Item L4 SECOND
* REVISED BACK-DP *
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Januaryy 21.2015-KW Department County Attorney
Bulk Item: Yes ^, No X Staff Contact Person: Bob Shillimger 292-3470
AGENDA ITEM WORDING: Semi-annual examination of public official bonds for County
Commissioners and Constitutional Officers pursuant to F. S. 137.05 and§2-28 of the Monroe County
Code and finding that all current bonds and/or insurance policies are adequate.
ITEM BACKGROUND: Florida Statute 137.05 requires that each of the 67 County Commissions
examine the sufficiency of the bonds for County officers in their respective Counties every January
and June. This statute affords each Commission the discretion to determine if the current bonds are
sufficient,and to require a new bond if the Board has reason to believe that any of the current bonds
have become impaired.
Under ordinance 029-2013,the minimum bond amounts are as follows:
a) Clerk of the Circuit Court $ 5,000
b) Sheriff $15,000
c) Tax Collector $50,000
d) Property Appraiser $10,000
e) County Commissioners $ 2,000
f) Supervisor of Elections $ 5,000
Section 2-28(2) authorizes the County Commission to waive the requirements for an officer to
purchase a bond if that officer purchases appropriate insurance coverage in excess of the required bond
amount
The County currently maintains sufficient insurance coverage for its county commissioners to satisfy
the requirements of the ordinance. Documentation of coverage for all constitutional officers is
included in the attached agenda backup.
At this time,there is no evidence to suggest that any of the current bonds are impaired or are likely to
become impaired.
PREVIOUS RELEVANT BOCC ACTION:
7/17/13 adopted Ordinance No. 029-2013
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: Approval of finding that the current bonds are adequate.
TOTAL COST: N/q BUDGETED: Yes _ No_
COST TO COUNTY: NL& SOURCE OF FUNDS:
REVENUE PRODUCING: Yes_ No AMOUNT PER MONTH Year
APPROVED BY: County Atty X OMB/Purchasing_ Risk Management
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM# L-4
* SECOND REVISED BACK-UP:
Additional Tax Collector Bond
Documentation Received After
Revised Agenda Deadline.
PUBLIC OFFICIAL BOND:
CLERK OF THE COURT
MONROI COUNTY CouITHOuse .•"r14. BRANCH OPPICI:
500 WIiITEHEAD STREET,SUITE 101 y s PLANTATION KEY
KEY WEST,FLORIDA 33040 'p• r GOVERNMENT CENTER
TEL.(305)2944641 * ,SCyi> 85820OVERSEAS HIGHWAY
FAX(305)295-3663 PLANTATION KEY,FLORIDA 33070
TEL.(303)852-T14S
BRANCH OPPICI: FAX(305)852-7146
MARATHON SUE COURTHOUSE
3117 OvERSEAs HIGHWAY CLERK OF THE CIRCUIT COURT ROTH BUILDING
MARATHON,FLORIDA 33050 50 HIGH POINT ROAD
TEL.(305)289-6027 MONROE COUNTY
PLANTATION KEY,FLORIDA 33070
FAX(305)289.6025 www.derk-of-the-court.com TEL.(305)852-7145
FAx(305)853-7440
January 23,2013
Ken Detzner,Secretary of State
Florida Department of State
The R.A.Gray Building
500 S Bronough Street
Tallahassee FL 32399-0250
Dear Mr.Detzner,
Enclosed please find a copy of the fully executed Public Official Bond for Amy Heavilin,
who posted a$5,000 bond,in connection with her service as Clerk. Also enclosed is the fully
executed Public Official Bond for Danny L. Kolhage,who posted a$2,000 bond,in connection
with his service as a County Commissioner. Please note that Mayor George R Neugent signed
under the County Commissioner signature lines—I have typed Chairman next to his signature to
identifr him.
I hereby certify that the original bonds are on file in the Office of the Clerk of the Circuit
Court,Sixteenth Circuit,Monroe County, Florida. Should you have any questions,please feel
free to contact me at(305)295-3130.
Sincerely,
Amy Heavilin
Clerk of the Circuit Court
and ex-officio Clerk to the
Board of County Commissioners
By: Pamela G. Hancock D.C.
Enclosures
cc: File
•
.� WESTERN SURETY COMPANY
P.O.Bees 6077 w® Bond No. 71352861
Sioux Falls,SD 57117.6077
-%(60f)338 0860 Effective Date: January 8— 2013
r
Western Surety C
State of Florida
I Secretary of State
Division of Elections
l' 500 South Bronough Street,Room 318
'' Tallahassee,Florida 32399-0250
11
1:. Public Official Bond
,.-1 County al Monroe
f KNOW ALL PERSONS BY TIME PRESENTS,That we, A%ry Heavi11f
.i ( 1 Naau)
1 as Principal,and WESTERN SURETY COMPANY
911,
es Surety, ars bound unto the Governor of the State of Florida, and his auocessora in oHics, in this sum of
i 5.000.00
Dollars,we hereby bind ourselves and each of our heirs,esscusors.
CI
A. administrators,successors and assigns,jointly and aaverally.
4 THE CONDITION OF THIS OBLIGATION IS SUCH, That, whens% said oi8eial was
11
I elected 0 appointed ® Court Clerk to hold this office for
(Name of Mos)
a term beginning Jauuar 8. 2013 and ending January 3. 2017 and until his/her
4 euoeesaor is qualified according to the Constitution and Laws of the State of Florida.
» NOW,THEREFORE,Mho official shall fsithh lly perform the duties of their aim as provided by law,this obligation is void.
fx •
X i/ %pie i!r
09. me.. a., .• )
Signed and 9eaLd this 3 rd day of December
1 101�Sou • Phillips Avenue
i�
WESTERN -it -u* COMP •• Sioint Fa118. SD 57104-6701
• ,gal/I1., Mock,as:+t. seq. a, )
THO PORTER-ALL EN CO.. INC• `.
'. 4' E„T).C. 513 SCUTHARD STREET(Name oJfaoot DownyJ
"1 e•• �. 0 Rey Went_ FL 33040-6015
as/
I: .T_ e p Jfq•
�j= ( e/Local Bosdiel Cowpony)
=mil
1 tail4 ;_ y Ignatius a(Lfooard xa,iaant Adam) •
1,. %;,•••SF A�j k�' 264 38 3239
r. '' � r (Social Scsity rm aher at Licensed Resident Apa)jN��THDA Appointed Agent of SuretyDavid W Freeman''+++nHrautt
' b day of 41111 to
13 tram.er Liaaaed Anidaat Apat)
The above is approved thin
by: fr. •mmimn' .
r Chairman. ( •A a f/ _
{ onddoa(02/0I)
i
4b t Rona 1346-12-2004 ��� 4,t:.. ,••:-
j .
Western SuretyCompany
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY,a corporation organized and existing under the laws of the State of South Dakota,and
authorized and licensed to do business In the States of Alabama,Alaska,Arizona,Arkansas,California,Colorado,Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa. Kansas, Kentucky, Louisiana, Maine,
Maryland,Massachusetts,Michigan,Minnesota,Mississippi,Missouri,Montana,Nebraska,Nevada,New Hampshire,New Jersey,
New Mendco, New York, North Carolina,North Dakota,Ohio, Oklahoma,Oregon,Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah. Vermont, Virginia, Washington, West Virginia, Wisconsin,Wyoming, and the Untied
States of America,does hereby make,constitute and appoint
z,. Mock of Sioux Falls
State of South Dakota ,with limited authority,its true and lawful Attomeyin-Fad,with full power and
authority hereby conferred to sign,execute,acknowledge and deliver for and on Its behalf as Surety and as its act and deed,the
following bond:
One caTi r r-r firtx
bond with bond number 71352861
for MY HEAVILIN
as Principal In the penalty amount not to exceed: Ss.a o o_o 0
Western Surety Company further certhas that the following is a bus and arum copy of Section T of the by-laws of Western Surely Company
duly adopted and now In force,to•wlt
Section 7. Al bonds,potides,undertakings,Powers of Attorney,or other obligations of the corporation shall be exacted in the conporsts
name of the Company by the President,Secretary.any Assist4rd Secretary,Treasurer.or any Vice President,or by such other officers as the
Board of Diectors may authorize. The President any Vice President, Seaetarr.any Assistant Spry, or the Trossurer may appoint
Attorneys-in-Fact or agents who shall have authority to issue bonds,polldes,or undertakings In the name of the Company. The corporate seat is
not necessary for the validity of any bonds,pollee,undertakings,Paws of Attorney or other obligations of the corporation. The signature of any
such oflor and the corporate seat may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its
Vice President with the corporate seal affixed this 3rd day of December
2012
ATTEST WESTOSURET OMPANY
a . (IAA& BY c—,Z 77-
A.Vist,Assistant Secretary Paul T. Vice President
h41/4 ?yes
hlgnnruq
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isus!
esri
_WtV •__� '
STATE OF SOUTH DAKOTA • SC h '/'k�=
se t '. ee
COUNTY OF MINNEHAHA OP�• �h
On this 3rd dayof December 2012peson lly appeared
,before me.a Notary Public.personally appeared
Paul T. Druflat and A. vietor
who,being by me duty sworn,acknowledged that they signed the above Power of Attorney as Vice President
and Assistant Secretary,respectively,of the said WESTERN SURETY COMPANY,and admowledged said Instrument to be the
voluntary cat s 44 d comiciRtiA0..i •
S. PETRIK •
ICRHOTARY PUBLIC ermk, ��i�%SOUTH DAKOTA
tr.,.,.w..••„v...••+.+M•w f Notary Public
My Commission Expires August 11.201e
Form 0244012
PUBLIC OFFICIAL
PERFORMANCE BOND:
PROPERTY APPRAISER
10598
PAYEE: KEY WEST INSURANCE VEND ID#:KW 3 CHECK DATE 4142013
INVOICE NO. INVOICE DATE INVOICE AmouNT DISCOUNT TAKEN NET MOM PAR)
MONRO S 3272013 $588.56 $0.00 5588.55
TOTAL 588.55
STA1 EMENT Pagel
Key West Insurance, Inc. ACCOUNT NO a„ nAraa)(TAlO
646 United Street,Suite 1 MONRO-6 DC 03/27/2013
Key West FL 33040
Phone: 305-294-1096 Fax: 305-294-8016
Monroe Co Prop Appraiser
P.O.Box 1176
Key Weal,FL 33041-1176
Inv #' Trn Due Date Descriptlon Balance Due
10949 REN 02/28/13 Policy renewal C ,M6-: )1064C y) 581.00
10949 CFE 02/28/13 Company fee 7.55
Total Balance Due: 588 .55
' ETVED
APR I Zii 13
r
M _. M 0 Page 1
Key West Insurance,Inc.646United Street,Suite 1 ACCOUNT NO OP DATE
Key West,FL 33040 MONRO-6 TM 02/11/2013
Phone: 305-294-1096 Fax: 305-294-8016 POLICY 114PORMATION
CCP994581719
F EP 1 3 2013 ; rY.s cr►scnvc zmRAT1oN
!;;�
CR-S 02/28/7.013 02/28(2014
Monroe Co Prop Appraiser
P.O.Box 1176
Key West,FL 33041-1176
Sherry Red Crime Policy Renewal
Please find enclosed a copy of the 13/14 Crime policy declaration page
and invoice. As you will note, the name has been corrected to read Mr.
Scott Russell, Monroe County Property Appraiser. Kindly attach this new
dec page to your file and make your payment made payable to Key West
Insurance. I have enclosed a return envelope for your convenience. If
you have any questions, please contact me. Thanks again.
T M
I
•
The
Administrative Office GOVERNMENT CRIME POUCY
1400American Lana Schaumburg,
DECLARATIONS
skt,aumburg,it.60,99 ; D
This policy Issued by: CA Fidelity and Deposit Company of Maryland Policy No. CCP 994581719
0 Colonial American Casualty and Surety Company
(a stock Insurance company)
Named Insured and Mailing Address Producer Name and Address:
Scott Russell,Monroe County Property Appraiser Key West Insurance,Inc.
500 Whitehead Street,4r"Floor(Rear) 646 United Street,Sults 1
Key West,FL 33040 Key West,FL 33040-3291
Policy Period:From 02/28/2013 to 02/2812014 at 1201 AM.Standard Time at your mailing address shown above.
IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS AND CONDITIONS OF THIS POLICY,
WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
INSURING AGREEMENTS,LIMITS OF INSURANCE AND DEDUCTIBLE
LIMIT OF INSURANCE DEDUCTIBLE AMOUNT
INSURING AGREEMENTS Per Occurrence Per Occurrence
1. Employee Theft—Per Loss Coverage $ 20,000.00 $ 500.00
2. Employee Theft—Per Employee Coverage Not Covered
3. Forgery Or Alteration Not Covered
4. Inside The Premises—Theft of Money and Securities Not Covered
5. inside The Premises—Robbery Or Safe Burglary Of Other Property Not Covered
8. Outside The Premises Not Covered
7. Computer Fraud Not Covered
8. Funds Transfer Fraud Not Covered
9. Money Orders And Counterfeit Paper Currency Not Covered
If Added By Endorsement,Insuring Agreement(s)
If'Not Covered' is Inserted above opposite any specified Insuring Agreement, such Insuring Agreement and any other reference
thereto In this policy is deleted.
'Policy Premium Is payable: $ 588.55 at inception; $ 1st Anniversary; $ 2nd Anniversary
'Includes Taxes and/or Surcharges: $7.55 2005 Florida Hurricane CAT Fund Assessment
ENDORSEMENTS FORMING PART OF THIS POLICY WHEN ISSUED:
CR 00 28 05 06 CR 25 01 03 00 CR 02 08 11 08 U-CR-109-A 0102 U-GU-728-B FL(01/11)
CANCELLATION OF PRIOR INSURANCE ISSUED BY US: By acceptance of this Policy you give ua notice canceling prior policy or
bond Nos. CCP 904581718
the cancellation to be effective at the time this Policy becomes effective.
COUNTERSIGNED: By:
(Date) Authorized Representative
tN WITNESS WHEREOF the Company has caused ells pocky to be signed by Its president and secretary but this policy shall not be valid unless
completed by the attachment hereto of a declarations page countersigned by a duly authorized representative of the Company.
Attest By
Secretary President
U-CR-D-103-A FL(Ed.07/11)
Includes copyrighted material of Insurance Services OfMce,Inc.,with Its pemilsslon.
LC,—02105/13 Copyright,Insurance Services Wilco,Inc,1998
I
ai
POLICY NUMBER CCP 994581719
COMMERCIAL CRIME
CR25010300
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUDE DESIGNATED PERSONS OR CLASSES
OF PERSONS AS EMPLOYEES
This endorsement modifies Insurance provided under the following:
COMMERCIAL CRIME COVERAGE FORM
COMMERCIAL CRIME POLICY
EMPLOYEE THEFT AND FORGERY POLICY
GOVERNMENT CRIME COVERAGE FORM
GOVERNMENT CRIME POUCY
and applies to the Employee Theft Insuring Agreement:
A. Schedule'
Persons Or Classes Of Persons
Scott Russell,Monroe County Property Appraiser
'Information required to complete this Schedule,if not shown on this endorsement,will be shown In the Decla-
rations.
B. Provisions
'Employee'does not include any person named
or class of persons shown In the Schedule.
CR 25 01 03 00 Copyright,Insurance Services Office, Inc., 1998 Page 1 of 1
y
I
y
•
Key West Insurance,Inc. INVOICE# 10949 Page 1
Dm
646 United Street,Suite 1 MONRO-6 DC 02/1
Key Welt,FL 33040
02/11/13
Phone:305-294-1096 305-294-8016 Crime
roucv•
CCP994581719
COM7ANY
Zurich North America Surety
vfncrtvs :xrotAtlo» eAurKsnuson
Monroe Co Prop Appraiser 02128/13 02R8/14 OIR8113
AWIWIT 7AID AMOUMDUI
P.O.Box 1176 S 588.55
Key West,FL 33041-1176 4
Itm It Dag Tm PoUoy 0 Description Amount
INVOICE 0 10949
194697 02/11/13 CCP994581719 Policy renewal S 551.00
194698 02/11/13 CCP994581719 Company lea S 7.55
Invoice Balance: S 58855
Crime bond naming Scott Russell the Appraiser
I
PUBLIC OFFICIAL BOND
Know All Men by These Presents: Bond No. 5-820491
That Scott P Russell
of 2505 Fogarty Avenue Key west FL 33040
Principal and the NGM Insurance Company
of 4601 Touchton Rd East Ste 3400 Jacksonville,FL 32245-6000
(hereinafter called the Surety) a corporation organized under the laws of the State of Florida, with its principal
office In the City of Jacksonville and State of Florida are held and firmly bound unto
Florida Secretary of State
(hereinafter called the Obligee)In the sum of
Ten Thousand and 00/100 Dotars ($10,000.00 )
for the payment whereof to the Obligee the Principal binds himself, his heirs, executors, administrators and
assigns,and the Surety binds itself,its successors and assigns,jointly and severally,firmly by these presents.
Signed, seated,and dated this 21st day of December , 2oi2 .
Whereas the above-named Principal has been duly appointed or elected to the office of
Property Appraiser
Now,therefore,the condition of the foregoing obligation is such that If the Principal shall during
the period beginning on 01/01/2013 ,and ending on 01/01/2017
faithfully perform such duties as may be imposed on him by law and shall honestly account for all money that
may come into his hands in his official capacity during such period,period,then this obligation shall be void;
otherwise it shall remain in force.
This Bond Is executed by the Surety upon the following express conditions, which shall be conditions
precedent to the right of recovery hereunder.
First That the Surety may,if it shall so elect, cancel this Bond by giving thirty(30)days notice in writing to
the Obligee and this Bond shall be deemed canceled at the expiration of said thirty (30) days; the Surety
remaining liable, however, subject to all the terms, conditions and provisions of this Bond, of any act or acts
covered by this Bond which may have been committed by the Principal up to the date of such cancellation;and
the Surety shall, upon surrender of this Bond and its release from all liability hereunder, refund the premium
paid,less a pm rata part thereof for the time this Bond shall have been in force.
Second: That the Surety shall not be liable hereunder for the loss of any public moneys or funds occurring
through or resulting from failure of, or default in payment by, any banks or depositories in which any public
moneys or funds have been deposited, or may be deposited by or placed to the credit, or under control of the
Principal,whether or not such banks or depositories were or may be selected or designated by the Principal or
by other persons;or by reason of the allowance to, or acceptance by the Principal of any interest on sad public
moneys or funds,any law,decision,ordinance or statute to the contrary notwithstanding.
Third: That the Surety shall not be liable for any loss or losses,result) from the failure of the Principal to
collect any taxes, licenses, levies, assessments, etc., with the collectio t-w • he may be chargeable by
reason of his election or appointment as aforesaid.
