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Certificates of InsuranceACORDM PRODUCER JOHNSON & MILLER INSURANCE 1225 N MILITARY TRAIL #2 WEST PALM BEACH, FL 33409 561-640-4333 INSURED ROY KHANNA DATE (MM/DD/YY) 02/25/2003 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 POLICIES BELOW. COMPANY A HERMITAGE INSURANCE CO. COMPANY B 3117 CAROL AVE COMPANY C PALM SPRINGS, FL 33461 Y COMPANY D (561) 641-2360 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANC E AFFORDED EXCLUSIONS OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS BY THE POLICIES DESCRIBED AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE HEREIN IS SUBJECT TO ALL THE TERMS, BEEN REDUCED BY PAID CLAIMS. co LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DDA Y) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 1 MILLION X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PRODUCTS - COMP/OP AGG sEXCLUDED OWNER'S & CONTRACTOR'S PROT #HGL 4 4 3 5 01 11 / 2 6 / 0 2 11 / 2 6 / 0 3 PERSONAL & ADV INJURY $ 1 MILLION EACH OCCURRENCE al MILLION FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS A APO A P person) NON -OWNED AUTOS K MAMA IY MENT BODILY INJURY BY (Per accident) $ DATE , , r� PROPERTY DAMAGE $ GARAGE LIABILITY ,�I, WAIVER ANY AUTO N/A YES a7 AUTO ONLY -EA ACCIDENT $ _ OTHER THAN AUTO ONLY: EACH ACCIDENT $ EXCESS LIABILITY AGGREGATE $ EACH OCCURRENCE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM AGGREGATE $ WORKERS COMPENSATION AND $ EMPLOYERS LABILITY WC STATU- OTH- TORY LIMITS ER THE PROPRIETOR/ EL EACH ACCIDENT $ PARTNERS/EXECUTIVE jNCL OFFICERS ARE: EXCL ___[ EL DISEASE -POLICY LIMIT EL DISEASE - EA EMPLOYEE a $ OTHER DESCRIPMON OF OPERATIONS/LOCATIONS/VEHK:LESISPECWL ITEMS MONROE COUNTY BOARD OF COUNTRY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSUREDS ON POLICY OHGL443501 WITH HERMITAGE INSURANCE CO. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY BOARD OF COUNTY EXPIRATION DATE THEREOF, THE ISSUIN COMPANY WILL ENDEAVOR TO MAIL COMMISSIONERS 10 DAYS WRITTEN NOTICE TO THE RTIFIC HOLDER NAMED TO THE LEFT, ATTN: RISK MANAGEMENT BUr URE TO AIL SUCH No E S LL IM SE NO OBLIGATION OR LIABILITY 1100 SIMONTON STREET OF ANY KIN UPON T E MP Y, IT AGENTS OR REPRESENTATIVES. KEY WEST, FL 33040 AUTHORIZED R NTATIV FAX:305-289-6336 %tA� _ AVORU DATE (MMIDDIYY) 'M 12/11/2003® PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN JOHNSON & MILLER INSURANCE ALTER THE COVERAGE AFFORDED BY THE POLICIES B 1225 N MILITARY TRAIL #2 COMPANIES AFFORDING COVERAGE WEST PALM BEACH, FL 33409 561-640-4333 COMPANY A HERMITAGE INSURANCE CO. INSURED COMB NY ROY KHANNA COMPANY 3117 CAROL AVE PALM SPRINGS, FL 33461 COMPANY D (561)641-2360 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 EXPIRATIONLTR LIMBS DATE (MM/DD/YY) DATE (MM/DDfM GENERAL LIABILITY GENERAL AGGREGATE $ 1 MILLION X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP /OPAGG $EXCLUDED CLAIMS MADE ❑ OCCUR PERSONAL & ADV INJURY $ 1 MILLION A OWNER'S & CONTRACTOR'S PROT # H GL 4 4 3 5 01 11 / 2 6 / 0 3 11 / 2 6 / 0 4 EACH OCCURRENCE $1 MILLION FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS }gy BODILY INJURY (Per person) $ INJURY HIRED AUTOSIA"�A M `(Per Tq ��.BODILY $ NON -OWNED AUTOS accident) DA 1444 �.. �.� PROPERTY DAMAGE $ GARAGE LIABILITY F/ A AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WC STATU- OTH- $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER EL EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE - POLICY LIMIT $ OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS MONROE COUNTY BOARD OF COUNTRY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSUREDS ON POLICY #HGL443501 WITH HERMITAGE INSURANCE CO. ---------------------------------- ------------------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY BOARD OF COUNTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL COMMISSIONERS 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATTN: RISK MANAGEMENT BUT F RE T MAb UCH NO SHALL IMPOSE NO OBUGAT10N OR LIABILITY 1100 SIMONTON STREET OF KIND UPON THE PANY, IT GEN AOR EPRESENTATIVES. KEY WEST, FL 33040 AUTHO D EPR NTATN FAX:305-289-6336 -0 INDICATED, NOTWITHSTANDING CERTIFICATE MAY BE ISSUED _EXCLUSIONS AND CONDITIONS Co L R TYPE OF INSURANCE GENERAL LIABILITY ANY REQUIREMENT, TERM OR OR MAY PERTAIN, THE INSURANCE OF SUCH POLICIES. LIMITS SHOWN POLICY NUMBER CONDITION OF AFFORDED MAY HAVE BEEN POLICY EFFECTIV DATE (MM/DDIYY) ANY CONTRACT BY THE POLICIES REDUCED BY POLICY EXPIRATIO DATE (MM/DDMI) OR OTHER DOCUMENTD DESCRIBED HEREIN PAID CLAIMS. LIMITS WITH RESPECT TO IS SUBJECT TO AL X COMMERCIAL GENERAL LIABILI GENERAL AGGREGATE i $1 MILLION PRODUCTS - COMP/OP AG $EXCLUDED CLAIMS MADE OCCUR PERSONAL & ADV INJURY $1 MILLION A OWNER'S & CONTRACTOR'S PR T # HGL 4 4 8 9 7 8 - 0 5 12 / 01 / 0 5 12 / 01 / 0 6 EACH OCCURRENCE $1 MILLION FIRE DAMAGE (Any one fire) $ 50,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS MED EXP (Any one person) $ 5,000 COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS p -.,AIY Ili ' iv I BODILY INJURY (Per accident) $ PROPERTY DAMAGE AUTO ONLY - EA ACCIDEN $ $ GARAGE LIABILITY ANY AUTO r ! , A Y E, _ _^ OTHER THAN AUTO ONLY: Wz EACH ACCIDEN ,� $ EXCESS LIABILITY AGGREGAT $ UMBRELLA FORM OTHER THAN UMBRELLA FORM t EACH OCCURRENCE $ AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL OFFICERS ARE: EXCL OTHER TORY LIMIT ER EL EACH ACCIDENT $ EL DISEASE -POLICY LIMI $ EL DISEASE - EA EMPLOYE MONROE COUNTY BOARD OUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED. C C 1 .,O.V1 C*.. MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN RISK MANAGEMENT 1100 SIMONTON STREET KEY WEST, FL 33040 FAX: 305-289-6336 SHOULD ANY OF THE ABOVE DESCII POLICIES BE CANCELLED BEFOI EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BUT F IL RE TO MAI SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIAI OF ANY KIND UPON THE /COMPANY IT AGENTS OR REPRESENTATI PHORI DDD�„ ..,wc i i i i r 11/30/2004 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC JOHNSON & MILLER INSURANCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLICIES B 1225 N MILITARY TRAIL #2 COMPANIES AFFORDING COVERAGE WEST PALM BEACH, FL 33409 COMPANY 561-640-4333 A HERMITAGE INSURANCE CO. INSURED COMPANY ROY KHANNA B COMPANY 3117 CAROL AVE C PALM SPRINGS, FL 33461 COMPANY (561)641-2360 D T LTR - •- INDICATED, NOTWITHSTANDING CERTIFICATE MAY BE ISSUED EXCLUSIONS AND CONDITIONS TYPE OF INSURANCE • � R;7 REQU''. " "'r: ua I to ANY IREMENT, TERM OR OR MAY PERTAIN, THE INSURANCE OF SUCH POLICIES. LIMITS SHOWN POLICY NUMBER t3twW HAVE CONDITION OF AFFORDED MAY HAVE BEEN POLICY EFFECT[ DATE (MM/DD/YY) BEEN ISSUED TO ANY CONTRACT BY THE POLICIES REDUCED BY POLICY EXPIRATIO DATE (MM/DD/YY) THE INSURED NAMED OR OTHER DOCUMENT DESCRIBED HEREIN PAID CLAIMS. LIMITS OV ABE OF R THE P WITH RESPECT TO IS SUBJECT TO AL A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILI CLAIMS MADE ❑ OCCUR OWNER'S & CONTRACTOR'S PR T # HGL 4 4 3 5 01 12 / 01 / 0 4 12 / 01 / 0 5 GENERAL AGGREGATE $1 MILLION PRODUCTS - COMP/OP AG $EXCLUDED PERSONAL & ADV INJURY $1 MI LL I ON EACH OCCURRENCE $1 MILLION FIRE DAMAGE (Any one fire) $ 50,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS it�P+Ct%�'i1 .. ti DATE11 k�e�i,�.' v� �� MED EXP (Any one person) $ 5,000 COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO , - r V •- - AUTO ONLY - EA ACCIDEN $ OTHER THAN AUTO ONLY: EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH ACCIDEN $ AGGREGAT EACH OCCURRENCE $ $ AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL OFFICERS ARE: EXCL OTHER $ TORY LIMIT ER EL EACH ACCIDENT $ EL DISEASE - POLICY LIMI $ EL DISEASE - EA EMPLOYE S MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED. MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN RISK MANAGEMENT 1100 SIMONTON STREET KEY WEST, FL 33040 FAX: 305-289-6336 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOI EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 1_ DAYS WRITTEN TICE TO THE CERTIFICATE HOLDER NAMED TO THE BUT RE TO MAIL SU H NOTICE SHALL IMPOf NO OBLIGATION OR LIAI OF ANY KIND UPON T C ANY, ITS A NTS OR REPRESENTATI FHORI PRESENTATIVE cc, GEICO GENERAL INSURANCE COMPANY Certificate of Insurance o P.O. BOX 33040 o Lakeland, FL 33807-3040 0 Named Insured and Address: ROY R KHANNA AND DEBRA L KHANNA 1033 VALENCIA RD ti KEY LARGO FL 33037-4678 a Name and Address: REGEIUED APR 2 7 2006 MONROF COUNTY Date of Certificate: 01-15-06 Policy Number: 0452-55-09-08 Policy Period:03-09-06 to 09-09-06 (12:01 A.M. Standard Time) (12:01 A.M. Standard Time) MONROE CO BOARD OF CO COMM f PO BOX 1026 KEY WEST FL 33041 l 4—37"1-L_._ _ .. � During the term of coverages provided, the, Company and the insured shall be bound by the provisions of the policy (or policies) of insurance in Mim current use by the Company in the state. This is to certify that the captioned policy includes the limits specified herein for each person and for each occurence under the Bodily Injury Liability Coverage; the limits specified herein for each occurrence under the Property Damage Liability Coverage; and limits specified herein for each person and for each occurrence for Bodily Injury under the Uninsured Motorists Coverage. Description of Vehicle: 88 FORD 1FDKF37M2JNA69080 Description of Vehicle: COVERAGE LIMITS OF COVERAGE Bodily Injury Liability Property Damage Liability Uninsured Motorists (Bodily Injury) $ 10 M and $ 20 M (Each Person) (Each Occurrence) $ 25M (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) INTERESTED PARTY LIMITS OF COVERAGE $ M and $ M (Each Person) (Each Occurrence) (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) We agree to provide you with written notice of termination in the event this policy becomes cancelled. Notice provided may be more than ten (10) days, but not less than ten (10) days. C CD , � U99 (5-87) Agency Auto" P.O. BOX 1802 ALPHARETTA, GA 30023 AIG 2896514 ADDITIONAL INSURED COPY COMMERCIAL VEHICLE POLICY NEW DECLARATION * * * * * * EFFECTIVE 04/0 04/03/06 ROY KHANNA 3117 CAROL AVE PALM SPRINGS, FL AIGCVDEC 1204 FED EtV'ED 6 Lu JV r'u LI'V MONROE COUNTY RISK MANAGEMENT 04/03/07 1 NEW HAMPSHIRE INDEMNITY CO lo9oo986 JOHNSON & MILLER INS 1225 NO MILITARY TRAIL #2 WEST PALM BCH, FL 33461 33409 YOUR COVERAGE BEGAN ON 04/03/06 AT THE LATER OF 12:01 AM OR THE EFFECTIVE TIME SHOWN ON YOUR APPLICATION. THIS POLICY PERIOD ENDS ON 04/03/07 AT 12:01 AM. Form of Business Individual/Sole Proprietorship Vehicles Covered Unit St Ter Yr Make -Description Serial Number Radius BT/UC Stated Amount 001 FL 096 96 INTE RNATIONAL CC 1HTSLAAM6TH274156 100 K32 $10,000 Coverages Limit of Insurance Full -Term Premium Bodily Injury Liability(BI) $100,000 PER PERSON 300,000 PER ACCIDENT $353.00 Property Damage Liability(PD) Personal 100,000 PER ACCIDENT SS 02.00 N9.00 Injuryy Protection(PIP) NAMED INSURED r; RESIDENT RELATIVE Comprehensive(CMP) SEE VEHICLE SCHEDULE FOR DEDUCTIBLE FOR EACH COVERED AUTO $74.00 Collision(COL) SEE VEHICLE SCHEDULE FOR DEDUCTIBLE FOR EACH COVERED AUTO $179.00 Total Term Premium $967.00 Liability Premium by Vehicle Unit BI PD PIP 001 $353.00 $302.00 $59.00 CONTINUED ON NEXT PAGE R3P C09 2 1 1-0 AIGCVDEC 1204 � Agency Autos" P.O. Box 1802 ADDITIONAL INSURED COPY ALPHARETTA, GA 30023 NEW DECLARATION * * * * * * EFFECTIVE 04/03/06 CAFL07 08/04* ALL TERDSC 10/04* ALL CAFL02 10/05* 001 CAFL11 08/04* 001 CA2304 10/01* 001 CA2305 12/933* 001 CA9927 ol/87* 001 CA2210 07/M 001 ADDITIONAL INSURED FOR UNIT #000 MONROE COUNTY BOARD OF COUNTY 1100 SIMONTON CA0001 10/01* 001 CAOIC 08/04* 001 CA2018 12/93* 001 CA202 05/94* 001 IL0021 07/02* 001 CACW05 01/04* 001 ADDITIONAL INSURED FOR UNIT #000 CITY OF BOYNTON BEACH 100 E BOYNTON BEACH BLVD KEY WEST FL 33040 BOYNTON BEACH FL GARAGE LOCATION FOR UNIT #001 33425 33037 POLICY PERIOD 12:01 AM PREMIUM THIS TRANSACTION......... $1,042.00 JOHNSON & MILLER INS 04/05/06 -------------------------------------- AUTHORIZED REPRESENTATIVE DATE R7P C09 4 1 I=0 JOHNSON & MILLER INS 1225 NO MILITARY TRAIL #2 WEST PALM BCH, FL 33409 AIG 2896514 R3P C09 7 1 I=0 #BWNFGHF #28965143# MONROE COUNTY BOARD OF COUNTY 1100 SIMONTON KEY WEST FL 33040-3110 ADDITIONAL INSURED GEICO GENERAL INSURANCE COMPANY P.O. BOX 33040 Lakeland, FL 33807-3040 Named Insured and Address: ROY R KHANNA AND DEBRI L KHANNA 1033 VALENCIA RD KEY LARGO FL 33037-4678 Name and Address: Certificate of Insurance C� 0 IFE K l.1'. LD JUL 2 6 P4)rdRpE C00PlTY MONROE CO BOARD OF CO COMMISSI PO BOX 1026 KEY WEST FL 33041 Date of Certificate: 07-17-06 Policy Number: 0452-55-09-08 Policy Period:09-09-06 to 03-09-07 1:01 A.M. Standard Time)(12:01 A.M. Standard Time) U t 1 .& U 7,4� -0i During the term of coverages provided, the Company and the insured shall be bound by the provisions of the policy (or policies) of insurance in current use by the Company in the state. This is to certify that the captioned policy includes the limits specified herein for each person and for each occurence under the Bodily injury Liability Goverage; the limits specified herein for each occurrence under the Property Damage Liability Govemge; and limits specified herein for each person and for each occurrence for Bodily Injury under the Uninsured Motorists Coverage. r Description of Vehicle: 88 FORD 1FDKF37M2JNA69080 Description of Vehicle: COVERAGE LIMITS OF COVERAGE Bodily Injury Liability Property Damage Liability Uninsured Motorists (Bodily Injury) $ 10 M and $ 20 M (Each Person) (Each Occurrence) $ 25M (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) INTERESTED PARTY LIMITS OF COVERAGE $ M and $ M (Each Person) (Each Occurrence) (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) We agree to provide you with written notice of termination in the event this policy becomes cancelled. Notice provided may be more the ter1(10) days, but not less than ten (10) days. Gc: � -L U99 (5-87) ACORDM hlFi �4 !�� I } f I! It,I OATS IMM/200 $vr [ !!1! R RI!f.i I tGI}f S 12/18/ PRODUCER 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 JOHNSON & MILLER INSURANCE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1225 N MILITARY TRAIL #2 COMPANIES AFFORDING COVERAGE WEST PALM BEACH, FL 33409 COMPANY 56:3r640-4333 A HERMITAGE INSURANCE CO. INSURED COMPANY ROY KHANNA B COMPANY 3117 CAROL AVE C PALM SPRINGS, FL 33461 (561)641-2360 COMPANY D m MU THI IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IND (CATED, 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 LTR TYPE OF INSURANCE �y POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MM/DD/YY) DATE IMM/DD/YY) LGEN'cRALLIABILITY GENERAL AGGREGATE $1 MILLION COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGO $EXCLUDED PERSONAL& ADV INJURY $1 MILLION CLAIMS MADE C]OCCUR A.:t OWNER'S& CONTRACTOR'S PROT #HGL448978-06 12/01/06 12/01/07 EACH OCCURRENCE $1 MILLION FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 5,000 TOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per BODILY $ PROPERTY DAMAGE $ -,RAGE LIABILITY - -- "� "" EA ACCIDENT $ ANY AUTO (JI ,�I� ~ / OTHERAUTO THAN OTHER THAN AUTO ONLY p EACH ACCIDENT I —- $ AGGREGATE $ -E%CESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ ., OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND WCSTATU- TORV LIMITS OER ), "5'+fi djv :' EMPLOYERS' LIABILITY :t. ' EL EACH ACCIDENT PROPRIETOR' $ EL DISEASE -POLICY LIMIT $ INCL _AR PAR RINERS/E%ECUTIVE -OFFICERS ARE. EXCL EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLE$.SPECIAL ITEMS MONROE COUNTY BOARD Or' COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED. �e� ,.:: A I fv�.rnr:? ,: I' I' ''! . a'• 77A �q 5 .. i t Iti a i% r 7 r 1 I hI a Iat :7 lrv,, Nu _. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY BOARD OF COUNTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL -- COMMISSIONERS 1,Q—DAYS WRITTEN NOTICE TO THE CERTIFICATEHOLDER NAMEDTO THE LEFT, ATTN RISK MANAGEMENT T FAI RETO MAIL $ CH NOTICE SHALL IMPOSE NO OBLIGATIONOR LIABILITY 1100 SIMONTON STREET OF KIND UPON 11HE 960PANY. ITS AG6TS OR REPRESENTATIVES. KEY WEST, FL 33040 1 AUTHOMFAREPREgENTAn "ak FAX 305 289 6336 :.: L la. t ..?`a„i�;:.; '96t(161A,L". tll.Sa. fa 5.. .i ".!�ih`d.tr'; ...... iB%RWtiN" iBYti:! :"II'? II nlRhTe+7film,t>li'iL.11itw:RNYyygga;: s 4 1 jV Agency Autdm P.O. BOX 1802 ALPHARETTA. GA 3CC2.3 CERTIFICATE OF COMPANY NAME-. NEW HAMPSHIRE INDEMNITY CUSTOM:ERSERVICE REP SAIMA.ALUUNDERWRITER INSURFD ROY KIiANNA 3117CAR0I.AVF. PAL.V SI'RIN(iS, Fl, 33461 AGFNCY NUMBER. 0900986 AGF"NCY'. JOHNSON & MILI.ER INSURNACE 1225 NO MTLI"I'ARY TRAIT. H2 WEST PALM BEACH, FI, 33409 CERTTFICA'FE HOLDER- MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SLMONTON STREET KEY WEST, Fl. 33040 RECEIVED FEB 16 2007 MONROE COUNTY RISK MANAGEMENT POLICY NTJ:MBER A.1(328955 14 POLICY PERIOD. C4/03,1200 TO 04A032007 Cc,�e CC4y1�.1dLQ t:l1�v.. TNIS DOCUI✓ TNT CERTIFIES THAT INSURANCE POLICIES IDENTIFIED BELOW LiAVE BEEN ISSIJFD BY ME DLSI(rNATFD INSURER TO ITIE INSURED NAMED ABOVE FOR THE PERIOD(S) INDICATED. THIS CTRTTFICATE. IS ISSUED FOR WFORMAT:ION PIJRPOSES ONLY. IT CONVEYS NO RIGHTS UPON THE, CERTIFICATE HOLDER AND DOFS NOT CHAN(iE, ^^ IATR, MODIFY', OR EXTEND THE COVERAGES AFFORDED BY THE POLICIES LISTi E) BELOW. I'Iili. (:OVEItACFS AFTORDED BY THF. POLICIES USIFI) BELOW ARE SIJB..ECT TO ALL THE TERMS, EXCLUSIONS, LP✓T'fAl'IONS. FM)ORSE\IFNIS AND CONDITIONS OF IIF, SF POLICIES. NSIIRANCF COVF.RACE(S): LIMITS. BODILYINJURY I00-300 PROPERTY DAMAC.F INCLUDED WITH BODIL Y INJURY 100 PIP INCLUDED HIRED AUTO BI NONE HIRED AUTO PD NONE NON -OWNED AM 0 131 NONE NON -OWNED AUTO PD NONE CON4P AND C011, DEDIJCFIABLES 500/500 DES<1RIPIIUN Oh I O( %1'lTONM."'HICLFS/SFECIAI. EC)UIPMF�II': 1 96 INTF RNA TIONA1. CC 1HTSLAAM6TH2741% NAMED ADDIITONAL ]NSLII2ED _ __ ____. MONROE COUNTY BOARD OF COUNTY COMMISSIONERS l 100 SIMONTON STREET KEY WEST, Fl, 33040 CERTIFICATE NLJMBFIZ (IE A.PPLICABLF): CANCELLATION PLEASE BE ADVISED THAT THE CERTIFICATE HOLDER WILL NOT BE NOTIFIED IN TFIL' EVENT THE POLICY TS CANCELLED MID TERM X 9_rl� 1,��lSOC`CL AUTHORIZED REPF SF.,NTAITVE P\I PM4M 1141C ,� LL C Agency Autd' P.O. BOX 1802 ALPHARETTA, GA. 30023 CERTIFICATE OF INSURANCE COMPANY NAME: NEW HAMPSHI RE INDEMNITY CUSTO NIEP. SERVICE REP: SAIMA. ALI/UNDERWRITER INSURED: ROY KBANNA 3117 CAROL AVE PALM SPRINGS, FL 33461 AGENCY NUMBER: 0900986 AGENCY: JOHNSON & MILLER INSURNNCE 1225 NO MILITARY TRAIL #2 WEST PAL:LI BEACH, FL 33409 FAX-: 5616400514 CERTIFICATE HOLDER: MONROE CO[ T]-fY BOARD OF COUNTY COMMISSIONERS 1100 SMIONTON STREET KEY WEST. FL 33G40 FEB 2 0 ;p07 ICY POLICY NUMBER: AIG 2896514 POLICY PERIOD: 04103/206 TO 04/03; 2007 vo &-ZUL�L add -off THIS DOCUMENT CERTIFIES THAT INSURANCE POLICIES IDENTIFIED BELOW HAVE BEEN ISSUED BY THE DESIGNATED INSURER TO THE INSURED NAMED ABOVE FOR THE PERIOD(S) INDICATED. THIS CERTIFICATE IS ISSUED FOR INFORMATION PURPOSES ONLY. IT CONVEYS NO RIGHTS UPON THE CERTIFICATE HOLDER AND DOES NOT CHANGE, ALTER, MODIFY, OR EXTEND THIS COVERAGES AFFORDED BY THE POLICIES LISTED BELOW. THE COVERAGES AFFORDED BY THE POLICIES LISTED BELOW ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS, LIMITATIONS, ENDORSEMENTS AND CONDITIONS OF THESE POLICIES. INSURANCE COVF'.RAGE(SI: BODILY INJURY PROPERTY DAMAGE PIP HIRED AUTO BI HIRED AUTO PD NON -OWNED AUTO BI NON-017vNED AUTO PD COMP AND COLL DEDUCTIABLES LIMITS: 100-300 INCLUDED WITH BODILY INJURY 100 INCLUDED NONE NONE NONE NONE 5001500 DESCRIPTION OF LOCA'IIONNERICLES/SPE:CIA EQUIPMENT: 1 96 INTE RNATIONAL CC 1HTSLAAM6111274156 NAMED ADDI170N AL INSURED: MONROE COLN.Y BOARD OF COUNTY COMMISSIONERS 1100 SINIONLON STREET KEY WEST, FL 33G40 CERTIFICATE NUMBER (IFAPPLICABLE): CANCELLATION: PLEASE BE ADVISED THAT THE CERTIFICATE HOLDER WILL NOT BE NOTIFIED IN THE EVENT THE POLICY IS CANCELLED IV1ID TERM. X AUT&ORI/_ED REPRESENTATIVE CV CNf 00 040 Page I of 2 r L AF' GEICO GENERAL INSURANCE COMPANY Certificate of Insurance P.O. BOX 33040 Lakeland, FL 33807-3040 , i Named Insured and Address: JUL 3 0 2007 ROY R KHANNA AND DEBRA L KHANNA-- 1033 VALENCIA RD - KEY LARGO FL 33037-4678 D ate of Certificate: 07-25-07 P . c:y Number: 0452-55-09-08 Policy Period:09-09-07 to 03-09-08 (12:01 A.M. Standard Time)(12:01 A.M. Standard Time) Name and Address: MONROE CO BOARD OF CO COMMISSI PO BOX 1026. KEY WEST FL 33041 Wu s� During the term of coverages provided, the Company and the insured shall be bound by the provisions of the policy (or policies) of insurance in current use by the Company in the state. This is to certify that the captioned policy includes the limits specified herein for each person and for each occurence under the Bodily Injury Liability Coverage; the limits specified herein for each occurrence under the Property Damage Liability Coverage; and limits specified herein for each person and for each occurrence for Bodily Injury under the Uninsured Motorists Coverage. m Description of Vehicle: 88 FORD 1FDKF37M2fNA69080 Description of Vehicle: COVERAGE LIMITS OF COVERAGE Bodily Injury Liability Property Damage Liability Uninsured Motorists (Bodily Injury) $ 10 M and $ 20 M (Each Person) (Each Occurrence) $ 25M (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) INTERESTED PARTY LIMITS OF COVERAGE $ M and $ M (Each Person) (Each Occurrence) (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) We agree to provide you with written notice of termination in the event this policy becomes cancelled. Notice provided may be more than ten (10) days, but not less than ten (10) days. U99 (5-87) T rp 2rra GEICO GENERAL INSURANCE COMPANY Certificate of Insurance P.O. BOX 9105 Macon, GA 31208-9105 Named Insured and Address ROY R KHANNA AND DEBRA L KHANNA 1033 VALENCIA RD KEY LARGO EL 33037-4678 Date of Certificate: 01-23-08 Policy Number:0452-55-09-08 Policy Period:03-09-08 to 09-09-08 (12:01 A.M. Local Time) (12:01 A.M.l.oral'mov) Name and Address: MONROE CO BOARD OF CO COMMISSI PO BOX 1026 KEY WEST FL 33041!1 \(/ (This Certificate of Insurance does not amend, extend, or alter the coverage afforded by this policy.) Drying the lerm of coverages provided. We Company and the insured shall be bound by the provisions of the policy (or policies) of insurance in current use by the Company in the state. This is to certify that the captioned policy includes the limits specified herein for each person and for each nccmrence under the Bodily Injury Liability Coverage; the limits ,specified herein for each occurrence under the Property Damage Liability Coverage; and limits specified herein for each person and for each occurrence Jar Bodily Injury under the Uninsured Motorists Coverage. Description of Vehicle: 88 FORD 1FDKF37M2JNA69080 Description of