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HomeMy WebLinkAboutCertificates of InsuranceACaR& CERTIFICATE OF LIABILITY INSURANCE �"'� DATE(MWtDWY`YYYI 7113f2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT Donna Marlene zzRosa Keys Insurance Services PHONE (305)294-4494 AtC Na.(305)T4]-058I 805 Peacock Plaza polo es .drosatkeysinsurance.com _ INSURER(S) AFFORDING COVERAGE NAIC d Key West FL 33040 INSURER A:COvin ton Specialty ins. INSURED INSURERB:Pro ressive iszprss Ins Co. Thomas R. Beaver MD Medical Corp. INSURERC: PO Sox S23207 INSURER INSURER E Marathon FL 33052 tN$UReRF: 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. INSR TYPE OF INSURANCE I D�S�iUR ILTR wyn POLICY NUMBER POLtCtf EFF POLICY EXP j M lD � LIMITS X ; CCS6ttdERCTA( faSENERAItIAsttITY i A GLM4S NWt3E OCCUR EACH OCCURRENCE 1 3 1,000,D00 tiE�tSRTRTEe 100,000 PREMISES {E.! . a gQPAf S X VSA31925600 7/20/2014 7/20/201S i MED E" (Ar7 ompersm) 3 51000 3 PERSONAL 3 ADV INJURY i $ 11 000, 000 I GENL AGGREGATE LIMIT APPLIES PER X ' POLICY- 'PRO•~ GENERAL AGGREGATE 13 2,000,000 JECT tflC _ I PRODUCTS • COMPt(}P AGG (S BXCS+i7D13D OTHER j is AUTOMOaILE LIABILITY 1 j L( U 1 5 a dSiNGLi {EsMBao B ANY AUTO ' 025708700 17f13/2o15 j 7j1312o16 , BODILY INJURY (per peur) is 100,000 ! ALL OWNED SCHEDULED AUTOS X AUTOS X NON-0Y2iED HtREDAUTOS AUTOS I BODILY INJURY Per a kctCttl ( )3 300,000 PROPERTY DAMAGE Pet des $ 50,000 I $ UMBRELLA LIAR 1 !OCCUR EACH OCCURRENCE $ EXCESS LIAR [� j CG4It.iS hiAtJE I ` AGGREGATE 3 €I DER RETENTION 3 P ( $ WORKERS COMPENSATION i, • , PER OTC AND EMPLOYERS• YIN' STATUTE TA R S .W�E JANY PROPRIETO$bPARTNEFMXECUTIVE ! OFFICERNEMBER EXCLUDEDN t A ; 1 E.L. EACH ACCIDENT ill'r (tdandatory In HHl I ElDISEASE - EA EI+iPLOYEE 3 t yes. ownbe under DESCRIPTION OF OPERATIONS below i EE E L DISEASE - POLICY LIMB i S DESCRPTION OP OPERATIONS I LOCATIONS I VEHICLES (ACORD 141. Addiftnal Remarks lSchadula, may b* attached If mom spat* is mgutmd) Certificate Holder Is Also Listed As An Additional Insured With Respects To Genera iabilty & Automobile Liability AY PRO MEOIT WAIVER N• cr SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board Of County Co=ntssioner THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. STE 268 Rey West, FL 33040 AUTHORIZED REPRESENTATIVE Grimi BetancourtfLR 401988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 poiao+I . 66.� R CERTIFICATE OF LIABILITY INSURANCE D DD/YYYY) 8/2/22/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Keys Insurance Services 805 Peacock Plaza Key West FL 33040 NAM , C Donna Marlene Ross PHONE . (305) 294-4494 Fax .(305)743-0582 EMAILADDRESS,mross@keys insurance. com INSURERS AFFORDING COVERAGE NAIC # INSURER A:COvin on Specialty Ins. INSURED Thomas R. Beaver MD Medical Corp. PO BOX 523207 Marathon FL 33052 INSURERB:ASSOciated Industries Ins Co INSURERC:First Professional Insurance INSURERD: INSURER E : INSURERF: 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. INSR LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FOOCCUR X VEA31925600 7/20/2014 /20/2015 DAMAGE TO RENTED PREMISES (Ea occurr n $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECTLOC PRODUCTS - COMP/OP AGG $ EXCLUDED $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ ANY AUTO 1 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED O —O NED OS q PROPERTY DAMAGE Praccident) $ —UMBRELLA LIAB OCCUR EACH OCCURRENCE $ E%CESS LIAB CLAIMS -MADE AGGREGATE $ DIED RETENTION I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N / A ILWC1035894 7/20/2014 /20/2015 WC STATU- OTH- E.L. EACH ACCIDENT $ ZOO 000 E.L. DISEASE - EA EMPLOYE $ 100 000 E.L. DISEASE - POLICY LIMIT $ 500.000 DESCRIPTION OF OPERATIONS below C Professional Liability 1023195 /23/2014 /23/2015 General Aggregate 1,500,000 Each Occurrence 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate Holder Is Also Listed As An Additional Insured With Respects To General Liabilty Only. PP WAIVER N/A !