Witness:
ATTEST: nAS[7 0.119(A Scott P Russel _ (SEAL)
PRINCIPAL d""%, SHERRY WILSON
WI MY COMMISSION/E/r1711
BY: 'J� FJO'lJtB>w Mad U.201r,
ATTEST:� �� ity ,U4 /l/e.) NGM Insurance Company (SEAL)
SURETY
BY:
Attome actCLM5 ullen
8&1182(0512006)(Not appPcabla or Tax Cclladoral
88-04-0005b-12
J NGM INSURANCE COMPANY POWER OF ATTORNEY
S-820491
KNOW ALL MEN BY THESE PRESENTS:That the NOM insurance Company,a Florida corporation having its principal office
in the City of Jacksonville,State of Florida,pursuant to Article IV,Section 2 of the By-Laws of said Company,to wit:
"SECTION 2.The board of directors,the president,any vice president,secretary,or the treasurer shall have the power
and authority to appoint attorneys-in-fact and to authorize them to execute on behalf of the company and affix the seal
of the company thereto,bonds,recognizances,contracts of indemnity or writings obligatory in the nature of a bond,
recognizance or conditional undertaking and to remove any such attorneys-in-fact at any time and revoke the power
and authority given to then."
does hereby make,constitute and appoint Darlene May Cullen its true and lawful Attorney-in-fact,to make,
execute,seal and deliver for and on its behalf,and as its act and deed bond number S-820491 dated January 1.2013 ,
on behalf of �'"Scott P Russell""'
in favor of Florida Secretary of State
for Ten Thousand and 00/100 Dollars(S 10,000.00 )
• and to bind NGM Insurance Company thereby as fully and to the same extent as if such instrument was signed by the duly authorized
officers of the NGM Insurance Company;this act of said Attorney is hereby ratified and confirmed.
This power of attorney is signed and sealed by facsimile under and by the authority of the following resolution adopted by the Directors
of NGM Insurance Company at a meeting duly called and held on the 2nd day of December 1977.
Voted:That the signature of any officer authorized by the By-Laws and the company seal may be affixed by facsimile to any
power of attorney or special power of attorney or certification of either given for the execution of any bond,undertaking,
recognizance or other written obligation In the nature thereof; such signature and seal,when so used being hereby adopted
by the company as the original signature of such officer and the original seal of the company,to be valid and binding upon
the company with the same force and effect as though manually affixed.
IN WITNESS WHEREOF,NGM Insurance Company has caused these presents to be signed by its Assistant Vice President,General
Counsel and Secretary and its corporate seal to be hereto affixed Ihts 3rd day of January,2012
NGM INSURANCE COMPANY By: 1 1923
Bruce Fox
Assistant Vice President,General Counsel and Secretary
State of Florida,
County of Duval
On this 3rd day of January, 2012 before the subscriber a Notary Public of State of Florida in and for the County of Duval duly
commissioned and qualified,came Bruce Fox of the NOM Insurance Company,to me personally known to be the officer described
herein,and who executed the preceding instrument,and he acknowledged the execution of same,and being by me fully sworn,deposed
and said that he is an officer of said Company,aforesaid:that the seal affixed to the preceding Instrument is the corporate seal of said
Company,and the said corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority
and direction of the said Company;that Article IV,Section 2 of the By-Laws of said Company is now in force.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed by official seal at Jacksonville,Florida this 3rd dry of January,2012
,.�
arewrs
'44 :a++aram
tells CAMS
I,Brian J Beggs,Vice President of the NGM Insurance Company,do hereby certify that the above and foregoing is a true and coned
copy of a Power of Attorney executed by said Company which Is still in force and effect. IN WITNESS WHEREOF,I have hereunto
set my hand and affixed the seal of said Company at Jacksonville,Florida this 21 day of December , 2012 •
tra,
WARNING:Any unauthorized reproduction or alteration of this document is prohibited.
TO CONFIRM VALIDITY of the attached bond please call 1-603-358-1343.
TO SUBMIT A CLAIM: Send all correspondence to 55 West Street,Keene,NH 03431 Attn:Bond Claim Dept.
or call our Bond Claim Dept.at I-603-358-1229.
PUBLIC OFFICIAL INSURANCE
(IN LIEU OF BOND):
SHERIFF
F LORI DA'* . ~ SHERIFFS RISK MANAGEMENT FUND
•
Established 1978 \ ` Protecting Those Who Protect Us _ ^.--
FLORIDA SHERIFFS SELF INSURANCE PROGRAM
LAW ENFORCEMENT UABILITY COVERAGE DECLARATIONS
Certificate Number: 15-FSRMF-44
COVERED MEMBER: Monroe County Sheriffs Office
PRINCIPAL ADDRESS: 5525 College Road,Key West, FL 33040
ANNUAL AGREEMENT PERIOD: October 01,2014 EXPIRATION DATE: October 01, 2015
LEL REINSURANCE RETROACTIVE DATES: FIRST MILLION: October 01, 1985
SECOND MILLION: October 01, 1988
THIRD MILUON: October 01, 1998
DEDUCTIBLE: 0.00
THIS DECLARATIONS PAGE IS ISSUED TO THE COVERED MEMBER NAMED ABOVE,TO IDENTIFY THE ANNUAL AGREEMENT PERIOD AS WELL AS THE
UNITS OF COVERAGE AFFORDED.ALL TERMS,LINTS,DEFINITIONS,REGULATIONS,CONDITIONS,EXCLUSIONS,AND LIMTATIONSOF THE
APPLICABLE SELF INSURANCE COVERAGE AGREEMENT WHICH ACTUALLY AFFORDS COVERAGE BY VIRTUE OF PARTICIPATION IN THIS SELF
INSURANCE PROGRAM BY THIS PARTICIPATING COVERED MEMBER APPLY.THIS DECLARATIONS PAGE DOES NOT INCREASE,AMEND,OR MODIFY
THE COVERAGE OTHERWISE PROVIDED UNDER THE APPLICABLE SELF INSURANCE COVERAGE AGREEMENT ATTACHED HERETO.THE UNITS SET
FORTH UNDER THIS AGREEMENT APPLY ONLY TO THE EXTENT THAT MESS UNITS ARE COLLECTABLE FROM REINSURERS COVERING THIS
AGREEMENT.IN CONSIDERATION OF THE PAYMENT OF THE CONTRIBUTION AND IN RELIANCE UPON THE STATEMENT IN THE DECLARATIONS AND
THE APPLICATION FOR COVERAGE HEREUNDER AND SUBJECT TO THE INSURANCE AGREEMENTS,DEFINITIONS,EXCLUSIONS,AND CONDITIONS OF
THIS SELF INSURANCE COVERAGE AGREEMENT,THE OMITS OF LIABILITY AFFORDED FOR THE ANNUAL AGREEMENT PERIOD ARE AS FOLLOWS:
LAW ENFORCEMENT UABIUTY $5,000,000 Per Occurrence
$10,000,000 Annual Aggregate
SUBLIMITS:
Contracts/Agreements $1,000,000 Per Person, Per Occurrence, Annual
Aggregate
Jail Deficiencies Defense Costs/Legal Expenses $100,000 Per Occurrence
Property Damage to Structures $50,000 Per Occurrence
Claim by Family Member/Household Member $25,000 Per Any One Person
Firearms Training $1,000,000 Per Person, Per Occurrence, Annual
Aggregate
CONTRIBUTION PER EXPOSURE CATEGORY
High Hazard 345 $727.26 $250,904.70
K-9's(Apprehension) 0 $727.26 $0.00
Medium Hazard 43 $420.36 $18,075.48
Low Hazard 215 $207.27 $44,583.05
Volunteers 0 $37.82 $0.00
Subtotal 603 $313,543.23
Multi-Program Discount ($9,406.30)
TOTAL ANNUAL CONTRIBUTION $304,138.93
SIGNED:
2600 Centennial Place, Suite 200, Tallahassee, FL 32308
P.O. Box 12909,Tallahassee, FL 32317
Telephone: 0%6)292~CO`F - 39
I
F LORIDA`e i SHERIFFS RISK MANAGEmENT FUND
Established 1978 Protecting Those Who Probst Us
FLCRIDA SHERIFFS SELF INSURANCE PROGRAM
PUBLIC OFFICIALS UABIUTY COVERAGE DECLARATIONS
Certificate Number. 15-FSRMF-44
COVERED MEMBER: Monroe County Sheriff's Office
PRINCIPAL ADDRESS: 5625 College Road, Key West, FL 33040
ANNUAL AGREEMENT PERIOD: October 01,2014 EXPIRATION DATE: October 01, 2015
POL REINSURANCE RETROACTIVE DATES: October 01,1992
DEDUCTIBLE: None
THIS DECLARATIONS PAGE IS ISSUED TO THE COVERED AEI!NAMED ABOVE.TO IDENTIFY THE ANNUAL AGREEMENT PERIOD AS WELL A8 THE
LIMITS OF COVERAGE AFFORDED.ALL TERMS,LIMITS,DEFINITIONS,REGULATIONS,CONDITIONS,EXCLUSIONS,AND LIMITATIONS OF THE
APPLICABLE SELF INSURANCE COVERAGE AGREEMENT WHICH ACTUALLY AFFORDS COVERAGE BY VIRTUE OF PARTICIPATION IN THIS SELF
INSURANCE PROGRAM BY THIS PARTICIPATING COVERED MEMBER APPLY.THIS DECLARATIONS PAGE DOES NOT INCREASE.AMEND.OR MODIFY
THE COVERAGE OTHERWISE PROVIDED UNDER THE APPLICABLE SELF INSURANCE COVERAGE AGREEMENT ATTACHED HERETO.THE UATS SET
FORTH UNDER THIS AGREEMENT APPLY ONLY TO THE EXTENT THAT EXCESS LIMITS ARE COLLECTABLE FROM REINSURERS COVERING THIS
AGREEMENT.IN CONSIDERATION OF THE PAYMENT OF THE CONTRIBUTION AND IN RELIANCE UPON THE STATEMENT IN THE DECLARATIONS AND
THE APPLICATION FOR COVERAGE HEREUNDER AND SUBJECT TO THE INSURANCE AGREEMENTS.DEFINITIONS.EXCLUSIONS,AND CONDITIONS OF
THIS SELF INSURANCE COVERAGE AGREEMENT,THE LIMITS OF UABILITY AFFORDED FOR THE ANNUAL AGRFFNT PERIOD ARE AS FOLLOWS:
Public Officials Uability $5,000,000 Per Occurrence
$10,000,000 Annual Aggregate
CONTRIBUTION PER EXPOSURE CATEGORY
High Hazard 345 $129.35 $44,625.75
Medium Hazard 43 $74.76 $3,214.68
Low Hazard 215 $36.86 $7,924.90
Volunteers 0 $6.73 $0.00
Subtotal 803 $55,785.33
Multi-Program Discount ($1,672.96)
TOTAL ANNUAL CONTRIBUTION $54, 2.37
SIGNED: Rt24€44J1/--)t-gtCL-
2600 Centennial Place, Suite 200, Tallahassee, FL 32308
P.O. Box 12909,Tallahassee, FL 32317
Telephone: (850)320-6880 Facsimile:(850)320-6939
2014-2015 FSRMF COVERAGE RENEWAL BOOK
mow
PUBLIC OFFICIAL BOND:
SUPERVISOR OF ELECTIONS
el .-- . .o."..,.L.-- A
WESTERN SURETY COMPANY
I%, P.O.Box 5077 '("y
Sioux Falls,SD 57117-5077 V Bond No. 71508762
(606)335 0860 F.fkctive Date: January 8. 2014
Western Surety G
State of Florida
:) Secretary of State ,
Division of Elections + :
i 500 South Bronough Street,Room 316
Tallahassee,Florida 32399-0250 �;
ii,
Public Official Bond
County of Monroe x
Z I !
KNOW ALL PERSONS BY THESE PRESENTS,That we, R. Joyce Griffin
(officio/a Name)
as Principal,and WESTERN SURETY COMPANY 1
' as Surety, are bound unto the Governor of the State of Florida, and his successors in office, in the sum of
$ 5.000.00 I'-
Dollars,we hereby bind ourselves and each of our heirs,executors, �l~
administrators,successors and assigns,jointly and severally.
I•
THE CONDITION OF THIS OBLIGATION IS SUCH, That, whereas, said official was
elected ® appointed 0 Supervisor of Election County of Monroe to hold this office for
(Name of Office)
7 a term beginning January 8, 2014 and ending January 8, 2 018 and until his/her
successor is qualified according to the Constitution and Laws of the State of Florida.
NOW,THEREFORE,If the official shall faithfully perform the duties of their office as provided by Iaw,this obligation is void.
i ,
X
(Signature of Official) a
Signed and Sealed this 4th day of February 2014
101 S. Reid St., Ste. 300
WESTERN SURETY COMPANY Sioux Falls. SD 57103-7046
/' // i (.4ddreas of Main Surety Company)
"ir.►i"�
By ►--/ _ ,1i3rt—e' _ _ THE PORTER-ALLEN CO. , INC.
.,A01‘,...E T}�a� �i ;{,� at ac 513 SOUTHARD STREET(Name of Local Bonding Company)
-reso•" "ti fj ' KEY WEST FL 33040-6835
.�4, 0 Oft .'.' '.% (Address of Local Bonding Company)
40 �f‘ z I (SEAL) By X
:. (Signature of Licensed Resident Agent)
7. ��k4�1_,• " O~';` (Social Security Number of Licensed Resident Agent){„vrivD
• s�tatttfitililNlat�
(Type Name of Licensed Resident Agent)
r'
The above is approved this day of
by: County Commissioners
Chairman:
r 4bond.doc(02/04)
Form 1345-12-2012
Western Surety Company
POWER OF ATTORNEY
KNOW ALL,NiEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY,a corporation organized and existing under the laws of the State of South Dakota,and
authorized and licensed to do business in the States of Alabama,Alaska,Arizona,Arkansas, California, Colorado,Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland,Massachusetts,Michigan,Minnesota,Mississippi,Missouri,Montana,Nebraska,Nevada,New Hampshire,New Jersey,
New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United
States of America,does hereby make,constitute and appoint
H. Dahlstrom of Sioux Falls
State of South Dakota _,with limited authority,its true and lawful Attorney-in-Fact,with full power and
authority hereby conferred to sign,execute,acknowledge and deliver for and on its behalf as Surety and as its act and deed,the
following bond:
One SUPERVISOR OF F.i,F.r`TION COUNTY OF MONROE
bond with bond number 73 508762
for R. JOYCE GRIFFIN
as Principal in the penalty amount not to exceed: SS-00 0-00
Western Surety Company further certifies that the following Is a true and exact copy of Section 7 of the by-laws of Western Surety Company
duly adopted and now in force,to-wit
Section 7. All bonds,policies,undertakings,Powers of Attorney,or other obligations of the corporation shall be executed in the corporate
name of the Company by the President, Secretary, any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the
Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint
Attorneys-in-Fact or agents who shall have authority to issue bonds,policies,or undertakings In the name of the Company. The corporate seal Is
not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The signature of any
such officer and the corporate seal may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its
Vice President with the corporate seal affixed this 4th day of February
2014
ATTEST WESTOPSURET COMPANY
_ _____ ULt4L By G.... - _
A.Meter,Assistant Secretary Paul T. Vice President
00'/•Qaaq1. o%
STATE OF SOUTH DAKOTA 1 ;
g r+t 'PLC'AIr *C
COUNTY OF MINNEHAHA Vile.'