Vehicle: COVERAGE LIMITS OF COVERAGE Bodily Injury Liability Property Damage Liability Uninsured Motorists (Bodily Injury) $ 10 M and $ 20 M (Each Person) (P:ach Occurrence) $25M (Bach Occurrence) $ M and $ M (Each Person) (Each Occurrence) INTERESTED PARTY LIMITS OF COVERAGE $ M and $ M (Each Person) (Each Occurrence) (Each Occurrence) $ M and $ M (Bach Person) (Each Occurrence) We agree to provide you with written notice of termination in the event this policy becomes cancelled. Notice provided may be more than ten (10) days, but not less than ten (10) days. u99 (V7) CG � . ACORP 4'11' I. r'IBI�'�IYSRIY}il DATE(MeuDOml PRODUCER 12/07/2007 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JOHNSON & MILLER INSURANCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST N MILITARY TRAIL #2 __---'--"CO WEST PALM BEACH, FL 33409 PANIES AFFORDING COVERAGE 561-640-4333 R� INSURED —IiERIJITA E INSURANCE CO. ' ROY KHANNA COMPANY I PANY � DEC B.. 3117 CAROL AVE COMPANY c PALM SPRINGS, FL 33461 WIN (561)641 2360 "' T 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. T LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MMIDD/YY) DATE(MMIDD/YY) LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $1 MILLION PRODUCTS - COMP/OPAGG $EXCLUDED CLAIMS MADE1:1 OCCUR PERSONAL B ADV INJURY $W MILLION A OWNERS& CONTRACTORS PROT #HGL448978-07 12/01/07 12/01/08 EACH OCCURRENCE $1 MILLION FIRE DAMAGE (Anyone tire) $ 50,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY AF/AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS (Per BODILYINJURY .nl) nB S NON -OWNED AUTOS %1(� \J I 1Ypt1 PROPERTY DAMAGE $ -, i GARAGE LIABILITY ANYAUTO AUTO ONLY - EA ACCIDENT g OTHER THAN AUTO ONLY ` - _.. _.... EACH ACCIDENT S AGGREGATE EACH OCCURRENCE $ $ EXCESS LIABILITY UMBRELLA FORM IJf1 --- $ OTHER THAN UMBRELLA FORM � IAGGREGATE WORKERS COMPENSATION AND WC OTHEMPLOYERS'LIABILITY TORY LIMITS '. THE PROPRIETOR/ INCL EL EACH ACCIDENT $ PARTNERS/EXECUTIVE : OFFICERS AREEXCL EL DISEASE -POUCV LIMIT $ OTHER EL DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED. 777777 , E I I.y u NCLA716N _ , .. MONROE COUNTY BOARD OF COUNTY THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE COMMISSIONERS TE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TOMAIL RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ATTN RISK MANAGEMENT TO THE LEFT, 1100 SIMONTON STREET 4THEF O MAIL SUC NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY KEY WEST, FL 33040 UPON THE C ANY, ITS NITS OR REPRESENTATIVES. 305 SENT IVE (FAX: 289-6336 � 7 APO jq! :.(�/ ry"' uwf r4n J`JA9. >.:I CEICO GENERAL INSURANCE COMPANY P.O. 60X 9105 Macon, GA 31208-9105 Named insured and Address: ROY R KHANNA AND DEBRA L KHANNA 1033 VALENCIA RD KEY LARGO FL 33037-4678 Certificate of Insurance k` AUG 1 �[1CNi(OE COUNTY P1 Name and Address: MONROE' CO BOARD OF CO COMMISSI PO BOX 1026 KEY WEST FL 33041 ;u lxlY� Certificate: 0 7-2 7-08 Number: 045 2-5 5-09-08 Period:09-09-08 to 03-09-09 A.M. Local Time) (12:01 A.M. Local Time) Nsfi+ S4� r (This Certificate of Insurance does not amend, eor alter the coverage afforded by this policy.) Oaring the term of coverages provided, the Company and the insured shall be bound by the provisions of the policy (or policies) of insurance in current use by the. Company in the stale. This is to certify that the captioned policy includes the limits specified herein for each person and for each occurrence under the Bodily Injury Liability Coverage; the limits specified herein for each occurrence under the Property Damage Liability Coverage; and limits specified herein for each person and for each occurrence for Bodily Injury undei the Uninsured Motorists Coverage. Description of Vehicle: 88 FORD 1FDKF37M2JNA69080 Description of Vehicle: COVERAGE LIMITS OF COVERAGE Bodily Injury Liability $ 10 M and $ 20 M (Each Person) (Each Occurrence) Property Damage Liability $25M (Each Occurrence) Uninsured Motorists $ M and $ M (Bodily Injury) (Each Person) (Each Occurrence) INTERESTED PARTY LIMITS OF COVERAGE $ M and $ M (Each Person) (Each Occurrence) $ (Each Occurrence) $ M and $ M (Each Person) (Each Occurrence) We agree to provide you with written notice of termination in the event this policy becomes cancelled. Notice provided may be more than ten (10) days, but not less than ten (10) days. 1399 (9-07V ..{ gC�/ ORItD� FdIt IMMOI li• , vkir(Ilti DATEoYY) PRODUCER 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 JOHNSON & MILLER INSURANCE ------ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1225 N MILITARY TRAIL #2-ll (. COMPANIES AFFORDING COVERAGE COMPANY WEST PALM BEACH, FL 33409 - 561-640-4333 A IJERMTAGE INSURANCE CO. INSURED (�[n U Ll' 9 COMPANY , I ROY KHANNA 9 3117 CAROI, AVE "c PALM SPRINGS, FL 33461 COMPANY (561)641-2360 D VVdd IT i. e I 'I9: I i 1 ?, ,t+.,_{, t,. 1, t nv. + t I � 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MMIOD/YYI DATE(MIMD/YY) GENERAL LIABILITY GENERAL AGGREGATE S1 MILLION X PRODUCTS - COMP/OPAGO EEXCLUDED COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑OCCUR PERSONAL SADVINJURY E1 MILLION A OWNER'S$ CONTRACTOR'SPROT #HGL532267-08 12/01/08 12/01/09 EACH OCCURRENCE E1 MILLION FIRE DAMAGE (Any one lire) E 5o, 0oo MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY ALL OWNED AUTOS SCHEDULEDAUTOS (Per person) $ BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per awtlenU PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT E ANV AUTO OTHER THAN AUTO ONLY: 9 b EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE E ACCREGATE E UMBRELLA FORM S OTHER THAN UMBRELLA FORM Vo WORKERS COMPENSATION AND WC STATU- OTH TORY LIMITS ER Iq + p�en d Ipy - v t �+Xi EMPLOYERS' LIABILITY EL EACH ACCIDENT E THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE - POLICY LIMIT E EL DISEASE -EA EMPLOYEE E OFFICERSARE. EXCL OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED. �✓I � CC : Ce� I{I, AWMI 511 X: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY BOARD OF COUNTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL COMMISSIONERS '10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATTN RISK MANAGEMENT BUT FM E TO MAIL SUCH OTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1100 SIMONTON STREET OF NY NO UP THE CO Y, ITS AGENTS OR REPRESENTATIVES. KEY WEST, FL 33040 AUTHORIZE ESEN TIVE 305-289 633G II _ . 1 5 ..'.'i:} ,... i, f .I�..,.il,!. ......... ....,.. ..x..v... ........ .... , ....., ., ., .. ... ... ....♦ '2 .... .. :.�}'..... ............a......... ................ t .A ., \?♦:a,...t♦,•a?,2i.v,+.:v. $ .. >i:• `v,^ �• ] ... ... .. ....n..,.. 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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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMMERCIAL GENERAL LIABILITY PERSONAL & ADV INJURY $ CLAIMS MADE[j] OCCUR EACH OCCURRENCE $ A OWNER'S & CONTRACTOR'S PROT HGL— 5 32 2 6 7 — 0 8 12 / 01 / 0 8 12 / 01 / 0 9 FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY � $ B HIRED AUTOS FLC 93238 4 0 4 0 3 0 9 / / 4 0 3 10 / / T NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: :. >rA<.:��I< ;}}:1 ?.U{:..♦.......:.:2,::..Y:r,<X: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WC STATU- WORKERS COMPENSATION AND TORY LIMITS I I ER ?2>03€:}:;>}:,Y:„<: EMPLOYERS' LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE - POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL .._ EL DISEASE - EA EMPLOYEE $ OTHER g • DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE I.STED AS ADDITIONAL INSURED. MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN RISK MANAGEMENT 1100 SIMONTON STREET KEY WEST, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I () DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NAICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KNVD UPON THE COMPANY1 ITS AGENTS OR REPRESENTATIVES. ♦ v. v :. r ...v ..... .. .. .y. ............ .. ...�.. n{v:..G.a }...Y n.. r. ,2.. ,..vx .... .. 2.n...v,.. .. ...... h.h .}....}. G., .........n. 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THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JOHNSON &MILLER INSURANCE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE 1225 N MILITARY TRAIL #2 COMPANY WEST PALS! BEACH, FL 33409 -- A HERMITAGE INSURANCE CO. INSURED COMPANY ROY KHANNA B INTEGON NATIONAL 3117 CAROL AVE COMPANY PALM SPRINGS, FL 33461 C 561-641-2360 COMPANY D ........................................................:.::.......:..:..... : .....:..:. _ : ..x;}.:.}' , , , .+r'• ;Y .v}..,xG. ,,, ..vat. , YYr-' }.#: •. }�4�2 •. 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CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMMERCIAL GENERAL LIABILITY PERSONAL & ADV INJURY $ ££ CLAIMS MADE OCCUR . _�;� k.Yk2 . 7? EACH OCCURRENCE $ A OWNER'S & CONTRACTOR'S PROT HGL- 5 3 2 2 6 7- 0 8 12 / 0 2/ 0 9 12 / 0 2/ 10 FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ALL AWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ B NIRED AUTOS NON -OWNED AUTOS FLC 9323840 4/ 0 3/ 0 9 4/ 0 3/ 10 PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO ^ AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: Y ";n £}: _; ..£::`<?:'�:f:>.:ka:};; EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM _ $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND ,.. 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C ...a.. \ay. .. ,., .. ...vn-, G}.::a-.Y: �.v:R, ........, ............ ... .... .....0 ... .,£2t, ..t-. •: ,. �::: ,t:• v. ... ........,...s}r.-}a-..:.}}r:•v^..v�.4.}}:'.:w.r:•v., .w ..n;•.ant•:n+::-::t#:ti:•'.#::: k}::±kkr:....x ... ... n....:.. .. .., ., .X.. .n.,::.,..1.::..:t,.:...h-. t.2.k r. �, .....,>'.:....n........w...........:t..k i.n .... ..1... �r:x.,.;}:}}r}.:.:t3 NO .........:.,...... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY BOARD OF COUNTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL COMMISSIONERS I.a_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATTN RISK MANAGEMENT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1100 S IMONTON STREET OF ANY �KlUPON THE C PANY, ITS AGENTS 9A REPRESENTATIVES. AUTHORIZED ESENTATIV M P'L KEY WEST, FL 33040 F RAJ 2 .... . RAJ .................................. .. .................................. ........... 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Y3}5`:.}}}:4rn:}}}:: r:r . .. } . :...: ...............:..... �.?�: n�. •..�.�r................3.... r.. .. ................... ® ,4caRv CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/1/2010 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 JOHNSON & MILLER INSURANCE 1225 N Military Trail #2 a W Palm Beach, FL 33409 ' ' - CONTACT NAME: BRENDA JOHNSON-WEBB PHONE (561) 640. 4333 FAX A/c No E)d : - A/C, No): (5 61) 6 4 0 - 0 514 _ p Ess.� .mins@bellsouth . net JD i. a. CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC# INSURED ROY KHANNA tip 3117 CAROL AVE ° PALM SPRINGS, FL 33461 (561) 641-2360 INSURER A . I TAGE INSURANCE CO i ' 'INTEGON NATIONAL INSURER B . INSURER C INSURER o 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY MM/DD/YYYY LI Y EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_xi OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY 71 PRO LOC JECT X HGL-532267-08 12/2/0912/2/10 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTETT-- PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 110 0 0, 0 0 0 PRODUCTS - COMP/OP AGG $ 1 , 0 0 0 , 0 0 0 $ B AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X FLC 9 3 2 3 8 4 0 4/ 3/ 10 4/ 3/ 11 COMBINED SINGLE LIMIT (Ea accident) $ 110 0 0, 0 0 0 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAS OCCUR CLAIMS -MADE I EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE C� OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A �� WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ (-W61 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) MONTOE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED ` co - CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COMMISSIONERS THE EXPIRATION DATE EREOF, NOTICE WILL BE DELIVERED IN ATTN : RISK MANAGEMENT ACCORDANCE WITH THE PO ICY PROVISIONS. 1100 SIMONTON STREET KEY WEST, FL 33040 AUTHORIZED EPRESENTATIVE , i FAX: 305-289-6061 C 1988-2009 CORD CORPORATION. All rights reserved. ACORD25(2009/09) The ACORD name and logo are registered marks of AC9R 14c - CERTIFICATE OF LIABILITY INSURANCE 12/2`0/20 0' 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) the terms and conditions of the policy, certain policies may require an endorsement. certificate holder in lieu of such endorsement(s). must be endorsed. If SUBROGATION IS WAIVED, subject to A statement on this certificate does not confer rights to the DA JO SON-WEBB PRODUCER JOHNSON & MILLER INSURANCE [� 1225 N Military Trail #2 �`-, W Palm Beach, FL 33409 -� �'640 -6 4333 ac,ND:(561) 640-0514 E-MAIL ADDRESS :b7Webb johrisonmi1ler insurance. com PR DU ER -EUSTOMER ID'#P' a i INSUER(S) A : HERMI AGE ORDING COVERAGE INSURANCE CO NAIC# INSURED ROY KHANN�► �IINSURERA N N _TIONAL i 3117 CAROL AVE PALM SPRINGS, FL 33461 INSURERD: (561) 641-2360 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 CONDITIONE OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR ADDL SUBR NP LI Y E F LI Y XP LTR TYPE OF INSURANCE INSR I WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LI!(BILITY CLAIMS CI EACH OCCURO_RRENCE $ 1 , OOO , OOO PREMISES Ea occurU rrence $ 50,000 IVIED EXP (Any one person) $ 5 , 000 A -MADE OCCUR X N HGL-532267-09 112/2/1012/2/11 PERSONAL BADvINJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER X POLICY PRO- JECT LOC PRODUCTS -COMP/OP AGG $ 1,000,000 $ B AUTOMOBILE LIABILITY ANYAUTO Icy ALL OWNED AUTOS x SCHEDULED AUTOS HIRED AUTOS i X ! N ! FLC9323840 I ; 4�3�10,4/3/11 j COMBINED SINGLE LIMIT I (Ea accident) $ 1,000,000 ' NJURY Per erson) ( P $ EBBO�DILY]IINJURY(Peraccident)I $ .OPERTY DAMAGE (Per accident) $ NON -OWNED AUTOS $ j $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE N i !� LQJ, EACH OCCURRENCE $ AGGREGATE 1 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? C� andIf yes, esory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A I N — - ; ✓ A 17� 1 WC STATU- OTH- TORY LIMITS ER $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEEI $ E.L. DISEASE - POLICY LIMIT $ N � DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) IMONTOE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED I CERTIFICATE HOLDER CANCELLATION MONROE COUI4TY BOARD OF COUNTY COMMISSIONERS ATTN: RISK MANAGEMENT 1100 SIMONTON STREET KEY WEST, FL 33040 FAX: 305-289-6061 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH �HE POLICY PROVISIONS. REPRESENTA VE C 1988-20tq ACORD CORPORATION. All rights reserved. ACORD25(2009/09) The ACORD name and logo are registered marks of ACOR . cCERTIFICATE OF LIABILITY INSURANCE 12/2`0/2o0't=�T RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS FICATE 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 n A JO SON-WEBB JOHNSON & MILLER INSURANCE r( 1225 N Military Trail #2 ___ E-MAILD Xt: - _6 640 4333 A/C No:(561) 640-0514 W Palm Beach, FL 33409 PDDRESEbjwebb joh sonmillerinsurance.com R --GUSTO.CR ID11-,- INSU ER(S) A RIDING COVERAGE NAICM INSURED ROY KHANNA INSURER A HERMITAGE INSURANCE CO N N _TIOrLAL 3117 CAROL AVE ,1c"IT PALM SPRINGS, FL 33461 INSURER (561) 641-2360 INSURER E 4 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 I ADDL S—LI R P LI Y EFF P LI Y XP LTR TYPE OF INSURANCE INSR I WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY C PREMISES Ea occurrence $ 50,000 j MED EXP (Any one person) $ 5,000 A CLAIMS -MADE OCCUR I12/2/10112/2/11 PERSONAL & ADV INJURY $ 1,000,000 X N HGL-532267-09 GENERAL AGGREGATE $ 1,0001000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 1 , OOO , OOO X POLICY PRO I LOC JECT $ i AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ 1,000,000 BODILY INJ URY (Per person) $ B ALL OWNED AUTOS X SCHEDULED AUTOS X N i FLC9323840 4/3/10 4/3/11 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) (P I $ HIRED AUTOS NON -OWNED AUTOS $ I _ �b i UMBRELLA LIAB OCCUR EACH OCCURRENCE $ F1 EXCESS LIAB CLAIMS -MADE N AGGREGATE Is $ DEDUCTIBLE I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN , WC STATU- OTH- TORY LIMITS ER'� E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBH) EXCLUDED? IIN/A (Mantlatory in NH)-- N E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below IE.L. -y N i I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) MONTOE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED Ilef-I LF_ CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN: RISK MANAGEMENT 1100 SIMONTON STREET KEY WEST, FL 33040 FAX: 305-289-6061 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH �E POLICY PROVISIONS. AUTHORI REPRESENTA VE C 1988-21101 ACORD CORPORATION. All rights reserved. ACORD25(2009/09) The ACORD name and logo are registered marks of ACOR A"' DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/08/11 r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGP E COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES OT CONSj P ffWCT BE EN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERT ICATE Hdd �!+� IMPORTANT: If the certificate holder is an ADDITIONAL INS ED, the policy(ies) must be endorsed. If S ROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may r uire an endorsement. A state ant SIR rtificate does not confer rights to the certificate holder in lieu of such endorsement(s). P 1 3 20111 PRODUCER CONTACT BREN JOHNSON-WEBB PO Box 128Johnson & 9i11er Insurance iNiONRO� PHONE (561)6 333 FAX 561 640-0514 —bjwebb johnsonmillennsurance comA/c No ( _) - Loxahatchee, FL 33470 RISK MAC I INSURE ) AFFORDING COVERAGE - - NAIC # Phone (561)640-4333 Fax (561)640_0514 - - -- INSURERA: HERMITAGE INSURANCE CO INSURED - -- INSURER B : INTEGON NATIONAL Roy Khanna INSURER C : 3117 Carol Ave INSURER D : Palm Springs, FL 33461 (561) 641-2360 wsuRER 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. •V` ^VV VVy^ LTR TYPE OF INSURANCE POLICY NUMBER - _ (MM�WYYYYt (MMIDD/YYYY LIMITS GENERAL LIABILITY EACH _ . $ 1,000,000.00 DAMAGE TO RENTED �i COMMERCIAL GENERAL LIABILITY Y 12/02/2010 PREMISES (Ea occurrenceZ ,_ _$5OOOO.00 J OCCUR _ ❑ CLAIMS MADE A �, HGL-532267-09 MED EXP (Any one person) $ 5,000.00 12/02/2011 — - - - - j PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 1 GEN'L AGGREGATE LIMIT APPLIES PER. - 1 I 000,000.00 J PRODUCTS - COMP/OP AG� $ 1 000,000.00 !NJ POLICY I__- LOC -- $ - - - j--- -------- - - -- - --� -- -- 1,000,000.00 -- -i AUTOMOBILE LIABILITY -- — -- COMBINED SINGLE LIMB r _I 7 Ea accidents $- - _ _I ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED FLC9323840 ` - - -- I AUTOS L1 AUTOS Y 04/03/2011 04/03/2012 BODILY INJURY (Per accident) $ ---i NON -OWNED 1 PROPERTY DAMAGE HIRED AUTOS C_J AUTOS (Per accident) $ C _ �_ — -- $ I t �-UMBRELLA LIAB I � _ _-------- I �- --_ - ---- � - � f EACH OCCURRENCE $ OCCUR �L EXCESS L RETENTION AGGREGATE TAB --- - r- -- --��� - -- 1 — $ WORKERS COMPENSATION - -� __ ____.---------------- - -----. _ _ -� ._.__ WC STATU DED _ - OTH — - - - AND EMPLOYERS' LIABILITY Y / N I TORY LIMITS !- ER ANY PROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? -, , N ! A I - -' (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If es, describe under `� I -DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT] $ F! _ --- -- -=-----------------� ---- - i -- L_ DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schad 1e f more space is required) 9� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: RISK MANAGEMENT ACCOR CE WITH THE P LICY PROVISIONS. 1100 SIMONTON STREET -- ------ -- - ----- - - -- - AUTHORIZED RESENTAT E KEY WEST, FL 33040 FAX: 305-289-6061 ©198 010 ORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The A ORD na a and logo are registered marks of ACORD A D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/08/11 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 Johnson 8 Miller Insurance � PO Box 1289 NAME: BRENDAJOHNSON-WEBB P GNH E No (561)640-4333 FAX : (561)640-0514 ,vc x 'ADDRESS• bjwebb@johnsonmillerinsurance.com Loxahatchee, FL 33470 INSURERS) AFFORDING COVERAGE NAIC # INSURERA: WILSHIRE INSURANCE CO. Phone (561)640-4333 Fax (561)640-0514 INSURED INSURER B : INTEGON NATIONAL INSURER C : Roy Khanna 3117 Carol Ave INSURER D : Palm Springs, FL 33461 (561) 641-2360 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. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MM/DDY/YYYY EFF MM/DD/YYW LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY n CLAIMS -MADE ❑ OCCUR ❑ Y LB00128026 12l09/2011 12/09/2012 EACH OCCURRENCE $ 100,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence $ 1 OO,000.00 MED EXP (Any one person) $ 0.00 PERSONAL 8 ADV INJURY $ 100,000.00 i ❑ GENERAL AGGREGATE s 2,000,000.00 PRODUCTS - COMP/OP AGG $ 0.00 j — GEN'L AGGREGATE LIMIT APPLIES PER: © POLICY [-IPRO-❑ LOC JECT - - - -'- - --- $ --- AUTOMOBILE LIABILITY CE acc dEentSINGLE LIMIT 1,000,000.00 BODILY INJURY (Per person) $ B ❑ ANY AUTO ALL OWNED 0 SCHEDULED ❑ AUTOSAUTOS ❑ NON -OWNED HIRED AUTOS ❑ AUTOSp El Y FLC9323840 BY RISK MAMA 04/03/2011 04/03/2012 BODILY INJURY (Per accident $ PROERDAMAGE $ $ EACH OCCURRENCE $ ❑ UMBRELLA LIAB ❑ OCCUR b ZEW y5_ ❑ EXCESS LIAR ❑ CLAIMS -MADE AGGREGATE $ ❑ DED ❑ RETENTION $ , `� $ ATU-OTH- WORKERS COMPENSATION �r ' fl ❑ TO Y LIMIT ❑ ER AND EMPLOYERS' LIABILITY Y / N W • W ANY PROPRIETOR/PARTNER/EXECUT ❑ N / A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If es, describe under _ — E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I i _ �— space is required) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLESy(Attach ACORD 101, Additional Remarks Schedule, if more it i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCOR NCE WITH TH POLICY P VISIONS. ATTN: RISK MANAGEMENT AUTHOR ED EPRESENTATIVE 1100 SIMONTON STREET KEY WEST, FL 33040 FAX: 305-289-6061 f(//✓ V tftf-ZDl AI+VKU I,VRr'VRArIVrv. r�u nynw rcaw vca. ACORD 25 (2010/05) OF Th ACORD ame and logo are registered marks of ACORD I DATE(MMIDGMYY) ACOR& CERTIFICATE OF LIABILITY INSURANCE 08/09/12 THIS CERTIFICATE it ISSUED AS A MATTER 60 INFORMATION ONLY AND . CQ . CONFERS . FIRS NO I RIGHTS UPON THE CER_TIFICAT9*i4dC1DF - fl�iS 1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TH13 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE MOLDER. IMPORTANT; If the c•rUflwte holder Is an ADDI N_,AL WSU'R"E"11D, the policy(4s) must be endorsed. if SUBROGATION IS WAIVED, Subject to the arm and conditions of the WIcY, certain POlicia's may require an endorsament. A statement on this certificato does not confer rights to th* certificate howr in lieu of such endorsomw(s). BRENDA JOHNSON-WEBB Johnsonim- Lq PHONE Kill- --- - --- (561 L rN & Miller insurance )640-4333 AOC•Nol:__ L561)!�!9-0614 I W . .1140101. m0winsurarre.com PO Box 1289 Loxahatchee, FL 33470 FOROI"COVERAGE "IC 0 ,Phone (:p 1!!0-4333 Fax (661)640-0514 INSURER A! WILSHIRE INSURANCE CO, INSURED INFINITY . ..... Roy Khanna -INSURER C jWRE 1�.- Palm Springs. FL 33461 (561) 641-2360 A_ _ ___ -.1 .1 _____.J INSURER F ; I 3117 Carol Ave INSURER 0: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 WAY 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 PAN) CLAIMS, TR O"NSU POLICY NUMBER "Py"Y")L POUCYEXP LIMITS INSURANCE YY GENERAL LIMS."Y _WE S 100,000 EACH OCCURRENCE RE ...'000.00 gNTED AMAGE gfiRRIE 100.000.00 COMMERCIAL GENERAL LMILITY L-P Is's 1. ...... CLAIMS -MADE OCCUR I A Y ILSOW28026 ME0 EXP (Anyj" �Sfqn)__ S OLGO 12/09/2011 12/OW01 2 PERSONAL A ADV INJURY 2 100,000-00 2,000,000.00 GEWL AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGr, 1; 0.00 POLICY LJ LOC S AUTOMOBILE LL4lk9lLrry ,intmasi;&i UwT ANY AUTO ALL OWNED SCIIEDULED 509 80000-6780-001 J AUTOS AUTOS Y I 04/0312012 04/03/2013 HIRED AUTOS A'UT"O'S"60 LIAR❑ LJ OCCUR UMBRELLA EXCESS kp Gam LIAB D ci.Awwor. 03Y F I nfQ 1* 1 RQTflSTIQN; WORKER OOMrEN3ATION Tcw-- 5 AND 6UPLOYERV LIABILITY vim ANY PROPRIETORIPARTNERIEXECUTIVE UIE/V ILI OFFICGRAGMSER EXCLUDED? 11A, tll� I!NH) BODILY INJURY (Per padln) BODILY INJURY (Per aocloantJ 6 IC STATU- EASE ESCRIPTION Or OPERATIONS I LOCATIONS I VB41CLES (AIINM ACORD 101, AddhIonal Rem&A�@ Schodula, it mom apse* is raqwted) CERTIFICATE HOLDER MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN: RISK MANAGEMENT 1100 SIMONTON STREET KEY WEST, FL 33040 FAX' 305-289-6061 ACORD 25 1201010,W OF CC: CANCELLATION I ........... CA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES W CANCELLED REPOiRg THE EXPIRATION DATE THEREOF, NOTICE WILL 09 DELIVERED IN ACCORDANCE WITH THE P ICY PROVISIONS. AUTHO EPRESENTATIVE I i98W21i0140 CORD CORPORATION. All rights reserved I in C, The A;3RD and logo are reglaftred marks of ACORD • CERTIFICATE OF GARAGE INSURANCE DATE(MM/DD/YYYY) 1/14/2013 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 POLICIE 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 th certificate holder in lieu of such endorsements . PRODUCER CAPRICORN COVERAGE INC W Atlantic Ave #121 Delray Beach, FL 33484 A124072 NUUNTAUT AME: SANDRA VESSECCHIA PHONE (561) 499-3922 Ax (561) 499-3716 aC No: UVC,5180 E-MAIL ADDRESS: sandy@capricorncoverage.net INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Colony Insurance Co. INSURED Roy Khanna INSURER B : INSURER C . INSURER D : 3117 Carol Ave INSURER E Palm Springs, FL 33461 INSURER F 305-453-1646 COVERAGES PROD / CUSTOMER ID: CERTIFICATE #: REVISION #: 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 LTR TYPE OF INSURANCE INSD wvD POLICY NUMBER POLICY MM/DD/YYYY POLICY X MM/DD/YYYY LIMITS A GARAGE LIABILITY ALL OWNED HIRED AUTOS AUTOS ONLY NON -OWNED AUTOS J X GP8129690 1/9/2013 1/9/2014 AUTO ONLY (Ea accident) $ 1,000,000 OTHER THAN EA ACCIDENT $ 1,000,000 USED IN GARAGE BUSINESS Dealer Service Liab AUTO ONLY AGGREGATE $ 2,000,000 GARAGE KEEPERS LIABILITY X OMP OTC LOC $ 180,000 A X LEGAL LIABILITY DIRECT BASIS GP8129690 1/9/2013 1/9/2014 SPECIFIED LOC PERILS $ X COLLISION LOC $ 180,000 $ PRIMARY FXJ EXCESS LOC GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurrence $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY F7 PRO- 7LOC UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE i ' DED I I RETENTION $ $ on,ns c- A. -gym n ... AND EMPLOYERS' LIABILITY WC STATU- OTH-, E.L. EACH ACCIDENT _ $ ANY PROPP.IETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N N/A I E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) ❑ If yes, describe under(a��REMARKS below E.L DISEASE - POLICY LIMIT $ Q �• REMARKS (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED. CERTIFICATE HOLDER CANCFI I ATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WIL BE LIVERED IN ATTN • RISK MANAGEMENT ACCORDANCE WITH THE POLICY PROVISIONS. 1100 SIMONTON STREET AUTHORIZED REPRESENTATIVE KEY WEST, FL 33040 cz' © 2010 ACORD CORPORATION. All rights reserved. ACORD30(2010/12) The ACORD name and logo are registered marks of ACORD r ■ o -R CERTIFICATE OF LIABILITY INSURANCE TE WDDNYYY) 310213 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TINS 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 N THE WONG INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CER IMPORTANT: It the certificate holder is an ADDITI the terms and conditlons of the policy, certain pollcl certificate holder in lieu of such endorsement(s►. L INSURE s may require an endorsement be eu Astatement K SUBROGATION IS WANED, subject to In this certificate does not confer rights to the PRODUCER CAPRICORN COVERAGE INC 5180 W Atlantic Ave #121 Delray Beach, FL 33484 A124072 ,+art 20 N! MONROENSURERS) RISK MANAGEM . rah B. Howard (561) 429-2375 )499-3922 ,). (561) 499-3716 aressive e capriconrcoverage.net AFFORDING COVERAGE NAICe Express Insurance INSURED Roy R Khanna 3117 Carol Ave Halm Springs, FL 33461 305-453-1646 INSURER B: INSURER C: INSURER D: IINSURER E: 1INSURER 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. am LTR TYPE OF INSURANCE ADM MJBR POLICY NUMBER (MM/DWYY`) (XWIM LIMITS GENERAL LIABILITY EACH OCCURRENCE i COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR B pq W ( /1, + e L PREMISES (Ea occurrence) i MED EXP (Arri we Person) $ PERSONAL a ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S S PRO- POLICY n JECT LOC AUTOMOBILE LIABILITY Ea aoadenl 000 $ , BODILY INJURY (Per person) $ B ASCHEDULED ALLO TOS AUiOs AUTOS X 02121612-0 /3/2013 /3/2014 BODILY INJURY (Per accident) $ P P (Pa ) S NON -OWNED HIRED AUTOSAUTOS N $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN TRY LIMITS I ER ANY PROPRIETORIPARTNFNEXECUTIVE ❑ OFFMERIMEMBER EXCLUDED? (Mandatory In NH) NIA E.L. EACH ACCIDENT S E.L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ARech ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is listed as an additional insured. CFRTIFIRATF wni nFR CANCELLATION Monroe County Board of County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATI Key West FL 33040 C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORD del6 fAfAt royrkhanna@cs.com CERTIFICATE OF GARAGE INSURANCE DATE (MMDOPIYYY) 11912014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THUS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the conificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, 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). PRooucat Insurance Capital Management LLC 1035 S. State Road 7 NAME: Deborah B Howard A124072 P . 561-223-2199 C Na : 661-209-5581 us- OR icmlic13 ahoo.com Suite315-9 Wellington, FL 33414 INSURER(S) AFFORDING COVERAGE NAICI INSURERA: Colony Insurance Company INSURED Roy Khanna 3117 Carol Avenue Palm Springs, FL 33461 INSURER S INSURER INSURERo ERD: INSURER E INSURER F : d•AVOe AtM=Q esnn r rucrness:* in. CERTIFIQATE ee REVISION! 