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Certificates of Insurance 0.Fes.t...,,--7.-,••_ ..n.% 4„.. 4 ,_!.,,,,,,,,,., Dw JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION ** CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW** NON-CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 11/25/2017 EXPIRATION DATE: 11/25/2019 PERSON: ERIN L DEADY EMAIL: ERIN@DEADYLAW.COM FEIN: 453108752 BUSINESS NAME AND ADDRESS: ERIN L. DEADY, PA APPROVE - - 4GE ENT 701 NORTHPOINT PARKWAY, SUITE 2, 05 BYA TE „� ` �`' I�r WEST PALM BEACH, FL 33407 WAIVER N/AYES__ I ) 7 SCOPE OF BUSINESS OR TRADE: Attorney-All Employees& Clerical,Messengers,Drivers IMPORTANT:Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),.F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Florida Lawyers Mutual eY " RISKAt1► Ir INSURANCE COMPANY DA WAIVER P4/A YES_ CERTIFICATE OF INSURANCE 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 alter the coverage afforded by the policy listed below: NAMED INSURED AND ADDRESS: Erin L.Deady,P.A. 620 W.Bloxham Street Lake Worth,FL 33462 This is to certify that the policy of insurance listed below has been issued to the insured named above and is in force at this time. TYPE OF INSURANCE: LAWYERS PROFESSIONAL LIABILITY POLICY NUMBER: 88222 POLICY TERM: 09/20/2018 to 09/20/2019 LIABILITY LIMITS: 09/20/2018 to 06/07/2019 $500,000 Per Claim/$1,000,000 Total Limit 06/07/2019 to 09/20/2019 $2,000,000 Per Claim/$2,000,000 Total Limit CANCELLATION: Should the above-described policy be canceled before the expiration date thereof, the issuing Company will endeavor to mail 30 days written notice to the below named Certificate Holder,but failure to mail such notice shall impose NO obligation or liability of any kind upon the Company, its agents or representatives. NAME AND ADDRESS OF CERTIFICATE HOLDER: Monroe County Board of County Commissioners 1100 Simonton Street Key West,Florida 33040 June 10, 2019 DATE OF ISSUE A D NTATIVE 541 East Mitchell Hammock Road,Oviedo,FL 32765 P 800.633.6458 I F 800.781.2010 I flmic.com ____.........11 NATUCON -10 LVIDAL ACc RD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDrYYYY) 4 11..---- -- 6/27/2016 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 endorsement(s). PRODUCER License # 0C36861 NAME: ACT Kelly Mitchum Chantilly- Alliant Ins Svc Inc. PHONE ,-,A1) 397 -0977 FAX 397 -0995 4530 Walney Rd Ste 200 (A /C, No. Ext): (ac, No): ( 703 ) Chantilly, VA 20151 -2285 ADDRESS: INSURER(S) AFFORDING COVERAGE 1 NAIC # INSURER A : Great Northern Insurance Company 20303 INSURED INSURER B : Federal Insurance Company 20281 The Nature Conservancy INSURER C : Attn: John Dwelley 4245 North Fairfax Dr - #100 INSURER D : Arlington, VA 22203 -1606 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM /DD/YYYY) (MM /DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAIMS -MADE X OCCUR 35353977 07/01/2016 07/01/2017 DAMAGE TO RENTED a occ urrence) $ 1,000,000 PREMISES (E I MED EXP (Any one person) $ 10,000 1 — 1 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PEft GENERAL AGGREGATE $ 2,000,000 X POLICY PRO T X LOC PRODUCTS - COMP/OP AGG $ Included JEC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B X ANY AUTO 73246135 07/01/2016 07/01/2017 BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X AUTOS (Per accident) DAMAGE $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE 79729278 07/01/2016 07/01/2017 AGGREGATE $ 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A 1 (Mandatory M NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CD s- Sub- contract from Erin L. Deady, PA to The Nature Conservancy for sustainability and climate planning in Monroe County, F4tng 201 � O rn i "T7 r Z in CERTIFICATE HOLDER CANCELLATION f" CI (,) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 500 Whitehead Street / ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE 4.4_ • t. tiC.C' © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 410 DATE(MM/DDIYYYY) ACORLI CERTIFICATE OF LIABILITY INSURANCE 06/04/2019 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 endorsement(s). PRODUCER CONTACT NAME: Hiscox Inc. (AIONE C.No,-Ext): (888)202-3007 (A/C,No): 520 Madison Avenue AIL ADDRESS: contact@hiscox.com 32nd Floor New York,NY 10022 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B: ERIN L DEADY P.A. 54 1/2 SE 6TH AVE INSURER C: DELRAY BEACH,FL 33483 INSURER D: 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 INSD DDL SUBR WVD POLICY NUMBER IYPOLICY EFF POLICY EXP (MMIDD/YYYY)�{MMIDDYW) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 1 PREMISES(Ea occurrence) $ 00,000 MED EXP(Any one person) $ 5,000 A • Y Y UDC-2298363-CGL-19 06/29/2019 06/29/2020 PERSONAL BADVINJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ S/T Gen.Agg OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A )) (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) APPRO Ei tA(-EMENT DAT 191n — WAIVER N/A ' Y CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners 1100 Simonton Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Key West FL 33040 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ERIN L.DEAI P.A. 54%z SE 6`h Avenue Delray Beach, FL 33482 • 561.340.3625 June 6,2019 To whom it may concern: Erin L. Deady, P.A.is providing this correspondence as requested stating that the firm has less than 4 employees and has elected not to purchase Workers'Compensation/Employers Liability coverage as permitted by Florida Statutes. Erin L. Deady, P.A.does not maintain Workers'Compensation/Employers Liability coverage as permitted • by Chapter 440, Florida Statutes. Erin L.Deady has submitted a Certificate of Election to be Exempt from Florida Workers'Compensation Law in lieu of the Workers' Compensation coverage. It is attached again to this correspondence. Sincerely, C � Erin L.Deady 2018 Edition 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/Vendor: i Project or Service: ContractorlVendor t � � / /� r Address&Phone� �`: t � DV.rc b-CV1t Vic. _ ` 34 C3 • General Scope of Work: �1 n._. (& 4 ` oa '111-011-(41 Reason for Waiver or 0... Lk. Modification: Policies Waiver or Modification will apply to; ,,IW ' 1(- I( .UY L( ' `5 '47) Signature of Contra1ctorNendor: Date: 11 to 1 1_I Approved Not Approved Risk Management Signature:_ . .... Date: County Administrator appeal: Approved: Not Approved: Date: Board of County Commissioners appeal: Approved; Not Approved: -,_ Meeting Date: -" Administrative Instruction 7500.7 I64