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COI EXPIRES 11/17/2015A C�� 11 C4O �! CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDNYYY) 10/8/2014 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 certifica holder i n' lieu of such endorsement(s). PRODUCER Regan Insurance Agency 90144 Overseas Hwy. Tavernier FL 33070 CONTACT Lilliam Reyes PHONE (305) 852 -3234 F No: (305)852 -3703 A : lreyes @reganinsuranceinc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:BusinessFirst 11697 INSURED Florida Keys History of Diving Museum 82990 Overseas Highway Islamorada FL 33036 INSURER B: Key West, FL 33040 INSURER C: INSURER D: INSURER E: $ INSURER F: COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:CL1410802645 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 ADD I SR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM /DD/YYYY LIMITS PO Box 1026 GENERAL LIABILITY Key West, FL 33040 Joseph Roth /SPARKE EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS -MADE F1 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ $ POLICY PRO LOC JE AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO B M Y BODILY INJURY (Per accident) S ALL OWNED SCHEDULED AUTOS AUTOS NED HIRED AUTOS AUTOS DATE_ WAIV� Y PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AN D EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y/ N WC STATU- T 1OTH- E E.L. EACH ACCIDENT $ 100,000 OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N/A 2104715 11/17/2014 11/17/2015 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Florida RE - Capital Project FY 14 -15 R2 f_FRTlPlrATF Wf11 n9:R CANCF_I_LATION Slavik- Maria @MonroeCounty - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissione & Monroe County TDC c/o Risk Management AUTHORIZED REPRESENTATIVE PO Box 1026 Key West, FL 33040 Joseph Roth /SPARKE ACORD 25 (2010/05) INS1712. rgninnsi m ©1988 - 2010 ACORD CORPORATION. All rights reserves. Thn AnnPil nomn nnri Innn am rnniafnrnri morlrm of Annizil 1996 Edidon MONROE COUNTY, FLORIDA Request For Waiver Of Insurance Requirements It is requested that the insurance requirements, as specified in the County's Schedule of Insurance Requirements, be waived or modified on the following contract. Contractor: The Florida Keys History of Diving Museum, Inc. Contract for: History of Diving Museum Timeline Project Address of Contractor: 82990 Overseas Hwy, Islamorada, FL 33036 Phone: (305) 664 -9737 Scope of Work: Dive MuseumTimeline Enhancement Project Reason for Waiver: Waiver of Auto Insurance requirement: The Dive Museum does not have any automobiles Policies Waiver will apply to: Signature of Con Risk Managemei Date -Is County Administrator Appeal: Approved Not Approved Date: Board of County Commissioners Appeal: Approved Not Approved Meeting Date: Administration Instruction #4709.2 A'40 CERTIFICATE OF LIABILITY INSURANCE F lo /P/2014 DATEIMMIDD --'"' . THIS CERTIFICATE tS: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;. l the_ certificate holder lsr an ADDITIONAL INSURED; the policy(les) must be endorsed; If SUBROGATION IS WAIVED,. subject to the.terms and.conditions of the policy certain policies may require an endorsement:` A statement o6. certificate ._does not;confer rights to the certificate Holder In .fled of such:'endprsetttent 5 PRODUCER , _: ;:. _.... _ Regan Insurance Ag ency 3 Y 90144 Overseas H t^IY• CONTACT NAME:.. Lilliam. Reyasi PH ONE (305)..852 -3234 = Fes ",.(3os )esa =37as 0 E:Mnit .7.r ®yos @reganznsurancednc.com ' INSURER 3 AFFOE701Nt'a CQVERAGE- NAIC t! Tavernier FL 33070 _ INSURER A .Bu.BZnes.sFlrs t 11697 INSURED. :. 'Florda.Ke s History of Dvin Museum Y rY 4 INSURER 8'4 - ....... _. iNSURERC.r 82990 Overseas Highway: =1HSURER D:..- .. INSURER E :.` Islamorada FL_ 3303.6 .... COVERAGES CERTIFICATE NUMBER .-CL1410802645_. 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. J R 4TR _ TYPE OF INSURANCE....__ - .,. ,. DQ. POLICY NU?,98ER POLICYEFF., p / - POLICY EXP: &M1QD1YyyXl LIMITS .. GENERAL LIABILITY _ EACH. OCCURRENCE - S. PREF ! Fa' $: COMMERCIAL G) NEI fiLLiABtt)TY CLAIMS MADE OCCUR MED; EXP (AnYone:parsop)- $ RERSONAL $ AQV S GENERAL AGGREGATE $ GEN'LAGGREGATE:LIMIT APPLIES PER: PRO = POLICY CDC- PRODUCTS COMP /OPAGG $ , ': -.. ,AUTOMOBILE LIABILITY _ _ .. COSIRICIED:S[NGt E 1IPAIF s s ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOSWNED BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PERTYt}AMAGE( $ UMBRELLA L IAR EXCESS LIAB H CLAIMS-MME OCC UR EACH OCCURRENCE: AGGREGATE $ pats I I RETENTIONS, A. WORKERS COMPENSATION "" AND EMPLOYERS' LIABILITY Y! N ANY: PROPRIETOR/ PARTNERIEXECUTIVE OFE?CERIM � EMBER EXCLUDED? {P4dndAtaryln,NH): I6Yy daa uristar ..... . DESL . - N -F OPERATIONS 1101oW NIA A 2104715 1/17/201411/17/2015 WG STATU -: - 0TH= I ER . E L' EACH ACCIDENT S 10'Q OOQ EL DISEASE - >AIcMPLO(E $ 10.0: QOU E L t)ISEASE = POLICY LIMIT. it . 500 , 00.0 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more apace Is required) Florida V D B RISK ANAGEMENT RE = Capital Project FY 14 -15 R2 BY DATE v WAI _ WAIVER W, l YES v�a",r,vnia:.nvLUCn _ : _ UAI4(s1=LLAIIVI9 _.. .. Slavik- Maria @MonroeCounty - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissions ACCORDANCE WITH THE POLICY PROVISIONS. & Monroe County TDC c/o Risk Management 'AUTHORIZED REPRESENTATIVE PO Box 1026 Key West, FL 33040 Joseph Roth /SPARKS ACORD. 25 (2010/05) ©1988 -2010 ACORD CORPORATION_ All rinhtc racarvarl 1996 Edition Contract for: E Ucatie�n o , mm''ii #: tstory €af diving lltes .. rn Enhance me is Project Address of Contractor: 9U ver ea Hwy; IsI' ' da; FL 3 Reason for Waiver: - Nor of Auto. insurance tectUlrerhe fit: The' Div M s um dpos not have any automobiles. Policies Waiver will apply to: late Signature of Contractor: d roc. N j Approved Risk Management; (( Date: County Administrator Appeal: Approved Not Approved Date: Board of County Commissioners Appeal: Approved Not Approved Meeting Dates Administration Instruction #4709.2