�NAIGEIVIENT Monroe County Board of County O>I�rnss oner 1100 Simonton Street STE 268 Key West, FL 33040 SHOULID-ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i Tbfi OPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Marlene Ross M%'%JnU ca keu Iuwa) 01988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD AD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT F F. Hager NAME: Keys Insurance Services (vc°Nn o,Ext): (305)294-4494 (A/C, No): (305)743-0582 805 Peacock Plaza ADDRESS:lhager@keysinsurance.corn INSURER(S)AFFORDING COVERAGE NAIC# Rey West FL 33040 INSURER A:COVington Specialty Ins. INSURED INSURER B:Pro:Progressive Express xpress Insurance 10193 Thomas R. Beaver MD Medical Corp. INSURER C:First Professional Insurance Co. PO Box 523207 INSURERD: INSURER E: Marathon FL 33052 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1572709810 REVISION NUMBER: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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM)DDIYYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $D 1,000,000 GE TO RETED A CLAIMS-MADE X OCCUR PREMISES SES(Ea occurs nce) $ 100,000 X VBA39449200 7/20/2015 7/20/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENII_AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ EXCLUDED OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ 100,000 ALL OWNED X SCHEDULED AUTOS AUTOS X 02570870-0 7/13/2015 7/13/2016 BODILY INJURY(Per accident) $ 300,000 NON-O HIRED AUTOS AUTOS WNED (Perr a cident)AMAGE $ 50,000 Uninsured motorist BI split limit $ 100,000 UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y I N STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) _.- E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Professional Liabiity 1023195-01 7/23/2015 7/23/2016 General Aggregate $1,500,000 Claims Mile __I. Occurrence . $500,000 in of DESCRIPTION OF&RATOS/LOCATIOW VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificaim hoSder is.: ttso added as an additional insured for Gen a 'ty and Auto Liability. C i!: BY PR EMENT(,,J`�,{ h,r, .✓ f ` - __ Li G") • WAIVER N/A YES, �•f Qil'16., W raz J CERTIFICOE HOER o CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED Pe{ ICIES BE CANCELLED BEFORE Monroe County Board of County Commissione THE EXPIRATION DATE THEREOF NO E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PlIti ISIOOS. 1100 Simonton Street, Ste 268 Key West, FL 33040 AUTHORIZED REPRESENTATI , F Hager ' ' Adpin ©1988-2014 ACO-D CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref# %ascription Coverage Code Form No. Edition Date PKG PKG Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 10,000 0 $137.00 Ref# Description Coverage Code Form No. Edition Date Policy Fee POLFE Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $20.00 _ _Ref# _Description Coverage Code Form No. Edition.Date - -- Medical payments MEDPM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 5,000 $19.00 Ref# Description Coverage Code Form No. Edition Date CDLEX CDLEX Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001,AMS Services,Inc. ATE AC RDA CERTIFICATE OF LIABILITY INSURANCE DLir Ei3/2a s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO.RIGHTS UPON THE CERTIFICATE HOLDER. This CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies} must be endorsed: If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Donna Marlene zzRoss Keys Insurance Services P N Exit (305)294-4494 tuc,No):1305J713-0602 805 Peacock Plaza AD ESS:dross@keysinsurance.cem — INSURER(5)AFFORDING COVERAGE I NAIL: Key West FL 33040 _ INSURER A:Covin�c ton Specialty Ins. INSURED INSURERs:Progressive'Ezprss Ins Co. _ Thomas R. Beaver MD Medical Corp. INSURERC: PO Box 523207 INSURER 0: INSURER E: Marathon FL 33052 INSURER F: . COVERAGES CERTIFICATE NUMBER:2014-2015 REVISION NUMBER: 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCY EFF POLICY EXP ILTRR TYPE OF INSURANCE IAH5p R, POLICY NUMBER (MMIPDIYYYY) (MMIDONYYYI I LIMITS X I COMMERCIAL GENERAL LIABILITY I f i EACH OCCURRENCE 5 1,1,000,000 I FIT `GE TO gERTED A i CLAMS-MADE X OCCUR :PREMISES(Ea arrnrrenw) S 100,000 ; ( X ( VBA31925600 j 7/20/2014 j 7/20/2015 i MED EXP(Any one person) 1 S 5,000 1,000,000 PERSONAL 3 ADV INJURY I$ GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY I I dECOT LOG I ! i j PRODUCTS-COMP/OPAGG 5 EXCLUDED • t1 OTHER: • I 1 E $ AUTOMOBILE UABIUTY } f COMBINED SINGLE LIMIT i s B 1 ANY AUTO j 025700700 7/13/2015 7/13/2016 1 BODILY INJURY(Per person) S 100,000 ALL(PANED SCHEDULED , )AUTOS X AUTOS X ( j I BODILY INJURY(Per acci„erl) 3 300,000 NON-OWNED I PROPERTY DAMAGE f HIRED AUTOS i 1 s 50,000 _ AUTOS (Per,=ciders) 1 ! - • ... i ! . s UMBRELLJ►LJAe OCCUR �(( EACH OCCURRENCE ;$ EXCESS LU18 -. CLAIMS-MADE€ I AGGREGATE $ t CEO , •l•RETENTION 5 1 t • I I $ WORKERS.COMPENSATION- i i _ AND EMPLOYERS'UABIUTY - STATUTE I ERH ANY PROPRIETORIPARTNERIEXECUTIVE (J N1 NI A i I EL EACH ACCIDENT 1 5 OFFICERIMEMBER EXCLUDED?- !i ' (Myyaoondatary In NH) —1 I 1 j EL DISEASE•EA EMPLOYEE 5 If S. TION DESCRIPTION OF OPERATIONS below I i I EL DISEASE-POLICY LIMIT I 5 - 1 DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may bo attached If more space is required) - Certificate Holder Is Also Listed As An Additional Insured With Respects To Genera iabilty & Automobile Liability • f A,PPRO N NEW D E • WAIVER N/A _. €s=_ g_ Cc: !1✓ CERTIFICATE HOLDER CANCELLATION 1•' • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commssioner THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN . 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. STB 268 Key West, FL 33040 AUTHORI2EOREPRESENTATIVE Grimi Betancourt/LR O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2o1a01) A� or CERTIFICATE OF LIABILITY INSURANCE ATE (MM1DDfYYY FD9/29/2015Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hager F. Ha NAME: g aoNE (305)294-4494 ac No: (305)743-0582 Keys Insurance Services 805 Peacock Plaza E-MAIL ADDRESS: g lha er@keysinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Covin ton Specialty Ins. Key West FL 33040 INSURED INSURER B:PrO ressive Express Insurance 10193 INSURERC:First Professional Insurance Co. Thomas R. Beaver MD Medical Corp. INSURER D : PO BOX 523207 INSURER E : INSURERF: Marathon FL 33052 COVERAGES CERTIFICATE NUMBER:CL1572709810 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MM/DDNYYY) POLICY EXP (MM/DDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100 000 MED EXP (Any one person) $ 5,000 X VBA39449200 7/20/2015 7/20/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ EXCLUDED $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 100,000 B ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS NON -OWNED HIRED AUTOS AUTOS X 02570870-0 P V� g RIS M N 7 1 15 EMI 7/13/2016 BODILY INJURY (Per accident) $ 300,000 PROPERTY DAMAGE Per accident $ 50,000 Uninsured motorist BI split limit $ 100,000 UMBRELLA LIAR CESS LIAB tXED CLAIMS -MADE DATE N/A YE EACH OCCURRENCE $ HOCCUR AGGREGATE $ I I RETENTION$ $ WAIVER __.- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ DISEASE - EA EMPLOYE $ (Mandatary In NH) If yes, describe under f`J►�c. Cl DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ C Professional Liabiity 1023195-01 7/23/2015 7/23/2016 General Aggregate $1,500,000 Claims Made Occurrence $500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is also added as an additional insured for General Liability and Auto Liability. 11AN11W CERTIFICATE HOLDER I I 'Mill -Ni 1' l GANGELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of Coul; i i I07THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street, Ste h9:Lid^� � jM (ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 J80038 80,j a31'#AJITHORIZEDREPRESENTATIVE ACORD 25 (2014/01) INS025 (201401) F Hager ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GEICO Indemnity Company Certificate of Insurance One GEICO Center Macon, GA 31295-0001 Named Insured and Address: THOMAS RICHARD BEAVER PO BOX 523207 MARATHON SHRS FL 33052-3207 Name and Address: MONROE COUNTY 20 1111 12TH ST, STE 408 KEY WEST FL 33040 Date of Certificate: 01 -01 -16 Policy Number: 4360-52-94-67 Policy Period: 02-04-16 to 08-04-16 (12:01 A.M. Local Time) (12:01 A.M. Local Time) ,iX ..�• DWAIVE N/Ay, ES — I (This Certificate of Insurance does not amend, extend, or alter the coverage afforded by this policy.) During the term of coverages provided, the Company and the insured shall be bound by the provisions of the policy (or policies) of insurance in current use by the Company in the state. This is to certify that the captioned policy includes the limits specified herein for each person and for each occurrence under the Bodily Injury Liability Coverage; the limits specified herein for each occurrence under the Property Damage Liability Coverage; and limits specified herein for each person and for each occurrence for Bodily Injury under the Uninsured Motorists Coverage. Description of Vehicle: 14 RAM 1 C6RR7HT9ES451810 Description of Vehicle: COVERAGE LIMITS OF COVERAGE LIMITS OF COVERAGE Bodily Injury Liability Property Damage Liability Uninsured Motorists (Bodily Injury) $ 100 M and $300 M (Each Person) (Each Occurrence) $ 50M (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) INTERESTED PARTY We agree to provide you with written notice of termination in the evqjhj #i1,§pq*jbg6"&cancelled. Notice provided may be more than ten (10) days, but not less than ten (10) days. ' 9 .NIA z =Z Wd E NVP 9101 .ff 1�1 sr1 ?fQ.� 03111i CRU62 (9-07) l ® A CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YY 7/25/2016 v THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Keys Insurance Services 5800 Overseas Hwy CONT NAME: CT David Sheppard FAX /C No; (305)743-0582 PHONNo ExE (305)743-0494 (A/C. A/ A DRESS:dsheppard@keys insurance. com, INSURER(S) AFFORDING COVERAGE NAIC # P.O. BOX 500280 INSURER A:Covincrton Specialty Ins. Marathon FL 33050 INSURED INSURERB:First Professional Insurance Co. INSURERC: Thomas R. Beaver MD Medical Corp. INSURERD: PO BOX 523207 INSURER E : INSURERF: Marathon FL 33052 GUVtHAUt,— 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. OF INSURANCE GENERAL LIABILITY -MADE X❑ OCCUR rGEN'L ADDL X SUBR POLICY NUMBER VEA47436800 POLICY EFF MM/DD/YYYY 7/20/2016 POLICY EXP MM/DD/YYYYL 7/20/2017 LIMITS EACH OCCURRENCE $ 1,000,000 DAMAGE TORENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 E LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC X JECT PRODUCTS - COMP/OPAGG $ EXCLUDED OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident BODILY INJU Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS HIRED SAUTOS NON -OWNED AUTOS BODILY INJURT4Pvraccident) (,� (Q PROPERTY D Per accident (59 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURR AGGREGATE --1 `T1 y-I $� r DIED RETENTION WORKERS COMPENSATION PER _ H STATUTE t - ER E.L. EACH ACCID'T $ AND EMPLOYERS' LIABILITY Y / N--'` ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Liability 1023195-02 7/23/2016 7/23/2017 Each Occurrence 500,000 General Aggregate 1,500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder Is Also Listed As An Additional Insured With Respects To General Liabilty Only. APPR D MENT BY WAIVER N/A _ r! -�i« Monroe County 1100 Simonton STE 268 Key West, FL ACORD 25 (2014/01) INS025 (201401) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Board Of County Commssioner THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Street ACCORDANCE WITH THE POLICY PROVISIONS. 33040 AUTHORIZED REPRESENTATIVE Mel Montagne A/tAT1A\1 A11 . -64- ---A The ACORD name and logo are registered marks of ACORD A`� "® CERTIFICATE OF LIABILITY INSURANCE 8/2i2014 ""' -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Keys Insurance Services 805 Peacock Plaza Key West FL 33040 CONTACT Donna Marlene Ross NAME: PHONE , (305)294-4494 FAX (305)743-0502 E-MAILADDRESS,mross@keysinsurance.com INSURERS AFFORDING COVERAGE NAIC>r INSURER A:COvin on Specialty Ins. INSURED Thomas R. Beaver MD Medical Corp. PO BOX 523207 Marathon FL 33052 INSURERB:Associated Industries Ins CO INSURERC:First Professional Insurance INSURERD: INSURER E : 1 INSURERF: COVERAGES CFRTIFICATF NUMRFR-CL148207395 REVISION NIIMRFR- 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. INSLTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X VRA31925600 7/20/2014 /20/2015 DAMAX PREMI TO I ft RENTED occurrence, $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ EXCLUDED X1 POLICY JECTPRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE P r ' n $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ B WORKERS COMPENSATION WC STATU- OTH- I TOYrR AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A WC1035894 7/20/2014 /20/2015 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 C Professional Liability 1023195 7/23/2014 /23/2015 General Aggregate 1,500,000 Each Occurrence 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder Is Also Listed As An Additional Insured With Respects To General Liabilty Only. YP IVAGtE�1MvE�NT I/ WAIVER N/A v, v .r Cc �l le, -- - CFO( t,t- Monroe County Board of County on r 1100 Simonton Street STE 268 Key West, FL 33040 SHOULD -ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIJ21PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE Marlene Ross ACORD 25 (2010/05) INS025 (tot o05).01 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD /-70 A`40REP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 7/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 9 the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditbns of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Keys Insurance Services 805 Peacock Plaza Key West FL 33040 CONTACT NAME: F. Hager PHONE . (305)294-4494 FAX No: (305)743-0582 ADORIE :lhager@keysinsuranc@.cam INSURE S AFFORDING COVERAGE NAIC it INSURERA.Covington Specialty Ins. INSURED Thomas R. Beaver MD Medical Corp. PO Box 523207 Marathon FL 33052 INSURERS Pro ressive Express Insurance 10193 NSURERCFirst Professional Insurance Co. INSURER D : INSURER E : INSURER F r-numnAl:FC rCRTIFIr_ATF NIIMRFR-CL1572709910 REVISION NUMBER! 