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05th Amendment 05/22/2019 cpd cockra .44''74a Kevin Madok, CPA 30 .'`::�. t� Clerk of the Circuit Court&Comptroller—Monroe County, Florida ~Roe co; , DATE: February 13, 2020 TO: Tina LoSacco, Sr.Technician FROM: Pamela G. Hancori1.C. SUBJECT: May 22, 2019 BOCC Meeting Attached are electronic copies of the following items that were just received by this office for your records. C26 2nd Amendment to Contract with The Florida Keys Society for Prevention of Cruelty to Animals, Inc. for operation of the Marathon Animal Shelter reflecting a CPI-U increase of 1.9% effective November 15, 2019.The agreement amount will increase to $442,689.77/year or $36,890.81/month. C27 5th Amendment to the Amended and Restated agreement with The Florida Keys Society for Prevention of Cruelty to Animals, Inc. for the Key West Animal Shelter reflecting a CPI-U increase of 1.9% effective May 1, 2019.The agreement amount will increase to $550,886.80/year or $45,907.23/month. Should you have any questions, please feel free to contact me at(305) 292-3550. cc: County 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 FIFTH AMENDMENT TO AMENDED AND RESTATED AGREEMENT (Operation of the Key West Animal Shelter) THIS FIFTH AMENDMENT TO AMENDED AND RESTATED AGREEMENT is entered into this 22nd day of May, 2019, between Monroe County Board of County Commissioners (County) and Florida Keys Society for Prevention of Cruelty to Animals, Inc., a Florida not-for-profit corporation (FKSPCA/Contractor), in order to amend the agreement entered into on May 1, 2014, as amended on April 20, 2016 and May 17, 2017 and May 16, 2018 and August 15, 2018; WHEREAS, the parties entered into an Amended and Restated Agreement on May 1, 2014 for the FKSPCA to provide long-term animal control services and enforcement pursuant to the provisions of F.S. 255.065 (formerly F.S. 287.05712) from Mile Marker 0 through Mile Marker 16.7 (the Harris Channel Bridge), including the City of Key West (Agreement); and WHEREAS, the terms of the Agreement provide that the contract amount may be adjusted annually by the percentage change in the Consumer Price Index (CPI) for all urban consumers (CPI-U) for the most recent 12 months available ending in December of each year; and WHEREAS, the FKSPCA has requested a CPI adjustment as allowed under the agreement; and IN CONSIDERATION of the mutual promises contained herein, the parties hereby agree as follows: 1. In accordance with Paragraph 4. RENEWAL the contract amount is hereby adjusted by 1.9% CPI for all urban consumers (CPI-U) for the most recent 12 months ending on December 31, 2018. Effective May 1, 2019, the total compensation paid to the Contractor for its services under this agreement shall be $550,886.80 per annum or $45,907.23 per month. 2. In all other respects, the remaining terms of the Agreement entered into on May 1, 2014, as amended, not inconsistent herewith, shall remain if full force and effect. [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK] Page 1 of 2 FIFTH AMENDMENT TO AMENDED AND RESTATED AGREEMENT (Operation of the Key West Animal Shelter) FIFTH AMENDMENT TO AMENDED AND RESTATED AGREEMENT (Operation of the Key West Animal Shelter) =IN-=Mi NESS WHEREOF, the parties have caused these presents to be executed in the "`'% --\'iipeck4Tames. k '\ • • K,.VN i} ADOK CLERK BOARD OF UNT 1h MMISSIONERS 4� r � M i OF MO RO• OUN, .r�, •> -i ., , 'By By: / /r / Deputy Clerk Mayor/Chairman Date: V l l7 22 ZO 1 i q7 t MICA , 11v 1. ( t- . itness Signature THE FLORIDA KEYS SOCIETY FOR U-earle-tit vv LE I i CUMJ 51 20 i I q THE PREVENTION OF CRUELTY TO Print Name Date ANIMALS, INC. By: C1 itC k (`l G loiE ) Witness Signatur Present 1 re utrer- DidsL• • anez -Sl?C)IAA Date: 61 DAD Ilei . Print Name Date Address: 5'7 II Col troe.2aac(. Ivey West, Ft_ 3304( o •M MONROE COUNTY ATTORNEY w 1 Y� (V/7.4-PP,PLEDSrigeW:Q.. CF R1 tS 1 {1BRTBOO l tz M `�76. ASSISTANT Co A ORNEY WS O ^- DATE IL.) 1- —1 N Page 2 of 2 FIFTH AMENDMENT TO AMENDED AND RESTATED AGREEMENT (Operation of the Key West Animal Shelter) OP ID:CH ACORO° CERTIFICATE OF PROPERTY INSURANCE DATE(MM/DD/YVYY) 01/28/2020 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. CONTACT PRODUCER NAME: Atlantic Pacific-Key West lac.No.Eati:305-294-7696 FAX Not,305-294-7383 1010 Kennedy Dr,Suite 203 E-MAIL chernandez@apins.com Key West, FL 33040 AnnREss: Richard Horan PRODUCER FLOR-46 CUSTOMER ID. INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Mt.Hawley Insurance Co. 37974 Florida Keys S.P.C.A. • 5711 College Rd INSURER B: Key West,FL 33040 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: LOCATION OF PREMISES/DESCRIPTION OF PROPERTY(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) 5711 College Rd,Key West,FL 33040 WIND is included with Fire policy 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 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS LTR DATE(MMIDD/YYYY) DATE(MM/DD/YYYY) A X I PROPERTY MPC0602111 12/28/2019 12/28/2020 Y BUILDING $ 7,500,000 CAUSES OF LOSS DEDUCTIBLES Y PERSONAL PROPERTY $ 1,000,000 BASIC BUILDING BUSINESS INCOME $ 2,500 BROAD CONTENTS — EXTRA EXPENSE $ X SPECIAL 2,500 _ RENTAL VALUE $ EARTHQUAKE __ _ BLANKET BUILDING $ A X WIND 25,000 MPC0602111 12/28/2019 12/28/2020 _ BLANKETPERS PROP $ FLOOD BLANKET BLDG&PP $ $ $ • INLAND MARINE TYPE OF POLICY $ CAUSES OF LOSS $ NAMED PERILS POLICY NUMBER $ • CRIME TYPE OF POLICY APP O E AGEMENTBY DPTF ` $ I BOILER&MACHINERY! WAIVER N _ $ EQUIPMENT BREAKDOWN kw CJ Jcr'd $ SPECIAL CONDITIONS/OTHER COVERAGES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional insured listed as: Monroe County Board of County Commissioners, 1100 Simonton St,Key West,FL 33040 • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County Board of ACCORDANCE WITH THE POLICY PROVISIONS. County Commissioners 1100 Simonton St Key West,FL 33040 AUTHORIZED REPRESENTATIVE ACORD 24(2016/03). ©1995-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3 A Stock Company FFL 99.001 1018 �` P.O.Box 33003 0116407 St:Petersburg,FL 33733.-8003 .3/05/19 Customer'Service:.1-800-820-3242 Claims:vice: -800-872 200011523 FLD RGLR WRIGHT/ ' Might mond Flip 0111.11MCc company t 'FLOOD DECLARATIONS PAGE i NEW BUSINESS Policy Number. 'NFIP Policy Number 'Product Type:Standard Policy 09 115.1775622 00 1151775622 General'Property Form. Policy Period. . Date of Issue Agent Code . Prior Policy Number From:3/68/19'To:3/08/20`12:01 am Standard Time 03/05/2019 .0116407 ✓ ✓ _ f Agent(305)294.-7696 ATLANTIC PACIFIC INSURANCE INC FLORIDA KEYS SPCA 1010 KENNEDY DR STE 203 5711 COLLEGE RD • KEYj WEST FL 33040-4133 KEY WEST FL 33040-4311 Property Location(if other than above) Address may have been changed in accordance with USPS standards. - 5711 COLLEGE RD, SPCA BUILDING, KEY WEST FL.33040 ' Rating Information _ . , Original.New.Business Effective Date: 3/08/2019 Flood Risk/Rated Zone:AE { Grandfathered:No Building Occupancy: Business Non-Residential Primary.Residence: N Number of Floors: Two Floors Condo Type: N/A Building Indicator: Non-Elevated Community#: 120168 Map Panel/Suffix: 1528 K Basement/Enclosure/Crawispace: Community Rating: 07/15% Program Status: Regular No Basement Community Name: KEY WEST, CITY OF Elevation Difference: 1 I Coverage Deductible Annual Premium BUILDING $500,000 $50,000 $1,361.00 CONTENTS $500,000. $50,000 $885.00 ANNUAL''SUBTOTAL: '$2,246.00 THIS IS NOT A.BILL; . DEDUCTIBLE DISCOUNT/SURCHARGE: - $977.00 ICC PREMIUM: $5.00 DEAR MORTGAGEE COMMUNITY RATING DISCOUNT: . - $191.00 The:ReformfAct of 1994 requires you to notify SUB-TOTAL: $1,083.00 the WYO company this for this policy within 60 days • of any changes° .in the r er of this loan. RESERVE FUND ASSESSMENT: $162.00 The above message applies only when there . PROBATION SURCHARGE: $0.00 is a mortgagee on the insured location. FEDERAL POLICY SERVICE FEE: $50.00 HFIAA'SURCHARGE: $250.00 Premium Paid by: Insured TOTAL WRITTEN PREMIUM AND FEES: '$1,545.00 Special Provisions: This policy covers only one building. If you have more than one building on your property,please make sure they are all covered. See.III. Property Covered within your Flood policy for the NFIP definition of"building"or contact your agent,broker;or Insurance company. Please refer to the policy for completeltenns,conditions,and.exclusions. A full,digital copy of your flood policy form is available at www.wrightfiood.comJpolicyfonns.html.The form which applies-to-your policy coverage is:General Property Form ;i I Forms and Endorsements: WFL 99.415 1117 1117 FFL 99.310 1012 1010 WFL 99.116 0614 0614 li f This policy,is issued by NAIC company 11523 Wright National Flood Insurance Company A stock company Copy Sent To:As indicated on back or additional pages, if any. Pailu;„:,... . -9.50-% AP EMENT Patricia Templeton-]ones,President BA E I WAIVER N/A Y /VD 01164070911.5177562219064 00005. 