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COI Expires 11/17/2014AL a rT4 -1 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 7/17/2014 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. Regan Insurance Agency 90144 Overseas H Hw Tavernier FL 33070 CONTACT Lilliam'Reyes '' NAME: . -.._ .. PHONE (30.5).852 -3234 .. FAx 0 -3703 AML, -. . ] reyas@regarsn:auxanceine',:com. INSURERS AFFORDING COVERAGE' NAIC # INSURER A:Busi 11697 INSURED Florida Keys History of Diving Museum c/o Thomas Lockyear 82990. Overseas Highway Islamorada FL. 33036. __._..__ INSURER 8: MAMA INSURER C: EACH OCCURRENCE INSURER D; . A A k PRE . Fa eceurrenca . INSURER E. :. MED.EXP (Any.one erson) INSURER F: ..PERSONAL 8 ADV INJURY COVERAGES CFRTIFICATF NIJIVIRFR- CL14324UZ282 R1= VICInP1 Al11MRFR• THIS 1S 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. I I N .TR TYPE OF INSURANCE C L ®- POLICY NUMBER POLICY EFF D /Y Y YI "POLICYEXP ( MMIDDlYfal : LIMITS GENERAL LIABILITY .COMMERCIAL AL GENERAL LIABILITY CLAIMS MADE ,OCCUR � PPRIMV D B I MAMA ENT EACH OCCURRENCE $ A A k PRE . Fa eceurrenca . $ MED.EXP (Any.one erson) $ ..PERSONAL 8 ADV INJURY $.. GENERAL AGGREGATE $ GFN'l AGGR ELATE LIMIT'APOLIES PER. POLICY' PRQ^` F LOC PRODUCTS - COMP /OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED .AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BY - J DA WAIVER N/ COMB NLD.SINGLE LIMIT " Ea t3cc BODILY INJURY (Per person) $ BODILY INJURY.(Per accident) $ YES 'P $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED. RETENTION:: A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER /EXECUTIVE (Mandatory in ERF�CCLUDED? (Mandatory in NH) If yyes, describe under DESCRIPTION OF OPERATIONS. below. .NIA 2104715 11/17/201311/17 /2014 - WC STATU- TORY I IMIT9 OTH- E.L. EACH ACCIDEN 3 IO.O. OOO E.L. DISEASE - EA EMPLOYE . $ .. 100" 000 E.L, DISEASE - POLICY LIMIT $ 50Q 000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Florida Monroe Co Board of County Commissioners & Monroe Couynty TDC c/o Risk Management PO Box 1026 Key West, FL 33040 UANUtLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Joseph Roth /SPARKS" ACORD 26 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. co ° ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD .�� 03/24 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 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 NAME: Joseph Henry Roth III Regan Insurance Agency A/CC. No. Ell: (305) 852 -3234 FAX N. I: (305) 852 -3703 90144 OVERSEAS HWY E -MAIL ADDRESS: TAVERNIER, FL 33070 -2229 INSURERS AFFORDING COVERAGE NAIC # INSURERA: BusinessFirst Insurance Company 11697 INSURED The Florida Keys History of Diving Museum 82990 Overseas Htrry Islamorada, FL 33036 -3600 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 r11 IJ 1 L;tKIIt IHAI IHE 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 I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD /DY POLICY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR . A'R . V B WAIVER N/A YES E EACH OE $ DAMA T KENT ED PREMISES Ea occurrence $ MED EXP (Any one person) .. $ PERSONAL 8 ADV INJURY. $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ JECT LOC GENERAL AGGREGATE ' $ PRODUCTS - COMP/OP AGG $ ' $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ BODILY INJURY (Per person) $ ANY AUTO A O SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB H CLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DED RETENTION $ $ - —' A WORICERSCOMPENSATIDN -- AND EMPLOYERS' LIABILITY YIN ANY OF EXCLUDED? PROPRIETOR/PARTNERIEX ❑ N/A 0521 11 /17/2013 11/17/2014 X STATUTE ER E.L. EACH ACCIDENT $ 1 00,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory In NH) Dy SCRIPTION OF OPERATIONS below es, describe under DE E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Item 3. A.: Workers Compensation Insurance applies to the Workers Compensation Law of the states listed here: Florida Job: Proposed Capital Project vin r rrra.n r c nv6uCR GANGtLL.A I IUN Monroe Co Board of County Commissioners & Monroe County TDC C/O Risk Mangement SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 1026 ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE Carol Sipe (2 w&k:� ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ADORD name and logo are registered marks of ACORD JAN.07.2022 03:26 3056649736 DIVING MUSEUM #1533 P.001 /001 c �e Lam) ... &Nb7- '`) r�l L"" t VICe �I1Q Jd ;"A kp 1�t�1y�:, Q C�� 1"6 Edition U ' MONROE COUNTY, FLORIDA Request For Waiver or 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: Rotating Exhibit Space Project Address of Contractor: 82990 Overseas Hwy, Islamorada, FL, 33036 Phone: (305) 6649737 Scope of Work: Create area for future rotating exhibits Reason for Waiver: Waiver of Auto Insurance requirement: The Dive Museum does not have any automobiles Policies Waiver will apply to: Signature of Contractor: Itisk Ma Date: to 1 County Administrator Appeal: Approved Not Approved Date: Board or county Commiexioners Appeal: Approved Not Approved Meeting Date: Administration Instruction #4709.2