y,,lip . r�
firremosio
On this 4 th dayof February2 014 p personally appeared
,before me,a Notary Public, appeared
d Paul T. aruflat and A. vietor
who,being by me duly sworn,acknowledged that they signed the above Power of Attorney as vice President
and Assistant Secretary, respectively,of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the
voluntary ,s ,plti LGQ iPlio.+
S. PETRIK
cam; tdOTARY PUBLIC r
s
skeIWSOUTH DAKOTA allr a _
+ + Notary Public
My Commission Expires August 11,201t3
Form 872-8-2012
ems.--m. __�._....
ACKNOWLEDGMENT OF SURETY
STATE OF SOUTH DAKOTA ss (Corporate Officer)
County of Minnehaha
On this 4th day of February 2014 ,before me,a Notary Public in
•
and for said County,personally appeared H.Dahlstrom,Ass't Sec.
personally known to me, who being by me duly sworn, did say that he is the aforesaid officer of WESTERN SURETY
COMPANY,a corporation duly organized and existing under the laws of the State of South Dakota,that the seal affixed to the
foregoing instrument is the corporate seal of said corporation, that the said instrument was signed, sealed and executed on
behalf of said corporation by authority of its Board of Directors, and further acknowledge that the said instrument and the
execution thereof to be the voluntary act and deed of said corporation.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal the day and year last above
written.
My commission expires
tit:_
RAK
My Commission Expires 4-10-2017
Notary Public
Fong 1034248
PUBLIC OFFICIAL
PERFORMANCE BOND:
TAX COLLECTOR
1-800-331-6053
Fax 1-605-335-0357
www.cnasuretv.com
P0 sox 5077 Sioux Falls SD 57117-5077 Email. uwservicesebcnasuretv.com
January 15, 2015
Danise D. Henriquez
1200 Truman Ave.
Key West,FL 33040
Re: Bond#69827193 - Danise D. Henriquez
$50,000.00-Tax Collector County Of Monroe
Company Code: 601 -Western Surety Company
Thank you for the premium payment for the above referenced bond. This document is to serve
as notice that payment in full has been remitted for the term of 01/07/2015 through 01/07/2016.
This type of bond remains in full force and effect without a renewal bond or Continuation
Certificate. If you have any questions, please contact your local agent.
SuretyePay. Payfor your
Consider makingyour payment through CNA y
bond/policy premium online using your own credit/debit card or ACH at your convenience 24
hours a day. Simply go to: onlinepay.cnasurety.com and follow the easy-to-use prompts. You
can pay your bill in minutes, saving you time and money.
i .
40- el
Western SuretyCam any
1
CONTINUATION CERTIFICATE
CI \"
Western Surety Company hereby continues in force Bond No. 69827193
briefly described as TAX COLLECTOR COUNTY OF MONROE
for DAN B . HENRI UE
, as Principal,
in the sum of$Fift Thousand and 00/100
Dollars, for the term beginning
Janua 7
2013_, and ending Januar 7 2017 , subject to all
the covenants and conditions of the original bond referred to above.
This continuation is issued upon the express condition that the liability of Western Surety Company
under said Bond and this and all continuations thereof shall not be cumulative and shall in no event exceed
the total sum above written.
Dated this 9th day of
January , 2013
WESTER ' SURETY COMPANY
`ltlftithryjt`
Paul T. Bru t,Vice President
r". i
�, 'TN'Dpv� its
"::++ssff��uea.+
THIS"Continuation Certificate"MUST BE FILED WITH THE ABOVE BOND.
SCANNED
Form gpA-8-2012 DATE EN ru o FEB 11 2013 0
INITIALS. MARIA„ •