1f;�ry ; Company i i OP ID:CH ACORCE CERTIFICATE OF PROPERTY INSURANCE DATE(MM/ 07/18/2019Y) 019 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. PRODUCER CONTACT NAME: Atlantic Pacific-Key West (NCNNo,Est):305-294-7696 FAX(NC Na) 305-294-7383 1010 Kennedy Dr,Suite 203 E-MAIL chernandez a ins.com Key West,FL 33040 ADDRESS: p Richard Horan PRODUCER FLOR-46 CUSTOMER ID; INSURER(S)AFFORDING COVERAGE NAIC U INSURED INSURER A:Mt.Hawley Insurance Co. 37974 Florida Keys S.P.C.A. Wright National Flood Ins Co 11523 5711 College Rd INSURER B: g Key West, FL 33040 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: LOCATION OF PREMISES!DESCRIPTION OF PROPERTY(Attach ACORD 101,Additional Remarks Schedule,if more space is required) 5711 College Rd,Key West,FL 33040 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 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS LTR DATE(MM/DDIYYYY) DATE(MM!DDIYYYY) A X I PROPERTY MPC0601461 12/28/2018 12/28/2019 Y BUILDING $ 7,500,000 CAUSES OF LOSS DEDUCTIBLES Y PERSONAL PROPERTY $ 1,000,000 BASIC BUILDING 2,500 BUSINESS INCOME $ BROAD CONTENTS EXTRA EXPENSE $ X SPECIAL 2,500 RENTAL VALUE $ EARTHQUAKE BLANKET BUILDING $ A X WIND 3% BLANKET PERS PROP $ B X FLOOD 50,000 09115177562200 03/08/2019 03108/2020 BLANKET BLDG&PP $ y FId-Bldg $ 500,000 Y FId-Cts $ 500,000 INLAND MARINE TYPE OF POLICY $ CAUSES OF LOSS $ NAMED PERILS POLICY NUMBER $ CRIME TYPE OF POLICY APP AGEMEMI $ Blab $ BOILER&MACHINERY/ EQUIPMENT BREAKDOWN WAIVER N/ $ SPECIAL CONDITIONS!OTHER COVERAGES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Listed as additional insured/interest-Monroe County Board of County Commissioners,1100 Simonton St,Key West,FL 33040 CERTIFICATE HOLDER CANCELLATION MCBCCOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County Board of County ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West,FL 33040 ACORD 24(2016/03) ©1995-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �....41, FLOR-46 OP ID:CI{ ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/......------- 01/28/2020 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 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 305-294-7696 CONTACT Atlantic Pacific-Key West PHONE 305-294-7696 1 FAX 305-294-7383 1010 Kennedy Dr,Suite 203 (A/C,No,Extl: INC,No): Key West, FL 33040 nr nRlEss.chernandez@apins.com Richard Horan INSURERS)AFFORDING COVERAGE NAIC# INsuRERA:Penn-America Insurance Co 32859 FINSURED INSLIRFRB:NGM Insurance Co. lorida Keys S.P.C.A. 5711 College Rd INSURER C: Key West,FL 33040 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 ADDLSUBR pOLICYNUMBER POLICYEFF POLICY EXP LIMITS LTR INSD WVD IMMIDDIYYYYI,IMM/DDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR y PAV0191856 07/01/2019 07/01/2020 PRFPsIlG,SEE60(Ea occurrence) $ 100,000 A x Professional Liab PAV0191856 07/01/2019 07/01/2020 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ja LOC PRODUCTS-COMP/OP AGG $ included OTHER: Prof Liab $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ - ANY AUTO APPR V NA EMEN1 BODILY INJURY(Per person) $ OWNED SCHEDULED BY _ AUTOS ONLY _ AUTOS DATE BODILY INJURY(Per accident) $ H RED NON-OWNED WAIVER N/A PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY _(Per accident) $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTF FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below _E.L.DISEASE-POLICY LIMIT $ B Employee Dishonest F271572N 06/26/2019 06/26/2020 Bond 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) Locations covered:5711 College Rd,Key West,FL 33040(including 21 acres of Mt Trashmore); 10550 Aviation Blvd,Marathon,FL 33050; Parcels Q,R&S, Little KnockEm 0Down Key,FL 33042 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe CountyBoard of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. County Commissioners 1100 Simonton St Key West,FL 33040 AUTHORIZED REPRESENTATIVE IV] AI ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • * * * COMM ERCIAL LINES COMMON POLICY DECLARATIONS *ow . INSURANCE IS PROVIDED BY THE COMPANY DESIGNATED BY AN"X" Stock *D. X PENN- * s Group * ❑ AMERICA INSURANCE COMPANY Company * *•* ❑. PENN-STAR INSURANCE COMPANY FAV0161601 IRe ew.a 616Om o er ❑ PENN- PATRIOT INSURANCE COMPANY . Rewrite of Number Bala Cynwyd, Pennsylvania 19004 5+0e4376troI Number POLICY NUMBER: PAV0191856 1. y NAMED INSURED: rLPA KEYS S.P.C.A. 9DBA: Prod Agent: Christine Hemandez Address: 11382 Prosperity Farms Road;#123 MAILING ADDRESS: 5711 College Rd Palm.Beach Gardens FL 33410 Prod.Agcy: Atlantic Pacific Insurance,Inc. ti Key West, FL 33040 Address: 11382 Prosperity Farms Road;#123 Palm Beach Gardens FL 33410 2. 1 POLICY PERIOD: From. July 1,2019 To July 1,2020 at 12:01 A.M. Standard Time at your mailing address shown above. 3. y FORM OF BUSINESS: Corporation OTHER DESC: 4. BUSINESS DESCRIPTION: ANIMAL SHELTER IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND-SUBJECT TO ALL THE TERMS OF THIS POLICY WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. 5. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial General Liability Coverage Part $ 3,612.00 Commercial Property Coverage Part $ NOT COVERED Commercial Crime Coverage Part $ NOT COVERED r .Commercial Inland Marine Coverage Part $ NOT COVERED Professional Liability Coverage Part $ - INCLUDED Liquor Liability Coverage Part $ NOT COVERED Commercial Umbrella Coverage Part $ NOT COVERED - I Owners Contractors Protective Coverage Part . $ NOT COVERED TRIA $ NOT COVERED 6: .. TOTAL PREMIUM PAYABLE AT INCEPTION $ 3,612.00 Service Fee 35.00= Surplus Lines Tax $ Stamping Fee $ 182.35 ola I 00 $ 3.65, , $ Other: $ TOTAL $ 3,833.00 $ C Gig 4-7 7. FORM(S)AND ENDORSEMENT(S)MADE A PART OF THIS POLICY AT THE TIME OF ISSUE:* AS PER FORM S1007(1212000)SCHEDULE OF FORMS AND ENDORSEMENTS ATTACHED Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations. THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE PART DECLARATIONS,COVERAGE PART COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. Agency.Code:02169 i AmWINS Access Insurance Services, LLC 7108 Fairway Drive,Ste 200 By:. Palm Beach Gardens, FL 33418 Authorized Representative h DF/KZ 07/18/2019 S1100(09/2016) Page 1 of 1 i • * Stock *y * COMMERCIAL GENERAL LIABILITY COVE GE PAIDcompany *[][! * DECLARATIONS 41,15 '•o * Group * • * * -11- , w. ) 5 at ' 156.g' , �3 q1 POLICY NUMBER: PAV0191856 r , e ( ±±2 _ 1012.11 (v1 1 1. NAMED INSURED: FLORIDA KEYS S.P.C.A. 3(0 g l a 2. LIMITS OF INSURANCE-INSURANCE APPLIES ONLY FOR COVERAGE FOR WHICH A LIMIT OF ✓SJt INSURANCE IS SHOWN. General Aggregate Limit(Other than Products/Completed Operations) $ 2,000,000 � Products/Completed Operations Aggregate Limit $ Included Each Occurrence Limit $ 2,000,000 Personal& Advertising Injury Limit $ 2,000,000 Damage to Premises Rented to You Limit - $ 100,000 any one premises Medical Expense Limit $ 5,000 any one person 3. LOCATIONS of all premises you Own, Rent, or Occupy Address City Zip No. 1 1 Parcels Q,R&S,Lot 3 Section 23 Little KnockEm Down FL 33042 PREMIUM BASIS • RATES ADVANCE PREMIUM 4. CLASS** Code/ Exposure Prod/CO All Other Prod/CO All Other t•If Classifications are Numbered,the coverage applies to the corresponding Location No. No. 1 Bldg 1 49451 e) 13 Inc! 1.982 Included 26.00 IV\( Vacant Land-Other than Not-For-Profit i! 1. No. 1 Bldg 1 o) 1 Inc' Flat Included 750.00 V� v \n 1 Increased GL Limit ' No. 1 Bldg 1 e) 2 Inc! Flat Included 100.00 KW Additional Insured-Managers or Lessors of Premises—Per Form CG2011 I, • No. 2 Bldg! 1 45450 e) 26 Ind 39.618 Included 1,030.00 , y� Kennels t 1 •: No. 3 Bldg 1 45450 e) 42 Inc! 39.618 Included 1,664.00 Kennels K� ••If Classifications are Numbered,the coverage applies to the corresponding Location No. I; TO L AL: $ 3,612.00 (s)',grosssales-per$1000 (c) total cost-per $1000 E (m)admissions-per 10 ojo (e) each (p) payroll-per $1000 (a) area-per 1000 sq. ft (u) units (o) other 5. Policy may be AUDITABLE (t) see classification notes In company o • Commercial ones Manual 6. SPECIFIC GENERAL LIABILITY FORMS/ENDORSEMENTS As per S1007[12-00] This page alone does not provide coverage and must be attached to a Commercial Lines Common Policy Declarations Common Policy Conditions,Coverage Part Coverage Form(s)and:any other applicable forms and endorsements. S2000 (06/01) Page 1 of 1 . Stock * h * COMMERCIAL GENERAL LIABILITY COVERAGE PART Company 0 SUPPLEMENTAL DECLARATIONS POLICY NUMBER: PAV0191856 N ED. F i asKeys`•S'.P. . . O. LOCATIONS of all premises you Own, Rent,or Occupy 2 i1 10550 Aviation Blvd, Marathon, FL 33050 aoit-.P1 3 1 5711 College Rd, Key West, FL 33040 . NO. CLASS PREMIUM BASIS. RATES ADVANCE PREMIUM Code/ Exposure Prod/CO All Other Prod/CO All Other 3 Bldg 1 49451 e) 21 Inc' 1.982 Included 42:00 0/4 Vacant Land-Other than Not-For-Profit • • Total Premium This Page $ See Form S2000 Accumulative Total $ for Total Premium (s) gross sales-per$1000 (c) total cost-per$1000 (m)admissions-per 1000 (e) each (p) payroll-per$1000 (a) area-per 1000 sq.ft. (u) units Policy may be AUDITABLE SPECIFIC GENERAL LIABILITY FORMS/ENDORSEMENTS • This page alone does not provide coverage and must be attached to a Commercial Lines Common Policy Declarations Common Policy Conditions, Coverage Part Coverage Form(s)and any other applicable forms and endorsements. S2001 (10/2013) Page 2 of 2 ATLANTIC PACIFIC INC P/7®(7/7LJfWE 11382 PRSPRTY FRM 123 - COMMERCIAL PALM BCH GARDENS,FL 33410 Policy number: 06456454-7 Underwritten by: Progressive Express Ins Company Insured: MC BOARD COUNTY COM FL KEYS S.P.C.A. 1100 SIMONTON S June 8,2019 KEY WEST,FL 33040 Policy Period:Jun 30,2019-Jun 30,2020 Mailing Address / Progressive Express Ins Company PO Box 94739 Additional insured endorsement , Cleveland,OH 44101 1-800-444-4487 Name of Person or Organization / For customer service,24 hours a day, MC BOARD COUNTY COM,/ 7 days a week 1100 SIMONTON S KEY WEST,FL 33040 The person or organization named above is an insured with respect to such liability coverage as is • afforded by the policy,but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability - Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms,limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number:06456454-7 Issued to(Name of Insured):FL KEYS S,P.C.A. Effective date of endorsement:06/30/2019 Policy expiration date: 06/30/2020 Form 1198(01/04) �f1tJ E ANAGEMENT DAT N/A _ , ATLANTIC PACIFIC INC "Rtieff 11382 PRSPRTY FRM 123 COMMERCIAL PALM BCH GARDENS,FL 33410 Policy number 06456454-7 Underwritten by: Progressive Express Ins Company May 18,2019 FL KEYS S.P.C.A. Policy Period:Jun 30,2019-Jun 30,2020 5230 COLLEGE RD KEY WEST,FL 33040 He:wised r }n e vai] MI and p4o ky htft' rat t n i c©s,.d This information was revisec on May 18 2019 Please[review you poky documents today We send your renewal policy information early so that you have the opportunity to review it at your convenience. Your Commercial Auto Insurance Coverage Summary lists drivers,current driving history,the autos insured,the coverages selected and the premiums by coverage. Your current policy will expire on June 30, 2019 at 12:01 a.m. If we recently sent you a Cancel Notice because the remaining balance on your current policy has not been received please pay that amount by the due date to avoid policy cancellation. This(mill aloes not stsperrsei Ie any Cancellation Notice. If you have already sent this payment- thank you. If you do not make this payment,the offer to renew this policy is withdrawn. If you've scheduled a payment,it is not reflected in the amount due. Revised premium axial payment iriffot tati®ai • • Revised renewal policy premium $11,901.00 Milnitrmaam amount doe $9 9,901.00 Dare plate Some ®,2019 To renew your policy,please pay the amount shown above,or call us for other available options,by the due date. To pay with a check or credit card by phone,call Customer Service at 1-877-278-1615,or login to progressiveagent.com. Please see teverrse side for additional information. Continued on b� 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 e 0 0 0 0 0 0 0 0 0 0 0 0 " eve o e • e e P y i;e Coupon � Wto Policy nu • ben 06456454-7 Policyholder: FL KEYS S.P.C.A. Minimum amount due $11,9iri If you pay by check,please allow 5 to 7 Dale mate ynne 30,Z01 9 days for your payment to reach us. Write your policy number on the check and make it Amount enclosed $ payable to Progressive Express Ins Company, If you wish to change your method of payment,please call Customer Service at °1to11111°t1°Intl°II11111°I11111111°Ii°°IIIIt1°llot°°°IIIt°I1hi 1-800-444-4487 before the scheduled PROGRESSIVE EXPRESS INS charge date. DEPT 0561 CAROL STREAM IL 60132-0561 Do not write below this section of coupon. CA-11092 056106456454 09414 1190100 1190100 5000101 8857267 007006301902 ATLANTIC PACIFIC INC PRY" HIRE 11382 PRSPRTY FRM 123 COMMERCIAL PALM BCH GARDENS,FL 33410 Named insured Policy number: 06456454.7 Underwritten by: Progressive Express Ins Company May 18,2019 FL KEYS S.P.C.A. Policy Period:Jun 30,2019-Jun 30,2020 5230 COLLEGE RD Page 1 of 4 KEY WEST,FL 33040 provessiveagent.com Online Service • Make payments,check billing activity,print policy documents,or check the status of a Bairn. C© erda[i Auto [IfY� �p �A r� �� 1-561-624-1800 hJ91suTance Coverage Summary ATLANTIC PACIFIC INC �" Contact your agent for personalized service. This is your revised Renewal 1-000444-4467 Declarations Page For customer service if your agent is unavailable or to report a Balm. Your policy inf•rmat on has changed This Renewal Declarations Page is effective only if the minimum amount due to renew your policy is received or postmarked by June 30,2019. Your coverage begins on June 30,2019 at 12:01 a.m. This policy expires on June 30,2020 at 12:01 a.m. • This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto,unless the policy contract allows the stacking of limits.The policy contract is form 6912(06/10).The contract is modified by forms 1652FL (08/12), 1198(01/04),4852FL (10/04),4881 FL (01/13)and Z228(01/11). The named insured organization type is a corporation. P®iicpychanges effective June 30, 2019 Premium change: -$1,493.00 Changes: The driver information has changed. The changes shown above will not be effective prior to the time the changes were requested. 0aatiine of coverage . . . Description Limits Deductible Premium Liability To Others $9,998 Bodily Injury and Property Damage Liability $1,000,000 combined single limit Uninsured/Underinsured Motorist Rejected Basic Personal Injury Protection 251 Without Work Comp-Named Insured&Relatives $10,000 each person $0 Comprehensive 648 See Auto Coverage Schedule Limit of liability less deductible Collision 984 See Auto Coverage Schedule Limit of liability less deductible Subtotal poky premium $11,881 Fees 20 Total 12 month policy premium and fees $11,901 • Continued Foam 6489 FL(01115) Policy number: 06456454-7 FL KEYS S.P.C.A. Page 2 of 4 Rated drrivev 1. MATT ROYER 2, TAMMY FOX 3. ADAM DAYYZ 4. LINDSEY THOMPSON 5, TIFFANY BURTON 6, DELBERT DUNSMORE 7. TARA M VICKREY 8. MARIEASIMPSON 9. JENNIFER R SHOWALTER 10.HUGH J SMITH 11.SARA E BENTLEY 12.CECIL L LAWSON Auto coverage schedulelaiEl 1• 2014 Ford Reono/Cliu b II* Actual Cash Value (plus$0.00 Permanently Attached Equip) VIN; 1 FTNE2EW4EDA90169 Garaging Zip Code: 33050 Radius: 100 Liability Liability PIP M Premium $2,423 $56 e Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total e • Premium $250 $127 $250 $178 v lid $2,aiB4 0 S m O 2. 2015 Miss DIV 200 2.5s/Sv Stated Amount: *$22,100(including Permanently Attached Equip) VIN: 3N6CMOKNOFK718821 L , Garaging Zip Code; 33040 Radius: 50 Liability Liability PIP y Premium $1,980 $47 � E Comp Comp Collision Collision , Physical Damage Deductible Premium Deductible Premium Auto Total a — Premium $250 $155 $250 $268 .... ..• $2;450 3. 2005 Ford Econo/Clog IRiV Actual Cash Value (plus$0.00 Permanently Attached Equip) VIN: 1 FMRE11 WX5HA98430 ,,s Garaging Zip Code: 33040 Radius: 50 Liability Liability PIP �A Premium $1,655 $46 Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium $250 $88 $250 $65 $1,054 • Continued Form 6489 FL(01/15) • Policy number: 06456454-7 FL KEYS S.P.C.A. Page 3 of 4 • 4. ZOOG Ford acono/Club Wgn Actual Cash Value (plus$0.00 Permanently Attached Equip) VIN: 1 FTNS24W76DA11489 \ Garaging Zip Code: 33050 Radius: 100 Liability Liability PIP Premium $1,973 $56 Comp Camp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total • Premium $250 $101 $250 $93 $2,223 5. 2010 Chevrolet Express ta25O0 Stated Amount: 125,000(including Permanently Attached Equip) VIN: 1 GCWGAFG411 904 1 99 Garaging Zip Code: 33040 Radius: 50 Liability Uablllry PIP .Premium $1,967 $46 . Camp Camp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium $250 $177 $250 $380 $2,570 *A vehicle's stated amount should indicate its current retail value,including any special or permanently attached equipment. In the event of a total loss,the maximum amount payable is the lesser of the Stated Amount or Actual Cash Value,less deductible. Be sure to check stated amount at every renewal in order to receive the best value from your Progressive Commercial Auto policy. het1r Wm discounts Policy 06456454-7 Business Experience and Paid In Full Vehicle 2014 Ford Econo/Club Wgn Anti-Lock Brakes and Air Bag 2015 Niss NV 200 2.5s/Sv Air Bag 2005 Ford Econo/Club Wgn Anti-Lock Brakes and Air Bag 2006 Ford Econo/Club Wgn Anti-Lock Brakes and Air Bag 2018 Chevrolet Express G2500 Anti-Lock Brakes and Air Bag Additional] insured information t 1 . Additional Insured MC BOARD COUNTY COM 1100 SIMONTON S KEY WEST,FL 33040 Agent's signature (J�a • Continued Farm 6489 FL(01/15) • ATLANTIC PACIFIC INC PROGRESSIVE' 11382 PRSPRTY FRM 123 PALM BCH GARDENS,FL 33410 COMMERCIAL FL KEYS S.P.C.A. Policy Number: 06456454-7 Underwritten by: Progressive Express Ins Company FL KEYS$.P.C.A. Date of Mailing:June 14,2019 5230 COLLEGE RD KEY WEST,FL 33040 Policy Period: Jun 30,2019-Jun 30,2020 Page 1 of 1 • ATLANTIC PACIFIC INC 1-561-624-1800 Online Service progressiveagent.com Customer Service 1-800-444-4487 Commercial Auto Insurance Bill Your premium has changed Tired of writing checks? Save time and money with Electronic Funds Remaining balance $5,058.00 Transfer(EFT)!Contact your agent Payments remaining 0 for more information. Minimaym amount due �� 0! To maintain your coverage,please pay the minimum amount due by the due date. Any amount you pay above your minimum will be credited to your next payment. If you've scheduled a payment,it is not reflected In the amount due. Billing detail forApril 14, 2019 -June 14, 2019 Payment on May 6-thank you -$696.00 Payment on June 6-thank you -$11,901.00' Current amount(based on premium change) $5,058.00 --. $5,058.00 Minimum amount due1..1 r_ Payments received after June 14 will appear on your next statement. ������ Policy Number: 06456454-7 Payment Coupon FL KEYS S,P.C.A. For immediate payment,please go to Remaining balance $5,058.00 progressiveagent.com or call 1-877-278-1615. Minimum amount due $5,058.00 If you pay by check,please allow five to seven days for your payment to reach us. Write your Due date June 30,2019 policy number on the check and make it payable Amount enclosed $ to Progressive Express Ins Company. • TIIIII' 111uii-in 1'( •11i1 ••ll11•,,"111nl.(1..lil-lll-I PROGRESSIVE DEPT 0561 CAROL STREAM IL 60132-0561 Do not write below this section of coupon. CA-I 1092 Form 6265(10/10) • 056106456454 09414 0505800 0505800 5000118 4988547 007006301902 ATLANTIC PACIFIC INC ` ROS f Idl®VE 11382 PRSPRTY FRM 123 CO/MERCY/IL PALM BCH GARDENS,FL 33410 Named insured Policy number: 06456454-7 Underwritten hy: Progressive Express Ins Company June 15, 2019 FL KEYS S.P.C.A. Policy Period:Jun 30,2019-Jun 30,2020 5230 COLLEGE RD Page 1 of 4 KEY WEST,FL 33040 progressiveagent.com Online Service Make payments,check billing activity,print policy documents,or check the status of a ,i1�R11, g"3 ��::,1iji l a claim. 1-561-624-1000 C©verr Ae Su i Y„mar ry ATLANTIC PACIFIC INC �l Contact your agent for personalized service. This is your Ded drat ins )age 1.000-444-4457 Your coverage has changed For customer service if your agent is unavailable or to report a claim. Your coverage begins on June 30,2019 at 12:01 a.m. This policy expires on June 30,2020 at 12:01 a.m. This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto,unless the policy contract allows the stacking of limits.The policy contract is form 6912(06/10).The contract is modified by forms 1652FL (08/12), 1198(01/04),4852FL (10/04),4881FL (01/13)and Z228(01/11). The named insured organization type is a corporation. changes effective Sore 311, 2019 Premium change: $5,058.00 Changes: The driver information has changed. The changes shown above will not be effective prior to the time the changes were requested. Mane©f coverage :1 Description Limits Deductible Premium Liability To Others $14,474 Bodily Injury and Property Damage Liability $1,000,000 combined single limit Uninsured/Underinsured Motorist Rejected Basic Personal Injury Protection 371 Without Work Comp-Named Insured&Relatives $10,000 each person $0 Comprehensive 648 See Auto Coverage Schedule Limit of liability less deductible Collision 1,446 See Auto Coverage Schedule Limit of liability less deductible Subtotal policy premium $16,939 Fees 20 Total 12 month policy premium and fees $16,959 Ratted driver 1, MATT ROYER 2. TAMMY FOX Continued Fotm 6489 FL(01/15) • ri.nc, o,r.�.m. Page 2 of 4 3, ADAM DAYTZ 4. LINDSEY THOMPSON 5. TIFFANY BURTON 6. DELBERT DUNSMORE • 7. TARA M VICKREY 8. MARIE A SIMPSON 9, JENNIFER R SHOWALTER 10.HUGH 1 SMITH • 11.SARA E BENTLEY 12.CECIL L LAWSON 13.MARIA RODRIGUEZ . 14.AMBER MURPHY - 15.LAUREN'MOON • Auto coverage schedule O �r 1, 2014 Fond Econo/Club Qllfgi Actual Cash Value (plus$0.00 Permanently Attached Equip) iwiw VIN: 1 FTNE2EW4EDA90169 Garaging Zip Code: 33050 Radius: 100 m Liability Liability PIP ^iA �` .,i,.:.,): 1 al Premium $3,517 $83 E.t Comp Comp Collision Collision A Physical Damage Deductible Premium Deductible Premium Auto Total o, Premium $250 $127 $250 $262 $3,989 e lialii v MI v 2• 2015 bl9lss NV 200 2.5s/Sv Stated Amount: "$22,100(including Permanently Attached Equip) � VIN: 3N6CMOKNOFK718821 Garaging Zip Code: 33040 Radius: 50 o e Liability Liability PIP 4.h,/t k: 4� .. 2 e Premium $2,865 $64 6' r, _.* s = Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total a s Premium $250 $155 $250 $394 $3,483 3. 2005 Ford Fcono/Club 1llfgn. Actual Cash Value (plus$0.00 Permanently Attached Equip) VIN: 1 FMRE 11 WX5HA98430 Garaging Zip Code: 33040 Radius: 50 • Liability Liability PIP (.1,+ ? t Premium $2,389 $68 " ',r U "-•' r t; Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium $250 $88 $250 $96 • $2,641 SI Continued Form 6459 fL(01/15) Policy number: 064564547 FL KEYS S.P.C.A. Page 3 of 4 4, 2006 Forel Econo/Clam'Vign Actual Cash Value (plus$0,00 Permanently Attached Equip) VIN: 1 FTNS24W76DA11489 Garaging Zip Code: 33050 Radius: 100 Liability Liability PIP l Premium $2,856 $83 ! ., ,�`;•r_.... • Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium $250 $101 $250 $136 $3,176 5. 2090 Chevrolet ERpress G2500 Stated Amount: 125,000(including Permanently Attached Equip) VIN: 1GCWGAFG4J1904199 Garaging Zip Code: 33040 Radius: 50 Liability Liability PIP \'- /r kf`' Premium $2,847 $68 '° ( Comp Camp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium $250 $177 $250 $558 $3,650 *A vehicle's stated amount should indicate its current retail value,including any special or permanently attached equipment. In the • event of a total loss,the maximum amount payable is the lesser of the Stated Amount or Actual Cash Value,less deductible. Be sure to check stated amount at every renewal in order to receive the best value from your Progressive Commercial Auto policy. Premium discounts Policy • • 06456454-7 Business Experience and Paid In Full Vehicle 2014 Ford Econo/Club Wgn Anti-Lock Brakes and Air Bag 2015 Niss NV 200 2.5s/Sv Air Bag 2005 Ford Econo/Club Wgn Anti-Lock Brakes and Air Bag 2006 Ford Econo/Club Wgn Anti-Lock Brakes and Air Bag 2018 Chevrolet Express G2500 Anti-Lock Brakes and Air Bag Additional Insured information • 1 . Additional Insured MC BOARD COUNTY COM 1100 SIMONTON 5 KEY WEST,FL 33040 Agent signature • Continued Form 6429 FL(01/15) n 3 10 • atin J. o r' t ..q Ot • • un I, •^c c 5 T r -- • ouv rn N N 4, /-D A 0 P1 A a D PGULS01pKI016546 003 ' 003 003 <0391> • IO11l1II18I1111 111111111111IIIIII111Iu11IIW11I111I1I1111111l11 11 NGM Insurance Company 4601 Touchton Rd East Ste 3400 Report of Execution - Renewal P.O.Box 16000 Jacksonville,FL 32245-6000 Agency Code: 09-0236 Bond Number: F-271572-N Atlantic-Pacific Ins Bond Effective Date: 26/2019,) 11382 Prosperity Farms Rd#123 Bond Expiration Date: 6/26/2020 Palm Beach Gardens,FL 33410 Type of Renewal: Continuous Principal: Obligee: Florida Keys SPCA Inc 5711 College Rd Key West,FL 33040 (-Type of Bond Classification Penalty Premium insuring Agreement 1:Blanket Emp yee Fid Non-profit Orgn/all Other $100 Dishonesty Per Loss ,000 $0 Endorsement include Agents and Non-Employees N6 TOTAL PREMIU $2588) Description: C� - G � ' �� ra � \\v ' `,) Corn 1t.lY1e-gran:it►n Remarks: \A `� ( as P rt(;r �� /1 Include Volunteer Workers Additional Principals: Additional Obligees: 13uctoa lea bI tins: I4 W I la. 5 = 1 l'/. � rnanrltd. Z0.6 p IPQ T9IED Attorney: Other: APR 2 9 20t By SYSTEM P13/9