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. NBR LTR TYPE OF INSURANCE ADDL BR POLICY NUMBER POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE �X OCCUR PRAERENTED M SES E ToEa occurrence $ 100, 000 MED EXP (Any one person) $ 5,000 X VSK39449200 7/20/2015 7/20/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN1- AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ >: xcLrmsD X �E LOC POLICY ❑T $ OTHER: AUTOMOBILE LIABILITY INN mSING LIMIT $ BODILY INJURY (Per person) $ 100,000 B ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS NON -OWNED HIRED AUTOS AUTOS X02570870-0 7/13/2015 7/13/2016 BODILY INJURY (Per accident) $ 300,000 PPROPERTY DAMAGE $ 50,000 [Uninsured motorist BI sdh limit $ 100,000 UMBRELLA LIAR OCCUR H OCCURRENCE $ HCLAIMS-MADE [7GREGATE $ EXCESS LIAB BY DED I I RETENTION $ WORKERS AND EMPLOYERS'L COMPENAABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE WANS W/ YES TATUTE OE TRH- ISE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (IWdatory In NH) N / A E.L. DISEASE - EA EMPLOYE $ DISEASE - POLICY LIMIT N yes describe under DESCRIPTION OF ERAT�NS below6V4—'E.L. C Professional Liabiity IL023195-01 j7r�/23/2015 7/23/2016 General Aggregate $1, 500, 000 Claims MadeOccurrence $500, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached N more space is required) Certificate holder is also added as an additional insured for General Liability and Auto Liability. I =1; La11I13,-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street, Ste 268 ACCORDANCE WITH THE POLICY PROVISIONS. Rey West, FL 33040S �6 C�— AUTFtORQEDREPRESENTATIVE 080038 91111ir 019W2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (2ouo1) J, ACC) CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) !/29/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 1ORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT F . Hager Keys Insurance Services PHONE . (305) 294-4494 FAX, Noll: (305) 743-0582 805 Peacock Plaza AotRlEss.lhager@keysinsurance.com Key West FL 33040 INSURE RA:COvin ton Specialty Ins. INSURED INSURER B:PrO ressive Express Insurance 10193 Thomas R. Beaver HID Medical Corp. INSURERC:First Professional Insurance Co. PO BOX 523207 INSURERD: INSURER E : Marathon FL 33052 INSURER F : CC)VFRAr;FR r`FRTIFIr`ATF kit IMC 11=04 T.11 ri797l10R1 n 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. ILTR TYPE OF INSURANCE A DL UBR POLICY NUMBER MM/ ICY EFF PO/ ICE XP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 X VBA39449200 7/20/2015 7/20/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: PRO POLICY JECT 7 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ EXCLUDED $ OTHER: TOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 100,000 B ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS WNEDRIS HIRED AUTOS AUUTOS X 02570870-0 P VE M 7 1 15 MCIV I 7/13/2016 BODILY INJURY (Per accident) $ 300,000 PROPERTY accidentDAMAGE $ 50,000 Uninsured motorist BI split limit $ 100,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE iv N/A YE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WAIVER _._.- WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under /�l fU1C. E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below C Professional Liabiity 1023195-01 7/23/2015 7/23/2016 General Aggregate $1,500,000 Claims Made Occurrence $500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) Certificate holder is also added as an additional insured for General Liability and Auto Liability. GCK 111-IL:A I t HULUtK ' I '1 'A l'1 - %i-t'l CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of Coul; i _i 6 HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street, Ste IV(ACCORDANCE WITH THE POLICY PROVISIONS. 'Key West, FL 33040 yJ O A a 3 =AJTHORIZED REPRESENTATIVE l C� 1J F Hager ©1988-2014 ACORD CORPORA TI N. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) GEICO Indemnity Company Certificate of Insurance One GEICO Center Macon, GA 31295-0001 Named Insured and Address: THOMAS RICHARD BEAVER PO BOX 523207 MARATHON SHRS FL 33052-3207 Name and Address: MONROE COUNTYari 1111 12TH ST, STE 408 KEY WEST FL 33040 Date of Certificate: 01-01-16 Policy Number: 4360-52-94-67 Policy Period: 02-04-16 to 08-04-16 (12:01 A.M. Local Time) (12:01 A.M. Local Time) Y PR E NAGEMEM r� WAIVE N/Ay, E (This Certificate of Insurance does not amend, extend, or alter the coverage afforded by this policy.) During the term of coverages provided, the Company and the insured shall be bound by the provisions of the policy (or policies) of insurance in current use by the Company in the state. This is to certify that the captioned policy includes the limits specified herein for each person and for each occurrence under the Bodily Injury Liability Coverage; the limits specified herein for each occurrence under the Property Damage Liability Coverage; and limits specified herein for each person and for each occurrence for Bodily Injury under the Uninsured Motorists Coverage. Description of Vehicle: 14 RAM 1 C6RR7HT9ES451810 Description of Vehicle: COVERAGE Bodily Injury Liability Property Damage Liability Uninsured Motorists (Bodily Injury) LIMITS OF COVERAGE $ 100 M and $300 M (Each Person) (Each Occurrence) $ 50M (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) LIMITS OF COVERAGE $ M and $ M (Each Person) (Each Occurrence) $ (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) INTERESTED PARTY We agree to provide you with written notice of termination in the evd#hJ ih1R Vjbg6c�6s,cancelled. Notice provided may be more than ten (10) days, but not less than ten (10) days. A I .8I3 Iil'1 i+�� 00 :z Wd C NVr 910Z rn N 0 O (O M CRU62 (9-07) 0 0 1�____"N e ACC) o CERTIFICATE OF LIABILITY INSURANCE ATE(MM/DD/YYYY) P7/25/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Keys Insurance Services 5800 Overseas H "� CONTANAME: David Sheppard PHONE (305)743-0494 Fax Ex A/C No : (305) 743-0582 E-MAILo ADDRESS: dsheppard@keysinsurance . com P.O. BOX 500280 Marathon FL 33050 INSURERS AFFORDING COVERAGE NAIC if INSURER A:Covington Specialty Ins. INSURED Thomas R. Beaver MD Medical Corp. PO BOX 523207 INSURERB:First Professional Insurance Co. INSURERC: INSURERD: INSURER E : Marathon FL 33052 INSURERF: COVERAGt5 CERTIFICATE NUMBER:2016-2017 Master GL 01=111elnlu w uADCD. 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR AM POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR EACH OCCURRENCE $ 1,000,000 _71PREMISES DAMAGE TO RENTED Ea occurrence $ 100, 000 MED EXP (Any one person) $ 5,000 X VBA47436800 7/20/2016 7/20/2017 PERSONAL & ADV INJURY $ 1,0002000 AGGREGATE LIMIT APPLIES PER: PRO POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 GEN'L X PRODUCTS - COMP/OP AGG $ EXCLUDED I $ OTHER: AUTOMOBILE LIABILITY LIMIT COMBINED SINGLE LIMIT Ea accident BODILY INJU - Per person) ANY AUTO ALL OWNED SCHEDULEDrn AUTOS AUTOS BODILY INJURY4 � HIRED AUTOS NON -OWNED AUTOS PROPERTY D Per accident $ 7 tr UMBRELLA LIAB OCCUR EACH OCCURRE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ - .� $j� _ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A STAPERT_ r-' ERH - ..� E.L. EACH ACCIDA�T $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS belo i E.L. DISEASE - POLICY LIMIT I It B Professional Liability 1023195-02 7/23/2016 7/23/2017 Each Occurrence 500,000 General Aggregate 1,500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate Holder Is Also Listed As An Additional Insured With Respects To General Liabilty Only. APPR D MENT BY WAIVER N/A _ v 'G"y' v CERTIFICATE HOLDER cenlcl:l I ATInKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commssioner 1100 Simonton Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. STE 268 Key West, FL 33040 AUTHORIZED REPRESENTATIVE Mel Montaigne 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)