Loading...
Certificate of Insurance DATE (MM/DDtYYYY) ,,---� ' a CERTIFICATE OF LIABILITY INSURANCE D A 02/26/2015 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 NAME: Risk Transfer Insurance Agency, LLC PHONE g66- 481 -9363 1 FAX 707 East Washington Street (NC. No. Ext); ' IA X C NO1.r Orlando, FL 32801 E ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # m INSURER A :Techno!o ` Insurance Company, Inc. E 42376 INSURED INSURER B : Stafflink Outsourcing, 11, 18, IV, V & VI Inc. 1776 N. Pine Island Road INSURER C : Suite 108 Plantation, FL 33322 INSURER D : INSURER E : INSURER F . COVERAGES CERTIFICATE NUMBER:Z83TTJMT 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 — TA.b0L SUER( PODGY EFF POLICY EXP TYPE OF INSURANCE LIMITS — — LTR I INSR WW1 MI 1 POLICY NUMBER IMM/DDIYYYY) : (MDDFYYYY) GENERAL LIABILITY 1 EACH OCCURRENCE I $ 8AMA8E f5 COMMERCIAL GENERAL LIABILITY j PREMISESi Ea occurrence) ! E f a MED EXP An ar e person) ': $ CLAIMS-MADE I I . • PERSONAL & ADV INJURY $ • I, GENERAL AGGREGATE 1 $ • GEN'L AGGREGATE LIMIT APPLIES PER: [ PRODUCTS COQ :IPIOP AGG j 5 POLICY SGT IOC 8 AUTOMOBILE LIABILITY C:OMBIN Q SINGLE LIMIT • • — (_a acc de t $ BODILY INJURY Per • perm ; $ • • ANY AUTO _... .--- f--'- -- -. __.._.....__. ALL OWNED SCHEDULED ' • EOD!LY INJURY Per accident; ; S AUTOS AUTOS PROPERTY DAMAGE NON-OWNED _..__.._— _... _....__..._, HIRED AUTOS AUTOS ,_i?er acr :den.i_.._..__ ..___..1 3 • ! s UMBRELLA LIAR OCCUR EACH OCCURRENCE ' 5 — i EXCESS LIAR CLAIMS-MADE AGGREGATE i'5 DED RETENTION $ 8 A I WORKERS COMPENSATION ( TWC3464905 1 03101/2015 i 03/01/2016 }(� W3v ST AT 3 j I 1OTH AND EMPLOYERS' LIABILITY Y / N ; ANY PROPRIETOR:PARTNER/EXECUTIVE ( ! E.L. EACH ACCIDENT ; $ 1,000,000 OFFICER /MEMBER EXCLUDED? N / j ' 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE: 5 If yes, oascxiba under I 1,000,004 DESCRIPTION OF OPERATIONS below . . i c E.L. D13EASE -POLICY LIMIT $ i i i ,S DESCRIPTION OF OPERATIONS / LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Coverage is extended to the !eased employees of alternate employer in all states except in monopolistic states (ND, OH, WA, WY) and other states (AK, H. ID, OK): Florida Keys Outreach Coalition, Inc. 4 6011 (Effective 03/01/14) f I 1 _,.� PPR. mill' . MENT �` W '• //' Cr ` CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED tN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissioners Attn: Monique Diaz, Risk Management Assistant AUTHORIZED REPRESENTATIVE 1100 Simonton Street - y i v 4 Key West, FL 33040 Art Page 1 of 1 O 1988 4010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ,...----.1 DATE (MMJDDIYYYYI AcCJRD CERTIFICATE OF LIABILITY INSURANCE 2 (MM/DD 1s THIS CERTIFICATE ' CE RTIFICATE 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). Kleyman PRODUCER Libertate Insurance LLC CONTACT NAME: R ada y Fax 707 East Washington Street PHONE 407- 613 -5482 IAJX,No): (A/c: No Extl; E-MAIL Orlando, FL 32801 ADDRESS: rkleymanto�,libertateins.com INSURER(S) AFFORDING COVERAGE NAIC A www.libertateins.com INSURER a: Technology Insurance Company, Inc 42376 INSURED INSURER B : Stafflink Outsourcing, II, III, IV, V & VI Inc. INSURER C: 1776 N. Pine Island Road, Suite 108 Plantation FL 33322 INSURER D: { INSURER E : — INSURER F COVERAGES CERTIFICATE NUMBER: 28696788 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. TYPE OF INSURANCE iADDLISUBR W ' JY POLICY EFF 1 POLICY EXP LIMITS 1 NTR INSOI VD i POLICY NUMBER (MMIDDYYY) I (MMJOD/YYYY) COMMERCIAL GENERAL LIABILITY 1 a EACH OCCURRENCE 5 _ .. DAMAGE TORENTED -. __. ---- -. CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ _ _ — MED EXP (Any one person) $ PERSONAL & ADV INJURY $ ; I GEN'L AGGREGATE LIMIT APPLIES PER i GENERAL AGGREGATE $ PR0. C LOC PRODUCTS - COMP/OP AGG $ s POLICY ( - � ITT $ 4 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ Ea accident ANY AUTO U 1 BODILY IN RY (Per person) $ ALL OWNED SCHEDULED I BODILY INJURY (Per acodent) $ AUTOS I AUTOS PROPERTY DAMAGE NON-OWNED (Per accident}_ $ HIRED AUTOS AUTOS NED - -- t s UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS -MADE i I AGGREGATE $ DED I RETENTION $ { $ a WORKERS COMPENSATION TWC3536831 3/1/2016 3/1/2017 / srarurE ORH AND EMPLOYERS' LIABILITY y J N i 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE i E.L. EACH ACCIDENT $ OFFICER /MEER EXCLUDED N r A 1 (Mandatory i NH) E.L. DISEASE - EA EMPLOYEES ,000 000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below I I I 1 DESCRIPTION OF OPERATIONS l LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 1 • PEO Client: Florida Keys Outreach Coalition, Inc. PPI ft E �' AGEMENT • Client ID # 6011 Effective 3/1/2014 ' "'Or Coverage is extended to the leased employees of alternate employer in all states except in monopolistic states. WAI ` N. y S = CM5; i CC •Prit CERTIFICATE HOLDER CANCELLATION 6011 vC : ,\IFlIJJ JOdNUW 1 ' ] e 12 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Com sslbn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Monique Diaz, Risk Management Assistant ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street Key West FL 33040 0 :1 Wd 6- iVW 9101 AUTHORIZED REPRESENTATIVE s ^ " =,t ^ 1 1 41 J y - L) - 1 OAT l i 7 Paul R. Hughes I © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 2669679/ 1 STAFOUT -04 1 WC PEO Vaster 16 /17 1 Rada Kleyman 1 2/24/2016 3:03:20 ?N i EST) 1 gage 1 of 1 This certificate cancels and supersedes ALL previously issued certificates.