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COI Expires 10/01/2016CERTIFICATE OF COVERAGE Certificate Holder Administrator Issue Date 7/26/16 MONROE COUNTY BOARD OF Florida League of Cities, Inc. Department of Insurance and Financial Services COUNTY COMMISSIONERS P.O. Box 530065 1100 SIMONTON ST Orlando, Florida 32853-0065 KEY WEST, FL 33040 COVERAGES ANY THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO THE DESIGNATED MEMBER FOR THE COVERAGE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION F CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUB]ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FMIT 0303 COVERAGE PERIOD: FROM 10/1/15 COVERAGE PERIOD: TO 10/1/16 12:01 AM STANDARD TIME TYPE OF COVERAGE - LIABILITY TYPE OF COVERAGE - PROPERTY General Liability ® Buildings © Miscellaneous Basic Form Inland Marine ® ❑X Comprehensive General Liability, Bodily Injury, Property Damage, Personal Injury and Advertising Injury ® Special Form Electronic Data Processing ® Errors and Omissions Liability ® Personal Property Bond 0 Employment Practices Liability ❑ Basic Form ❑X Employee Benefits Program Administration Liability ® Special Form ® Medical Attendants'/Medical Directors' Malpractice Liability Agreed Amount ❑X Broad Form Property Damage © Deductible $1,000 Law Enforcement Liability ® Coinsurance 100% ® Underground, Explosion & Collapse Hazard Blanket wl<c- U I6DE Limits of Liability Specific y ® [) * Combined Single Limit ® Replacement Cost Deductible $5,000 Actual Cash Value I Automobile Liability Limits of Liability on File with Administrator © All owned Autos (Private Passenger) TYPE OF COVERAGE - WORKERS' COMPENSATION ® All owned Autos (Other than Private Passenger) 0 Statutory Workers' Compensation © Hired Autos ❑X Employers Liability ;1,000,000 Each Accident ❑X Non -Owned Autos $1,000,000 By Disease $1,000,000 Aggregate By Disease Limits of Liability Deductible N/A * Combined Single Limit SIR Deductible N/A Deductible N/A Automobile/Equipment - Deductible ® Physical Damage Per Schedule - Comprehensive - Auto Per Schedule - Collision - Auto Per Schedule - Miscellaneous Equipment Other * The limit of liability is $200,000 Bodily Injury and/or Property Damage per person or $300,000 Bodily Injury and/or Property Damage per occurrence. These specific limits of liability are increased to $5,000,000 for General Liability and $1,000,000 for Automobile Liability (combined single limit) per occurrace, solely for 12t filed liabil' any liability resulting from entry of a claims bill pursuant to Section 768.28 (5) Florida Statutes or liability/settlement for which no claims bill has or imposed pursuant to Federal Law or actions outside the State of Florida. r- Description of Operations/Locations/Vehicles/Special Items r- r1T:'C RE: Street Light Maintenance RE: Events, activities, elections and functions authorized by the certificate holder involving the designated member while being held upon the pr f the certificate holder. The certificate holder is hereby added as an additional insured, except for Workers' Compensation and Employers Liability, as r the member's liability for the above described event. 2 ? 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 ALTERT GE AFFOR DESK THE AGREEMENT ABOVE. - Designated Member Utility Board of the City of Key West P.O. Drawer 6100 Key West FL 33041-6100 FMIT CERT (1012011) Cancellations AW W CO SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROGRAM, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE