3rd Amendment 04/17/2019 GV�S COURTq c
Kevin Madok, CPA
Clerk of the Circuit Court& Comptroller— Monroe Count Florida
o p Y,
E cOVN
DATE: June 14, 2019
TO: Lynn Gonzalez
Executive Administrator
FROM: Pamela G. Hancock, D.C.
SUBJECT: April 17' BOCC Meeting
Attached is an electronic copy of C39, 3rd Amendment to the Agreement with Adjusters
International, Inc. to reflect the name change of the corporation to Rising Phoenix Holding
Corporation, for your handling.
Should you have any questions,please feel free to contact me at (305) 292-3550. Thank
you.
cc: Countv Attorney
Finance
File
KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING
500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road
Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070
305-294-4641 305-289-6027 305-852-7145 305-852-7145
r
AMENDMENT 3 TO AGREEMENT FOR
FEMA PUBLIC ASSISTANCE CONSULTING SERVICES
1
This Amendment is entered into this(� v I
day of April, 2019, by and between Monroe County, a
political subdivision of the State of Florida, hereafter COUNTY, and Adjusters International, Inc., now
known as and legally operating under Rising Phoenix Holding Corporation,hereafter CONSULTANT.
WHEREAS, on November 296', 2017, the COUNTY and Adjusters International, Inc. entered
into an Agreement for FEMA Public Assistance Consulting Services; and
WHEREAS, County was notified by Adjuster's International, Inc. that it changed its name to
Rising Phoenix Holding Corporation effective January 1,2018; and
WHEREAS, this amendment is needed only to reflect the new corporate name and the
CONSULTANT has represented will otherwise have no impact on the Agreement; and
WHEREAS, CONSULTANT will continue to perform all of its obligations under the
Agreement;
NOW THEREFORE, in consideration of the mutual promises of the original agreement as
amended herein,the parties agree as follows:
1. Effective January 1, 2018,Adjuster's International,Inc. changed its corporate name to Rising
Phoenix Holding Corporation. There are no other changes to the Federal Tax Identification
Number (FEIN), corporate business address, bank accounts, wiring instructions, or company
management,technical staff and financial personnel.
2. CONSULTANT will continue to perform all of its duties, responsibilities, and obligations
under the Agreement.
3. Where the corporate name Adjusters International, Inc. appears in the Agreement, as
amended, the name shall be hereinafter amended to read Rising Phoenix Holding
Corporation.
4. The remaining provisions of the agreement dated November 29, 2017, as amended, not
inconsistent herewith,remain in full force and effect.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
Page 1 of 2
r.
BOARD OF COUNTY COMMISSIONERS
Attest: KEVIN MADOK,Clerk OF MONROE COUNTY,FLORIDA
By By:
Deputy Clerk Mayor/Chairman
Date:
CONSULTANT
RISING PHO OLDINGS CORPORATION
By:
J- ignature "20„,„"_
/),,,k, v ,rd�
Printed Name/Title
Date: %l ll l, 1 /
The foreg•ing instrument was acknowledged before me this 1 day of apiLl ,2019,by
§
-16p 'n T SIf?c2 who is(Xjpersonally known to me or( )produced a driver's license
as i ent ication.
•1 ARY PUBLIC, STATE OF—F 6 I Vora
BRIANNA L. MOYER
• Notary Public in the State of New York
Qualified in Oneida County 01M06294465
My Commission Expires Dec.23.20
Print,type of stamp commissionecrname of
notary
MONROE CO NTY ATTORNEY
AP OV S TO FORM
CHRIS A BROSIO
i-^
ASSI • NT OUNTY ATTORNEY
(
..1 •- Date: liyl v
ac
1_1.
`)
i�.s:.. O
Z
Page 2 of 2
....---'mfri ADJUS-1 OP ID:DI{
ACC:PR®- CERTIFICATE OF LIABILITY INSURANCE DATE
1412 19
03/ 4/20
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 poilcy(les)must have ADDITIONAL INSURED provisions or 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 315-766-8888wpm' Robert Broccoli
Gilroy,Kerman&Gilroy,Inc. P►O N.Ea):315-768-88=: I FAX 315-768.8600
210 Clnton Road Ia (A/C,Na):
P.O.Box 542 Miss;
New Hartford,NY 13413-0542
Robert Broccoli INSURERISI AFFORDING COVERAGE NAIC P
INSURERA;Cincinnati Insurance Co. 10677
INSURED Adjusters International Inc. wsuRER B:Federal Insurance Co. 20281
AKA Rising Phoenix Holdings _wsLIRER c ACE American 22667
corp.
126 Business Park Dr. INSURER D,Westchester Fire Insurance Co 10030
Utica,NY 13502 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 1S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRR Foxy POLICY ExP
TYPE OF INSURANCE POLICY NUMBER (MN DDI UYEYYYI FF I IMM
Ilr gp VDIYYYYI LIMITS
A x I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
CLAIMShtADE n OCCUR X X CPP5252643 12/09/2017 17/09/2020 PREld1s5;MElf[u pare) s 100,000
MED EXP!Any me°erS°n1 $ 5,000
PERSONAL P.ADV INJURY I 1,000,000
GEU'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000
POLICY n jge, I I LOC PRODUCTS-comp,oP AGG 1 2,000,000
I OTHER We: I
A ALIrOMO BILE LIABIUTY IE6�ESs IDSINGLELIMIT I - 1,000,000
__ANY AUTO X X EBA 0490929 1210912018 12109/2019 sootyFJJURY{per perscn1 s
OWNED SCHEDULED BODILY INJURY per academy $AUTOS��p ONLY AUUTOpSyyt D p
x AUTOS ONLY X AU OS OIIY I.PP ACECRaTenti AMAGE I
S
A X UMBRELLA LAB X OCCUR EACH OCCURRENCE S 20,000,000
EXCESS LIAR CLAIMS.MADE X X CPP5252643 12/09/2017 12/09/2020•AGGREGATE ; 20,000,000
DED X IRETENTION r 10,000
f
B y'OREERS COMPENSATION X PER I I GIN.
me EMPLOYERS'LIAB3LITY STATUTP ER
ANY PROPRIETOR,ARTNERIEYECUTIVE LLJ( 119)7176-83-24 06/0612018 0610612019
E LEACH ACCIDENT S 1,000,000
fFICER t�-1, EXCLUDED? N f A
^e toryln ) E L DISEASE.EA EMPLOYEE S 1,000,000
11 yyes.describe under 1,000,000
IESCRIPTION OP OPERATIONS below E L EeSEASE-POLICY LIMIT_ 3
D E&O G27456298 005 06101/2018 06101/2019 E&O 5M/5M
C Cyber F14612439 001 12/18/2018 12/1812019 Cyber 10M/10M
DESCRIPTION OF OPERATION I LOCATIONS I VEHCLES(ACORD 101,Additional Remarks Schedule,may be attached If more epic.Is required)
Certificate holder is included as Additional Insured on a primary/non-
contributory basis as required by written contract.Waiver of Subrogation APR
applies.The workers'compensation policy includes coverage in the state of p: MENT
Florida. DA +7�df!r E
WA,y . ;,�ik V
CERTIFICATE HOLDER CANCELLATION
MONR-07
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Monroe CountyBoard THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS. .
of County Commissioners
1100 Simonton Street AUTHORIZED REPRESENTATIVE
Key West,FL 33040
- 6,-/AA-e—c- 7--A iit,,y
ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ADJUS-1 OP ID: DH
'4�R�� CERTIFICATE OF LIABILITY-INSURANCL'`� °ATE`MM'°°""Y) '
-a 06/03/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICJ;TE HOLDER. THIS
• CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY) THE POLICLS
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT'BETWEEN THE ISSUING INSURER(S), -i'irMIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 315-768-8888 uACT Robert Broccoli
Gilroy Kernan&Gilroy,Inc. PHONE 315-768-8888 I Fax 315-768-8600
210 Clinton Road (NC,No,Exq: (A/C,No):
P.O.Box 542ss:
New Hartford,NY 13413-0542
Robert Broccoli INSURER(S)AFFORDING COVERAGE NAIC
INSURER A:Cincinnati Insurance Co. 10677
INSURED Adjusters International Inc. INSURER B:Federal Insurance Co. 20281 •
AKA Rising Phoenix HoldingsCorp. INSURER C ACE American 22667
2 Business Park Dr. INSURER D:Westchester Fire Insurance Co 10030
Utica,NY 13502
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD (MM/DD(YYYY) (MMJDO!VYYY)
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR . X X CPP5252643 , 12/09/2017 12/09/2020 P°REMISES Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5,000
- PERSONAL&ADV INJURY $ . 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: . GENERAL AGGREGATE $ 2,000,000
X POLICY j8T' LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
(Ea accident) $
— ANY AUTO X X EBA0490929 12/09/2018 12/09/2019 _BODILY INJURY(Per person) $
OWNED SCHEDULED
_ AUTOSRE ONLY AUTOS
yy Ep BODILY INJURY(Per accident) $
X AUTOS ONLY X AUTOS ONLY (Perr accident�AMAGE $
$
A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20,000,000
EXCESS LIAB CLAIMS-MADE X x CPP5252643 12/09/2017 12/0912020 AGGREGATE $ 20,000,000
DED X RETENTION$ 10,000 $
B WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY OTH-
X STATUTE ER
ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N (19)7176-83-24 06/06/2019 06/06/2020 • 1,000,000
OFFICER/MEMBER EXCLUDED? N I A E.L.EACH ACCIDENT $
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ - 1,000,000
lI es,describe under 1,000 000
DESCRIPTION OF OPER ATIONS below _ E.L.DISEASE-POLICY LIMIT $ J..__
D E&0 G27456298 005 06/01/2019 06/01/2020 'E&O 5M/5M
C Cyber F14612439 001 12/18/2018 12/18/2019 Cyber 10M/10M
DESCRIPTION OF OPERATIONS I LOCATIONS$VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Certificate holder is included as Additional Insured on a primarylnon-
contributory basis as required by written contract.Waiver of Subrogation
applies.The workers'compensation policy includes coverage in the state of. 'B` p
Florida. gy NAGEMENT
A 19D /A YE
CERTIFICATE HOLDER CANCELLATION
MONR-07
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,' NOTICE WILL BE DELIVERED IN
Monroe County Board ACCORDANCE WITH THE POLICY PROVISIONS.
of County Commissioners
1100 Simonton Street AUTHORIZED REPRESENTATIVE
• Key West,FL 33040 •
• 44tRA-4—e- 7.-A i An,lir ,
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD