Certificates of Insurancelrtq �• 0ee� fir. t�„ 2�t7
ZOVERAGE FOR VEHICLE # 1
2002 Lens S030
::. ERAGE LIMITS DEDUCTIBLE PREMIUM
Automobile Liability Insurance
• Bodily Injury $250,000 each person Not Applicable Suspended
$500,000 each occurrence
• Property Damage $100,000 each occurrence Not Applicable $60.90
Personal Injury Protection
$0 $77.86
Death Benefit
$5,000 each person
Aggregate Medical Expenses
(Emergency or Non -Emergency
Medical Condition),
Income Loss and Loss of Services
$10,000 each person
Medical Expenses - Emergency
Medical Condition
$10,000 each person
Medical Expenses - Non -Emergency
Medical Condition
$2,500 each person
Emeroency and Non -Emergency Medical Expenses are subject to the $10,000 per person aggregate limit.
Uninsured Motorists Insurance
$100,000 each person
Not Applicable
Suspended
for Bodily Injury
$300,000 each accident
Uninsured Motorists Insurance limits
of insured vehicles may be stacked
Auto Collision Insurance
Actual Cash Value
$500
Suspended
(Safe Driving Deductible Reward
- deductible reduction amount available is $400 )
Auto Comprehensive Insurance
Actual Cash Value
$250
$66.92
Rental Reimbursement Coverage
up to $30 per day for
Not Applicable
Suspended
a maximum of 30 days
Total Premium for 02 Was S030
$205.68
Page 4
MCD21-3 I � N@IIIIIUl�llll� Febwag2013 ROOM
CERTIFICATE OF COVERAGE
Certificate Holder
Administrator Issue Date 10,112116
MONROE COUNTY BOARD OF
Florida League of Cities, Inc.
COUNTY COMMISSIONERSBox
Department of Insurance and Financial Services
530065
1111 12TH STREET, SUITE 408
Orlando, Florida 32853-0065
KEY WES-Tr FL 33040
#SU= TO TH9 ANAM MAMMA fee 'm PIA100 INDlor" w;, "'v 41,hrrD,mT, `rnw, 0A W
=M_-T Firiscrmnlcwu MAY imimmie; MAY UArCTT1111 oi. P� ffPM-
rfIVERAQ,E Prrfl;v,)DED BY, FLORIDA MUNICIPAL INSURANCE TRUST
AGREEMENT HUMBERi FFIITII386
COVERAGE REACHED FROM, 1011.116
1 COVERAGE PERIOD. 7O10111171201ANSTANDARD"FIMF
TYPE OF COVERAGE - UABILFTY
TYPE OF COVERAGE - PROPERTY
General Liability
building, miscellaneous
Comprehensive General Letality, Bodily Injury, Prosody Damage,
Basic Form C] round Mimne
Per ire Injury and Adveresing Injury
Special Form [J Electronic Data Processing
Errors aryJ omissions nasality
C] Personal Property 13 send
Frnricn,-ners, traders Larger
Basic Form
0 Employee Borairts Program Administration Looney
Spread Form
HI AKA ArrendarmYNedical Directior' Malpractice rudest
0 Agreed chance
Broad Form Property Damage
0 I)edmtW N/A
Law Enforcement Liability
0 Coinsurance R/A
Underground, Explosion A Creston Placed
C] Market
Linaftsof Liability
C] smaic
I Combined Single Limit
C1 Rinswearmsont Cost
De[ ucyible NIA
0 Actual Cash Value
Automobile Liability
Limits of Liability an File with Administrator
All owned Autos i.Prwate Passenger)
'TYPE
OF COVERAGE - WORKERS' COMPENSAIION
All uwned Autos (OL k r the i Private Passenger;
Statutory WorkerV Compensation
Hired Autos
Employers Liability $I,OWr000 Each Accident
Na .-Owned Abdul
$1,000,1100 By Disease
a 1,000,000 Aggregate By Disease
Limits at Liability
0 Deductible NJA
I Colildned oralle Limit
35(10,000 Seff Insured Fl
De:uctibks PDA
Automobile/Equipment , Deductible
[@ Physical Damage PE- Schedule - Comprehensive - Auto Per Schedule - ConWon - PAY, NA - Miscenamsous Equipment
Other
The limit of lability Is $5,000,000 (combined a nane limit) bodily Injury @War property damayt t rh occurrence In excess of a self- Insured retention of $200 000,
This limit is solely for any halaky resulting from entry of a claims bill pursuant to Sectern, 7M 2.9 (S) Florida Statutes or llabilatoettlement for which no e-wims fall ran,
been filed or liability Imposed pursuant be reason Law or actions Pence the State of Florida.
APP�QVW; ftly MAKAaEME
Description of Operations/ L=aU*ns/Vichkles!Sp eciaI Items 9 Y
RE; Evidence of Insurance xjT
DATR
WAIVER dZ-1y7E.S.—
,vs N K, E Y"'Mo OR At " ta n, E =%RASE MWAN. 0 P , YMmrx� 7 AMES
nqs rrmv�
Designated Member
Cancellations
Monroe County Board of County Commissioners
SMD, _" PARF Cil"KAKY,% 0MR10to AC ES' SECAVLED WOUTpc lart A"IN,
1111 IOU Street Suite 408
P, Nrimir% M-MuYvA", EnoruvoY, t - twli, 45 Mys 1yonr7en Yotics tD o�e
croo a
wruq x
5, AWL WE= No
wo
Key West FL 33040