE S /c CI 45
MARATHON FL 33050 LETTER 4
COMPANY E WAIVER: N/A YES
LEITER , /.-.,f� y11' - IL" I
1
COVERAGES
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS r
LTR DATE (MM /DD/YY) DATE (MM /DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE S
COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP /OP AGG. E
CLAIMS MADE - OCCUR. PERSONAL & ADV. INJURY S
OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE E s
FIRE DAMAGE (Any one fire) S
MED. EXPENSE (Any one person) S
B AUTOMOBILE LIABILITY B 0 5 0 5 0 3A2 8 5 9 7/28 / 9 3 7/28 / 94 COMBINED SINGLE
ANY AUTO LIMIT S
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per person) $ 50,000
HIRED AUTOS
BODILY INJURY
X NON -OWNED AUTOS (Per accident) E 100,000
GARAGE LIABILITY
PROPERTY DAMAGE E
25,000
EXCESS LIABILITY EACH OCCURRENCE E
UMBRELLA FORM AGGREGATE E
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION STATUTORY LIMITS
EACH ACCIDENT E
AND Received
DISEASE -- POLICY LIMIT E
EMPLOYERS' LIABILITY Risk Mgmt. & Loss Control DISEASE - -EACH EMPLOYEE E
OTHER DATE /— / 3 - ?)'
INITIAL 6l.._-
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES /SPECIAL ITEMS
JANITORIAL SERVICE STATE OF FLORIDA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
MONROE COUNTY BD OF COMIS LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
5100 COLLEGE ROAD LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
STOCK ISL FL. 33040 AUIl10RIZEDREPRESEMATIVE
William Danaher BA
ACORD 25 -S (7/90) 0 ACORD CORPORATION 1990
i
CERTIFICATE OF INSURANCE ISSUE DATE (MM /DD /YYI
12/23/93
PRODUCE 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.
THE JOHNSONS INS AGCY COMPANIES AFFORDING COVERAGE
PO BOX 2346
MARATHON SHORES FL 33052 COMPANY A
LEITER
COMPANY B
INSURED LEITER STATE FARM
COMPANY C
E.G.A. INC. LETTER
PO BOX 1575 COMPANY D
MARATHON FL 33050 LETTER
COMPANY E
LEITER
COVERAGES.
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DD /YY) DATE (MM /DD /YY)
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILTTY PRODUCTS- COMP /OP AGG. $
CLAIMS MADE OCCUR.
PERSONAL & ADV. INJURY E
_ ...... OWNER'S & CONTRACT'OR'S PROT.
EACH OCCURRENCE $
FIRE DAMAGE (Any one fire) S
MED. EXPENSE (Any ono person) S
B AUTOMOBILE LIABILITY B 0 5 0 5 0 3 A2 8 5 9 7/28/93 7/28/94 COMBINED SINGLE
ANY AUTO LIMIT S j
ALL OWNED AUTOS
BODILY INJURY S
SCHEDULED AUTOS (Per person) 5 0 , 000
HIRED AUTOS
Recei BODILY INJURY
X NON -OWNED AUTOS Risk Mg `Pe` accident) 10 0 0 0 0
GARAGE IIAB LIABILITY
j &Loss C ontrol
DATE /, Q / 7 j S /y PROPERTY DAMAGE S
25,000
EXCESS LIABILITY INITIAL EACH OCCURRENCE S
UMBRELLA FORM AGGREGATE S
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION t
AND
EACH ACCIDENT S s
DISEASE -- POLICY LIMIT S
EMPLOYERS' LIABILITY
DISEASE- -EACH EMPLOYEE S OTHER
{
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
JANITORIAL SERVICE STATTE OF FLORIDA
CERTIFICATE B0I.0ER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI 1 FD BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
MONROE COUNTY RISK MANAGEMENT LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES
5100 COLLEGE ROAD
KEY WEST AUTHORIZED REPRESENTATIVE /
LINDA R HOLM - ISO
ACORD 25S (7J90) ' C ORPORATION 1990
03/04/1994 16:20 3052890213 JOHNSONS INSURANCE PAGE 01
xprq#
y
wr m11).-N=-7
_ -
JOHNS° " INSURANCE
Boo f 5OVERSEAS HIt WWAY 13361 OVERSEAS HIGHWAY
TAVERNIER. FL 33070 MARATHON SHORES, FL 33050
February 9, 1994
Monroe County Rink Management
Donna Perez
5100 College Road
Key West, Florida 33040
Re: E G A, Inc
State Farm Insurance
Automobile Policy B05- 0503- A28 -59
Dear Donna:
On January 20, 1994 I again requested that the State Farm
Insurance Company endorse the above captioned policy to reflect
Monroe County Risk Management as an additional named insured. I
encluded your correspondence where you are listed on the policy
for Ecosystematics policy with my request.
I received the attached letter from State Farm. In review of
the Ec;udysLemdLlue pulley, I eluted that this is not written
through the Joint Underwriting Association, which is the only
market for State Farm we have avdildble.•
Should you have any questions regarding this matter, please do
not hesitate to call me.
Si cer y,
ei; A
:arb. a Stuller
CSR
"YOUR FLORIDA KEYS INSURANCE CENTER"
TAVERNIER MARATHON RIB, PINE KFY WEST
MM89 • MM54 • MM3I • (No Location!
852.9247 289 -0213 872 -2888 294 -5248
03/04/1994 16:20 3052890213 JOHNSONS INSURANCE PAGE 02
•
F • F &IM
State Farm Insurance Companies 41116 .
IM5UI*Mci
February 2, 1994 Florida Otflae
7401 cypress esteems BOUiewro
venter Hawn, Florida 33888 -0007
MEMO TO: The Johnson Ins Agcy,7967
FROM: Susan Ebel
Spec Risk Auto
RE: Policy B05 0503- A28 -59
E G A INC
ENOL & HIRED CAR LIAB
I am returning the attached request, as the FAJUA does not have an
Additional Insured endorsement. This entity is shown on the policy as
an Insurance Certificate holder. Your agency has been told before that
we cannot place Monroe County Risk Management on this file as an
Additional Insured.
IMO!
CF vrn FP? f} v
HOME OFFICES: BLOOMINGTON. ILLINOIS 01710 -0001
6037F.11 CERTIFICATE OF INSURANCE
This is to certify that:
• 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 the coverage is
changed or terminated we will give 10 days written notice to:
MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS
5100 JUNIOR COLLEGE RD
KEY WEST FL 33040
Description CAR 1 NONOWNED AUTO
of Vehicle: CAR 2 HIRED CAR
LIABILITY - COVERAGE A
*APPLIES TO ALL CARS Limits of Liability
Bodily Injury Property Damage Bodily Injury and Property Damage
each person each accident each accident Single Limit
$ 50,000* $ 100,000* $ 25,000* $ N /A* each accident
This Certificate of Insurance does not change the coverage provided by the described policy.
Named Insured E G A INC
Policy number B05 0503- A28 -59 `
Effective date JUL-28--94 President
12:01 A.M. Standard Time
Countersigned , (Year)
6037F.11 BY
Authorized Representative
APPROVED By RISK MANAGEMENT
BY /1
J 7C L( )i DATE F Q 2/
WAIVER: N/A YES
��� Cv L
t-- ;t_e.}6.
/? • 111
STATE FARM
.fate Farm Insurance Companies
a
INSURANCE
\
February 2, 1994 Florida office
7401 Cypress Gardens Boulevard
Winter Haven, Florida 33888 -0007
MEMO TO The Johnson Ins Agcy,7967
FROM: Susan Ebel
Spec Risk Auto
RE: Policy B05 0503- A28 -59
E G A INC
ENOL & HIRED CAR LIAB
I am returning the attached request, as the FAJUA does not have an
Additional Insured endorsement. This entity is shown on the policy as
an Insurance Certificate holder. Your agency has been told before that
we cannot place Monroe County Risk Management on this file as an
Additional Insured.
r FER r) a Art
•
HOME OFFICES: BLOOMINGTON, ILLINOIS 61710 -0001
7 THE 1
'Ir dtrOl , e • A . .;:-. il I y % ,N lk, ..‹.--'r ,
JOHNSONS INSURANCE
1 ‘ 4 4:= I P P
89015 OVERSEAS HIGHWAY 1 3361 OVERSEAS HIGHWAY
TAVERNIER, FL 33070 MARATHON SHORES, FL 33050
February 9, 1994
Monroe County Risk Management
Donna Perez
5100 College Road
Key West, Florida 33040
Re: E G A, Inc
State Farm Insurance
Automobile Policy B05- 0503- A28 -59
Dear Donna:
On January 20, 1994 I again requested that the State Farm
Insurance Company endorse the above captioned policy to reflect
Monroe County Risk Management as an additional named insured. I
encluded your correspondence where you are listed on the policy
for Ecosystematics policy with my request.
1 received the attached letter from State Farm. In review of
the Ecosystematics policy, I noted that this is not written
through the Joint Underwriting Association, which is the only
market for State Farm we have available.
Should you have any questions regarding this matter, please do
not hesitate to call me.
Si cere y,
i
Barb a Stuller
CSR
F.w: v-d
j<3 1.: Is:X ? .l: - & Loss Control 0
YOUR FLORIDA KEYS INSURANCE CENTER"
TAVERNIER MARATHON BIG PINE KEY WEST
MM89 • MM54 • MM31 • (No Location)
852 -9247 289 -0213 872 -2888 294 -5248
RECEIVED JUL 1 1 094
General Liability
Amended Declaration
NOVA CASUALTY COMPANY Add additional insured
EFFECTIVE 5/11/94
POLICY NUMBER FROM POLICY PERIOD TO POLICY PERIOD
09AL007655 5/11/94 5/11/95 12:01 AM STANDARD TIME NFLO2016
{
NAMED INSURED AND ADDRESS
E.G.A., INC. THE JOHNSONS INSURANCE AGENCY
5800 OVERSEAS HWY. #35 -114 13361 OVERSEAS HIGHWAY
MARATHON FL 33050 MARATHON FL 33050
J
THE NAMED INSURED IS Corporation
COVERAGES
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS /POLICIES FOR WHICH A
PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
COVERAGE PART /POLICY ATTACHED PREMIUM
COMMERCIAL GENERAL LIABILITY COVERAGE APPROVED BY RISK MANAGEMENT _ $1,512.00
MISC., FEES AND TAXES BY A ■ • ` 7 1 $10.00
ci , I Ct `
TOTAL ADVANCE PREMIUM D ATE $1,522.00
YES
THE CHANGE IN THIS POLICY HAS RESULTED IN yr414114
NO PREMIUM CHANGE
COMMON FORMS THAT APPLY TO ALL COVERAGE PARTS
ENDORSEMENT NO EDITION DATE DESCRIPTION
CG0001 11 -88 Comm. General Liability
CG0220 07 -92 FL .Changes -Canc . S NonRn l Received
CG0300 11 -85 Deductible Liability Ins.
Risk I1lgixat. & Loss Control
CG2147 09 -89 Emply.Related Prac. Excl.
CG2149 11 -88 Total Pollution Excl. DATE - 343 - S �
IL0017 11 -85 Common Policy Conditions I NITIAL `
IL0021 11 -85 Nuclear Energy Exclusion
ADDITIONAL INSURED(S)
AI# INTEREST NAME AND ADDRESS
1 MONROE COUNTY, MONROE COUNTY
GOVERNMENT CENTER
2798 OVERSEAS HWY. SUITE 300
MARATHON FL 33050 -0000
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THE
COVERAGE PARTS /POLICIES ATTACHED, WE AGREE WITH YOU TO PROVIDE THE INSURANCE
DESCRIBED THEREIN. `
ak
COUNTERSIGNED BY EUGENE Y>I WAHISTRQM DATE 6/30/94
I'KUIJuc.tn
NCC(9/93) cc % ,S AUTHORIZED REPRESENTATIVE HR
_ . _ General Liability
Amended Declaration }
NOVA CASUALTY COMPANY Add additional insured
EFFECTIVE 5/11/94
i
POLICY NUMBER POLICY PERIOD
FROM TO POLICY PERIOD
I
09AL007655 5/11/94 5/11/95 12:01 AM STANDARD TIME NFLO2016
NAMED INSURED AND ADDRESS
E.G.A., INC. THE JOHNSONS INSURANCE AGENCY
5800 OVERSEAS HWY. #35-114 13361 OVERSEAS HIGHWAY
MARATHON FL 33050 MARATHON FL 33050
• LIMITS OF INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS - COMPLETED OPERATIONS) . $300,000
• PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT $300,000
PERSONAL & ADVERTISING INJURY LIMIT $300,000
EACH OCCURRENCE LIMIT $300,000
FIRE DAMAGE LIMIT (ANY ONE FIRE) $50,000
MEDICAL EXPENSE LIMIT (ANY ONE PERSON) $5,000
LOCATION ADDRESS(ES)
LOCATION 1
E.G.A., INC.
5800 OVERSEAS HWY. #35 -114
MARATHON FL 33050
COVERAGES
ITEM LOC TERR CLASS PREMIUM BASIS EXPOSURE PD DEDUCTIBLE
1 001 6 96816 Payroll 45000 $250 PER CLM
DESCRIPTION:
Premise /Operations Liability
Janitorial Services
LIABILITY PREMIUM $1,612.00
MISC., FEES AND TAXES . . . $10.00
FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART
LOC ITEM ENDORSEMENT NO EDITION DATE DESCRIPTION PREMIUM
1 1 *CG2026 11 -85 Add'l Ins. - Desig. Person
TOTAL ADVANCE PREMIUM $1,522.00
I
'P(
NCC (9/93) UUU ..tli
r
{
I Y
6028EE.1 NAMED PERSON(S) OR ORGANIZATIONS) AS INSURED
This endorsement modifies insurance provided under the following: Re erved
Risk Mx. & Loss Control
BUSINESS AUTO COVERAGE FORM
DATE D ��) —
GARAGE COVERAGE FORM
TRUCKERS COVERAGE FORM Ir<nT AL
This endorsement is a part of your policy. Except for the changes it makes, all other terms of the policy
remain the same and apply to this endorsement. It is effective at the same time as your policy if issued
with it. If issued at a later date the name, policy number and effective date must be shown.
Issued on behalf of the FLORIDA JOINT UNDERWRITING ASSOCIATION by the Servicing
Carrier, State Farm Mutual Automobile Insurance Company of Bloomington, Illinois.
Named Insured 'x&14'
Policy Number ttusu Su - Countersigned ,19
Effective Date 08 -31 -94 B
12:01 A.M. Standard Time Authorized Representative of Association
Named Person(s) or Organizations)
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
( PUBLIC SERV BLDG -WING 4
5100 COLLEGE RD
KEY WEST FL 33040
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
Each person or organization named above is an insured for LIABILITY COVERAGE, but only to the
extent that person or organization qualifies as an insured under the WHO IS AN INSURED provision
of SECTION II — LIABILITY COVERAGE.
e aT1133CLAZTu&k.9r
'7 RY RISK MANAGEMENT
PY
DATE / -
WAIVER: N/A YES
i02 EE. i
.-kP 9024 (Ed. Feb. L987 )
10 -11 -94 X 75116 PAGE 2 OF ?DECLARATIONS CONTINUED
FLORIDA JOINT UNDERWRITING ASSOCIATION
SERVICING CARRIER: STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY BLOOMINGTON, ILLINOIS I
7401 CYPRESS GARDENS BOULEVARD WINTER HAVEN, FL 33886
2 POLICY NUMBER BUS 0503- A28 -59a POLICY PERIOD AUG-31 -94 TO JUL -26 -95 TERR 32
0 NAMED INSURED 8°
a * ** ADDITIONAL INSURED 59- 7967 -7 E G A INC
MONROE COUNTY BOARD OF COUNTY 5800 OVERSEAS HWY # 35 - 114 5
*C* COMMISSIONERS MARATHON FL 33050 -2719 4 •
*0* PUt3LIC SERVICE BLDG-WING 4
*P* 5100 COLLEGE RD 3;
*Y* KEY WEST FL 33040 2
* **
•
ITEM 3
•
CAR YEAR MAKE MODEL BODY STYLE VEHICLE IDENTIFICATION NUMBER CLASS
• 2 00 NONOwNED
CAR AUTO UNOA
u0 0000 UNOA
S
F COVERAGES (AS DEFINED IN POLICY) DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE.
j SYMBOL VEHICLE - PREMIUM - COVERAGE NAME - LIMITS OF LIABILITY
,EXCEPTIONS AND ENDORSEMENTS
CAR 1 6028EE.2 PERSON(S) OR ORGANILATION(S) IDENTIFIED AS INSURED(S)-MONROE
COUNTY BOARD OF COUNTY COMMISSIONERS, PUBLIC SERVICE BLDG -wiNG 4 5100
COLLEGE RD, KEY WEST FL 33040.
CAR 2 6028EE.2 PERSONS) OR ORGANIZATIONS) IDENTIFIED AS INSURED(S)- MONROE
COUNTY BOARD OF COUNTY COMMISSIONERS, PUBLIC SERVICE BLDG -WING 4 5100
COLLEGE RD, KEY WEST FL 33040.
CAR 6 6S1� E.1 NUCLEAR ENERGY LIABILITY EXCLUSION. APPROVEOBY RISK MANAGEMENT
1_8 ADDITIONAL CONDITION. RY
6839/.2 SPLIT LIABILITY LIMITS.
V
6853J.5 FLORIDA CHANGES.
CAR 1 DATE //- Y -Sf.''
• ITEM 2- SYMBOL 9 NONOWNED AUTOS ONLY. WAIVER: N /A, L /Y ES,____,.,
CAR 2
6164FF.2 HIRED AUTOS SPECIFIED AS COVERED AUTOS YOU OWN.
ITEM 2- SYMBOL 8 HIRED AUTOS ONLY.
CAPS 1 &2.
EMPOLYEES NON OWNERSHIP LIABILITY.
• 0 TO 25 EMPLOYEES CAR 1.
HIRED CAR, IF ANY BASIS CAR 2.
, PRODUCER OF RECORD
THE JOHNSON'S INS AGCY
13361 OVERSEAS HWY
MARATHON SHRS, FL 33050 -3506
THIS PAGE, ANY ENDORSEMENTS INDICATED HEREON AND FORM 9362U. 2 CONSTITUTE THE POLICY IDENTIFIED BY THE POLICY NUMBER.
Includes Copyrighted Material of Insurance Services Office, with its permission. Copyright, Insurance Services Office, 1975, 1976.
REPLACED POLICY 8050503 -59A
26196 0892 155 -4078 FL.2
1 0 — 1 1 — 94 X 75116 PAGE 1 O F 2 DECLARATIONS CONTINUED
I FLORIDA JOINT UNDERWRITING ASSOCIATION
SERVICING CARRIER: STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY BLOOMINGTON, ILLINOIS I E f
7401 CYPRESS GARDENS i3OULEVARD WINTER HAVEN, FL 33888
a POLICY NUMBER 605 050 3 — A28 - 59 x3 POLICY PERIOD AUG - TO JUL - TERR 32 f
9
9 * ** ADDITIONAL INSURED 59- 7967 -7 E G A INC
MONROE COUNTY BOARD OF COUNTY 5800 OVERSEAS HWY N 35 -114 6,
*C* COMMISSIONERS MARATHON FL 53050 -2719
5
*0* PUBLIC SERVICE BLDG —WING 4 C
*P* 5100 COLLEGE RD 9 i
*Y* KEY WEST FL 33040
* **
ITEM 3
CAR YEAR MAKE MODEL BODY STYLE VEHICLE IDENTIFICATION NUMBER CLASS
NONOWNED AUTO UNOA
2 00 HIRED CAR 00 0000
UNOA
k COVERAGES (AS DEFINED IN POLICY) DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE.
SYMBOL VEHICLE - PREMIUM - COVERAGE NAME - LIMITS OF LIABILITY
CAR
A LIABILITY
1 $30.00 LIMITS OF LIABILITY—COVEAAGE A— BODILY INJURY
2 $31.00 EACH PERSON, EACH ACCIDENT
LIMITS OF LIABILITY - -- PROPERTY DAMAGES AND COVERED
POLLUTION COST OR EXPENSE COMBINE!)
EACH ACCIDENT
25,0U0
$61.00 TOTAL PREMIUM FOR POLICY PERIOD AUG -31 -94 TO JUL -28 -95
$67.00 TOTAL A
CURRENT 1 FOR JUL -28 -94 TO JUL -26 -95
CAR 1 $33.00 CAR 2 134.00
FOR QUESTIONS PROBLEMS, OR TO OBTAIN INFORMATION'v AMOUT COVERAGE CALL:
(813) 325 -4151.
CONTINUED
THIS PAGE, ANY ENDORSEMENTS INDICATED HEREON AND FORM 9 3 6 20 . 2 CONSTITUTE THE POLICY IDENTIFIED BY THE POLICY NUMBER.
Includes Copyrighted Material of Insurance Services Office, with its permission. Copyright, Insurance Services Office, 1975, 1976.
REPLACED POLICY 8050503-59A
26196 0 8 9 2 155 -4078 FL.2
JOHNSON INSURANCE
89015 OVERSEAS HIGHWAY 13361 OVERSEAS HIGHWAY
T N 6 1994 MARATHON SHORES, FL 33050
Ec, ci ved
t�f5`C M; n1 & LOSS Contr i
E.G.A. Inc.
5800 Overseas Hwy #35 -114
Marathon FL 33050 'N;l;,\i,
Re: Policy# SF- B050503A2859 (C /AUTO NON OWNED)
Effective July 28, 1994 . to July 28, 1995
Dear Insured:
Enclosed please find your revised policy, referenced above.
PLEASE NOTE: Like all insurance policies do, your policy
contains exclusions, coverage limitations, and conditions. It
is extremely important that you carefully read your policy and
let me know if you have any questions.
Thank you for insuring with The Johnson's Insurance Agency.
Sincerely yours,
Bill Danaher
Agent
X(A) /pe
"YOUR FLORIDA KEYS INSURANCE CENTER"
TAVERNIER MARATHON BIG PINE KEY WEST
MM89 • MM54 • MM31 • (No Location)
852 -9247 289 -0213 872 -2888 294 -5248