Loading...
Certificates of Insurance .. ........... ..... ......................................................... ..." --... ....... .. ... "... --. I ACORD. CIt~'tIF=ICA-rE5<UF=I...IAE3I.I...I.lrN~l.J~~f\JQ.lEcsRLIS DATE (MMlDDIYY) I< 03/30/99 .. . .............. ........ .......... ............... ... .... . ....... . . .... . ..... ....................................................... ..................................JOttWli!:2. ..... PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Johnsons Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 13361 Overseas Highway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marathon FL 33050 COMPANIES AFFORDING COVERAGE The Johnsons Insurance Agency COMPANY A scottsdale Insurance Co. Phone No. 305-289-0213 Fax No. INSURED COMPANY B Key West Business Guild COMPANY Monte Jackson C P.O. Box 1208 COMPANY Key West FL 33041 0 .i ...... .............> ............. .................. .......... ...... .............. ........> >> .. ....... ....... <...<d.....<d ...............<..... ..... ........ ....... ............ ............ 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM/DDIYY) DATE (MM/DDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000 --; A X COMMERCIAL GENERAL LIABILITY CLS0560715 02/24/99 02/24/00 PRODUCTS. COMP/OP AGG $ 1,000,000 -- l CLAIMS MADE ~ OCCUR PERSONAL & ADV INJURY $ 1,000,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 - - FIRE DAMAGE (Anyone fire) $ 50,000 MED EXP (Anyone person) $ EXCL AUTOMOBILE LIABILITY ,-- Jr~ COMBINED SINGLE LIMIT $ - ANY AUTO ,,-"t<f'1yvt ALL OWNED AUTOS BODILY INJURY - (Per person) $ SCHEDULED AUTOS ...,y- - 4- -S ~q~ - HIRED AUTOS - BODILY INJURY NON.OWNED AUTOS DII1I:_- - (Per accident) $ - - '(~ j-;" ,_L- YFS - WI,!VfR: PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ - ANY AUTO OTHER THAN AUTO ONLY: > >. - ~'. (00/1{]) EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY ~~ EACH OCCURRENCE $ ~ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND I WC STATU- \ 10TH. .<< .................... ..... EMPLOYERS' LIABILITY TORY LIMITS ER EL EACH ACCIDENT $ THE PROPRIETOR! RINCL EL DISEASE. POLICY LIMIT $ PARTNERs/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $ OTHER A Commercial Applica CLS0560715 02/24/99 02/24/00 DESCRIPTION OF OPERATIONS/LOCATIONSlVEHICLES/SPECIAL ITEMS Special Event-certificate holder is also an additional insured. d....... < .............................................>.< ............. < --' >.... ...... d .... .........> ........... ...... ....... .......> ............. > .................... MONR015 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Monroe County Board of .J:.L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, County Commissioners 5100 College Rd U/ I LqCl BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Key West FL 33040 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE D^TE ......~/ The Johnsons Insuranc:e .. . .< >. ................. ........ ............................ >-- ~'" . ............ - ..- ACORDm CERTIFICATE OF LIABILITY INSURANC~~~~ B~ DATE (MM/DDIYY) 08/15/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Key West Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 646 United Street, Suite 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Key West FL 33040 , INSURERS AFFORDING COVERAGE Phone: 305-294-1096 Fax:305-294-8016 INSURED I INSURER A Century Surety .- : INSURER B Key West Business Guild Inc. INSURER C: .u__ PO Box 1208 INSURER D: Key West FL 33040 INSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS APP BY OATE WANER 07/10/03 LIMITS EACH OCCURRENCE $ 1000000 07/10/04 FIRE DAMAGE (Any one fire) $ 50000 MED EXP (Anyone person) '$ 2000 , PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 1000000 PRODUCTS. COMP/OP AGG $ excluded TYPE OF INSURANCE POLICY NUMBER COMMERCIAL GENERAL LIABILITY BINDER CCP2 5 0 15 3 CLAIMS MADE xl OCCUR COMBINED SINGLE LIMIT i $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS BODILY INJURY (Per person) $ II BODILY INJURY (Per accident) $ ! PROPERTY DAMAGE I (Per accident) GARAGE LIABILITY ANY AUTO I AUTO ONLY. Ell. ACCIDENT EACH OCCURRENCE EAACC , $ I AGG I $ $ :$ $ $ OTHER THAN AUTO ONLY OCCUR CLAIMS MADE AGGREGATE : DEDUCTIBLE RETENTION $ I WORKERS COMPENSATION AND I EMPLOYERS' LIABILITY , f...-.---.-.-- $ TORY LIMITS ..~~__ , E.L EACH ACCIDENT $ I E.L DISEASE. Ell. EMPLOYEE $ E.L DISEASE. POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is additional insured CERTIFICATE HOLDER Y ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Monroe County BOCC & TOC ATTN: Marie Slavik 1100 Simonton Street Key West FL 33040 MONBOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...lL. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR B ITY OF A / /jr-__ Ke ACORD 25-S (7/97) 1996 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: The Kev West Business Guild Contract for: Gav and Lesbian Visitor Information Services for the Monroe County Tourist Develooment Council: District 1- EncomDassinsz the City of Key West - RFP - TDC - 169-196-2009 PURlCV Address of Contractor: 513 Truman Avenue Kev West.. FL 33040 Phone: 305-294-4603 Scope of Work: Provide Visitor Information Services and Visitor Information Center in Key West FL as stipulated in contract with the Monroe County Board of County Commissioners, the Tourist Development Council and District Advisory Committee I Reason for Waiver: The Kev West Business Guild does not own an automobile and therefore" does not have auto insurance Policies Waiver will apply to: The Key West Business Guild contract for District I Gay & Lesbian Visitor Information Services Signature of Contractor: ~ ~ ' E ';(6 01/1'; IIC JJ rn c-ft L; Date: ot Approved Risk Management: County Administrator Appeal: Approved Not Approved Date: Board of County Commissioners Appeal: Approved Not Approved Meeting Date: Administration Instruction #4709.2 ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP 10 TN I DATE (MMlDDIYYYY) KWBUS01 09/03/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Key West Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 646 United Street, Suite 1 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Key West FL 33040 Phone: 305-294-1096 Fax:305-294-8016 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Main Street America INSURER B: Key West Business Guild INSURER C: PO Box 1208 INSURER D: Key West FL 33040 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TR NSR TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR POLICY NUMBER LIMITS GEN'L AGGREGATE LIMIT APPLIES PER: ~~8i LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS $ $ $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ GARAGE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODIL Y INJURY $ (Per person) BODIL Y INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONL Y - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ EXCESS/UMBRELLA LIABILITY OCCUR D CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER TBA 08/28/09 X TORY LIMITS 08/28/10 E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Civic Club CERTIFICATE HOLDER Monroe County BOCC 1100 S~onton Street Key West FL 33040 CANCELLATION MONCNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTlFIC H LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL orJ LIAB F ANY KIND UPON THE INSURER, ITS AGENTS OR <... ACORD 25 (2001/08) @ACORDCORPORATION 1988 I CJiL"l I .TB c-.l'TTI) ACOIVJ. CERTIFICATE OF LIABILITY INSURANCE 08/26109 PNXIUCM ...... CERnFlCATE ISI88UED AI A MATTER OF INFORIIATION Key ...t: ID8Uranae, Inc. ONLY AND ~ RICJHI8 UPON THE CBTFlCATI HOLDER.1HB _ IE DOES NOT MIIND, EXTEND OR 646 United Sb:eet, Suite 1 ALTER THE COVERAtE AFFORDED BY THE POLICES BELOW. Key ---~ rL 33040 Pbone:305-294-1096 "':305-214-8016 INSURI!R8 ~ COVERAGE HAle . .... NIJRER A; -. ~i.t:er. INSURER 8: ~ ---1 ft.iDe.. Qai1d INSURER c: PO Box 20 INSURER D: Key ...t rIa 33040 INSURER E: COVBAGEa THE POLICIES OF INSURANCE LIlTED BELOW HAVE BEEN I8SlED TO TtE IN8lJREI) HAlED ABOVE FOR THE POlICY PERIOD facATED. NOTWITHSTANDING ANY REQUIREIENT. TERM OR CONDITION OF NfV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WtICH THIS CERTlilcATE MAY IE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY TtE POLICES DE8CRIJED HEREIN 18 SUBJECT TO ALl THE TERMS. EXCI.USIOttsAND CONDITIONS OF SUCH POLICEs. AGGREGATE I.MTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . L TIt ... 1'YPII 011 _IMIICII fIOUCY..-. ..... . ~ ...... L...-.nY EACH OCCURRENCE . 1000000 t--- 07/10/10 ~(e.......) A X Z COMaERCIAL GENERAL LtA8l.lTY CCPS91314 07/10/09 . 50000 - :J ClAIMS MADE [i] OCCUR - lED EXP (AnJ one......) . 2000 : PER8OIW... ADV INJURY . 1,000 ,000 GENERAL AGGREGATE . 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COIPIOP AGO . eac1uded I POlICY n 28i nLOC ~L...-.nY COIBNED SINGLE LMT - . ANY AUTO (E8~ ~ ALL OWNED AUTOS 80DL Y INJURY ~ . SCHEDULED AUTOS (Per person) I"-- !1 HIRED AUTOS \~ BODI. Y INJURY --- . NON-OWNeD AUTOS ~, (Pw~ - t0o- l.' PROPERTY DAMAGE ^Ci (Per~ . '- .. ~ L...-.nY '.' .,. .~, ~ ~1Q -'-/ I . "..,. ; AUTO ONLY - EA ACCIDENT . ~ANYAUTO ( 0-'" OTtER THAN EA ACe . AUTO ONLY: AGG . DlCl..tJ-.- ~ L...-.nY EACH OCCURRENCE . :JOCCUR o CLAIMS MADE AGGREGATE . q:= . ; . . . ..... oaw.IIA'IIOII MD ! I TORY LIMITS I IO.m- ; ~LIMI.ITY ANY PROPRIETORIPARTNERIEXECU1'1 E.L. EACH ACCIDENT . OFFICERIIEI&R EXClUDED? E.L DISEASE - EA EMPlOYEE . ~ ......... CIAI.. PROVISIONS.... E.L. DISEASE - POlICY uurr . OTHIR ~l.o.. OPOPIJtA~'LOCA"""WMCLDIac:w-.. ADDID IIY RMmllbd.lT IIPIICIM. ~ o1ub. ciric aezvic.. CERTIFICATE HOLDER CA""" lATION 1tCR%8K8 IfoDzoe COUJl~ ai.1t _t: Karia S1ari.1t 1100 S3aonb)D .S'l:reet Bey "at rL 33040 ACORD 25 (2001101) ----"'" KWBUS01 OP ID: TM AC-CPR CERTIFICATE OF LIABILITY INSURANCE DA (MM/DD/YYYY) • • 04/16/12 THIS.SERTIFICATE 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 305 - 294 - 1096 CONTACT Key West Insurance, Inc. NAME: 646 United Street, Suite 1 305- 294 -8016 A/C (AIC.No. Ext): ( Key West, FL 33040 E•MRIL (A/C, No): ADDRESS: Key West lnsurance, Inc. INSURER(S) AFFORDING COVERAGE NAIC # • INSURER A: National Grange Mutual INSURED Key West Business Guild INSURER B: Old Dominion Insurance . Attn: Rebecca Tomlinson PO Box 1208 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, E. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP JNSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 6 A X COMMERCIAL GENERAL LIABILITY X BPG30095 08/31/11 08/31/12 DAMAGE TO RENTED PREMISES (Ea occurzence) $ 500,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) _ $ 5,000 PERSONAL & ADV INJURY _ $ 1,000,00_0 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 I • POLICY PRO - .IFf.T LOC $ / AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ — ----. ANY AUTO BODILY INJURY (Per person) $ ^ ALL OWNED SCHEDULED r ; ,�( _ r BODILY INJURY (Per accident) $ AUTOS _AUTOS ( I1� _ NON -OWNED PROPERTY DAMAGE — HIRED AUTOS AUTOS ` f (Per accident) $ ly $ UMBRELLA LIAR — OCCUR EACH OCCURRENCE _ $ EXCESS UAB CLAIMS -MADE AGGREGATE _ $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' UABIUTY Y / N TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE WCG30095 08/31/11 08/31/12 E L. . EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? I N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 • DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) office Certificate holder is named additional isured as their interest may appear for General Liability coverage ony. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County BOCC THE EXPIRATION D • E THEREOF, NOTICE WILL BE DELIVERED IN 'DANCE WITH T P ICY PROVISIONS. and Monroe County TDC 1100 Simonton St. AUTHORIZ =• REPRESENT Key West, FL 33040 Key - 1- ran t Inc. ©19:: 010 A ' - D C RPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered ma - of ACORD t I996 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: The Key West Business Guild Contract for: Gay and Lesbian Visitor Information Services for the Monroe County Tourist Development Council: District 1— Encompassing the City of Key West — RFP — TDC — 169- 196 -2009 PUR/CV Address of Contractor: 513 Truman Avenue Key West, FL 33040 Phone: 305- 294 -4603 Scope of Work: Provide Visitor Information Services and Visitor Information Center in Key West FL as stipulated in contract with the Monroe County Board of County Commissioners, the Tourist Development Council and District Advisory Committee 1 Reason for Waiver: The Key West Business Guild does not own an automobile and therefore, does not have auto insurance Policies Waiver will apply to: The Key West Business Guild contract for District 1 Gay & Lesbian Visitor Information Services Signature of Contractor: ', , \ 1 64 - 1 J- 4 .-- - ' ' - it L ✓ '/ ,iJ rt C+1) L.. Approved . � ` � Not Approved Risk Management: C/, { ( Date: � 1 1 '— County Administrator Appeal: Approved Not Approved Date: Board of County Commissioners Appeal: Approved Not Approved Meeting Date: Administration Instruction #4709.2