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. ILTR les TYPE OF INSURANCE POLICYNUMBER LIMITS A GARAGELIABILITY ALL OWNED HIRED AUTOS AUTOS ONLY NON -OWNED AUTO X GP8177220 119/2014 01109/2015 AUTOONLY(Eaaccident) S 1'000'W0' OTHER THAN EA ACCIDENT S 1,000,W0, USED IN GARAGE BUSINESS Sealer Service Llablii AUTO ONLY AGGREGATE S 000 000. GARAGE KEEPERS LIABILITY �/ pTCP LOC S 180,000. g S 190,000. A LEGAL LIABILITY ERECT BASIS GP9177220 1/0912014 0110912015 SPECIFIED LOC PFRLsCOLLISION LOC $ PRIMARY EXCESS LOC COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE 0 OCCUR A DATE B*/A EM PREMISES Ea o turrenc S MED EXP An one person) S PERSONAL L ADV INJURY S WANGENL W AGGREGATE LIMIT APPLIES PER: POLICY Q PRO- [—] LOC JE CT GENERAL AGGREGATE E PRODUCTS- COMPIOP AGG S $ OTHER UMBRELLALIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESSLIIAB CLAIMS -MADE DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY S ATUTE R E.L. EACH ACCIDENT S ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBER EXCLUOED7 YIN (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYE S E.L- DISEASE - POLICY LIMIT E Ryes, describe under REMARKS below REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Monroe County Board of County Commissioners is listed as an additional Insured as Indicated above with an ")e" PCCTInt ATC I.I1`11 nCR CANCELLATION Monroe County Board of County Commissioners SHOULD ANY 0/ THE ABOVE DESCRIBED POLICIES 91 CANCELLED BEFORE Attn: Rick Management 9 THE EXPOIATION DATE THEREOF, NOTICE wRL BE DELIVERED IN 1100 Simonton Street ACCORDANCE 1MTH THE POLICY PROVISIONS. Key West FL 33040 AUTHORIZED REPRESENTATIVE Fax 305-289-6061 Fax 305-292-4487 / Al24072 / U ZU'l U, ZU14 ACUftO GOKFORA I IOR. A11 ngnrs reservem ACORD 30 (2014101) The ACORD name and logo are registered marks of ACORD Produced using Forms Bose Web software. www.FormsSoas.corn; 0 Impressive Publishing 800-200.1977 DATE t.yNV0D1Y-YY`Y) A CERTIFICATE OF LIABILITY INSURANCE 12/20/2010 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 INSURFRIS), 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)- --- I PR(',Du('FP -I BRMA JOL44SON-WEBB JOHNSON & MILLER INSURANCE !p I I FAX T) ��1,11061),64D 4333 ;lac) (561) 640-0514 J U` q *�-- 1225 N Military Trail #2 Ut ADDRESSb�webb @ oh sonmillerinsurance.com W Palm Beach, FL 33409 0 1 DING COVERAGE NAIC# INSITRED ROY KHANNA i Sk�'RER A HERMITAGE INSURANCE CO 3117 CAROL AVE PALM SPRINGS, FL 33461 1 NSURER D (561)641-2360 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER REVISION NLJIVIt3tK 7 —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. A155suPOLICY EFF f OLI P LTit TYPE OF INSURANCE INS RC WV0 dw� POLICY NUMBER ;0?AVDDfYYYY) iMMID LIMITS GENERAL LIABILITY EACH OCCURRENCE is 1,000,000 rx COMMERCIAL GENERAL LIABILITY 50,000 1 -oww I — CLAIMS-MAOF t ^-I OCCUR i MEOIEXPtAnyono person) 15 5,000 A x N HGL-532267-09 12/2/1012/2/11� PERS( 1,000,000 1 06-0-- GENERAL AGGREGATE s ''007C 'I 1i000,0001 I GEN`L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG t—x PRO. I POLICY JECT i LOC J AUT BILE LIA131LITY t-- COMBINED SINGLE LIMIT (Ea arc4wit) I s 1,000,000 �ANYAUTO BODILY INJURY (Per wum) ;S ALL OWNED AUTOS BODILY INJURY (Per actKieritill s B X; SCHEDULED AUTOS x N :FLC9323840 4/3/10 4/3/11 PROPERTY DAMAGE HIRED AUTOS $ (Per NON-OV4NEO AUTOS iI S I I UMBRELL EACH OCCURRENCE S EXCESS I -AGGREGATE N DEDUCTIBLE ETENTION WORKERS COMPENSATION 0 TORYLIMI`!§-�--IEL AND EMPLOYERS' LIA81t ITY ANY PROPPrElOFt,4�ARtNEft,EXECUTi*A Yin INIA I N EACH ACCIDENT OFF iCF.RW.MStR EXCLUOE.D' . NMI L DISEASE - EA EMPLOYEEwS IM-6." it Y" Cosa -tie xde, DLSCRiPTICN OF OPERATIONS Cato- E L DISEASE -POLICY LIMB 3 N L ti DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (AtIacI, ACORD 101 Add&onal Remarits ScneOul# f-otv &Paco 't MONTOE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COMMISSIONERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: RISK MANAGEMENT ACCORDANCE WITH HE POLICY PROVISIONS 1100 SIMONTON STREET AUTHOR,w6i REPRESENTA V'Z E KEY WEST, FL 33040 FAX: 305-289-6061 1988.2kdb. ACCORD CORPORATION All rights reserved 'ACOR025(2009109) The ACORD name and logo are registered marks of ACOR royrkhanna@cs.com ACORO� CERTIFICATE OF GARAGE INSURANCE DATE (MMlDDIYYYY) 1/9/2014 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 Insurance Capital Management LLC 1035 S. State Road 7 CONTACT NAME: Deborah B Howard A124072 PHONE 561-223 2199 (FA No: 561-209 5581 AD No Ext ADDRESS: icmllcl3@yahoo.com INSURERS AFFORDING COVERAGE NAIC # Suite 315-9 INSURERA: Colony Insurance Company Wellington, FL 33414 INSURED Roy Khanna 3117 Carol Avenue INSURER B INSURER C Palm Springs, FL 33461 INSURER D : INSURER E INSURER F : w — rconnrnTc e• RP\/ISIr1N 8• 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 LTR OF INSURANCE ADDLTYPE INSD SUER WVD POLICY NUMBER MM DPOLID/YYYY LI MM/DDY/YYYY LIMITS A GARAGE LIABILITY ALL OWNED HI RED AUTOS AUTOOWNEDAUTOS❑ ONLY USED IN GARAGE BUSINESS Sealer Service Liability X GP8177220 1/9/2014 01/09/2015 AUTO ONLY (Ea accident) $ 1,000,000. OTHER THAN AUTO ONLY EA ACCIDENT $ 1,000,000. AGGREGATE $ 2,000,000. GARAGE KEEPERS LIABILITY / COMP / LOD V OTC $ 1$0,000. $ $ 180,000. A LEGAL LIABILITY DIRECT BASIS GP8177220 01/09/201401/09/2015 PERILISIED LOC COLLISION LOC $ PRIMARY EXCESS LOC COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE $ CLAIMS -MADE DOCCUR TO RENTE PREMISES Ea occurDrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY ❑ PRO- F—] LOC JECT $ OTHER UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/ N (Mandatory in NH) N / A E.L. DISEASE -EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under ❑ REMARKS below REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Monroe County Board of County Commissioners is listed as an additional insured as indicated above with an 'Y' l:tK I IFII.H I t HULLJtK I,HIVI,CLLH I IVIY Monroe County Board of County Commissioners Attn: Rick Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. Key West FL 33040 Fax 305-289-6061 AUTHORIZED REPRESENTATIVE A Fax 305-292-4487 A124072 © 2010, 2014 ACORD CORPORATION. All rights reserved. ACORD 30 (2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web software. www.FormsBoss.com; © Impressive Publishing 800-208-1977 � vyI nI IaI a Ia�w.�.vl n ► CERTIFICATE OF GARAGE INSURANCE DATE1DIY4 0506120612014 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 Insurance Capital Management LLC S. State Road 7 Suite 315-9 Wellington, FL 33414 NCT CONTA AME; Deborah B Howard A124072 PHONE 561-223-2199 FAX No: 561-209-5581 IA Egir1035 ADML DRESS: icmllcl3@yahoo.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Company INSURED Roy Khanna 3117 Carol Avenue Palm Springs, FL 33461 INSURER B: Progressive Express Insurance Company INSURER C INSURER D INSURER E : INSURERF: I.VYCRAUr_0 rrtVu r vua l vm&n n+. --•-• •-------- THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE L POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS GARAGE LIABILITY AUTO ONLY (Ea accident) s 1,000,000. AAUTOS OWNED HIRED AUTOS ONLY X GP8177220 1/9/2014 01/09/2015 EA ACCIDENT $ 100000USED NON -OWNED AUTOS OTHER THAN $ 2,000,000, IALL IN GARAGE BUSINESS AUTO ONLY AGGREGATE Sealer Service Liability I �TC P / LOC $ 180,000. GARAGE KEEPERS LIABILITY $ LEGAL LIABILITY GP8177220 01109/201401/09/2015 SPECIFIED LOC PERILS A COLLISION LOC $ 180 000. DIRECT BASIS $ PRIMARY EXCESS LOC COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ — DAMAGE TO RENTE—D PREMISES Ea occurrence $ CLAIMS -MADE OCCUR ` MED EXP (Any one person $ APPR I K MENT PERSONAL & ADV INJURY $ DA WAIVER N/A S ��� GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- F-1 LOC JECT % : LI PRODUCTS - COMP/OP AGG $ $ OTHER: ` ll UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS MADE DED RETENTION $ PER OTH- $ WORKERS COMPENSATION STATUTE ER E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N / A OFFICER/MEMBER EXCLUDED? Y I N (Mandatory in NH) ❑ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under below REMARKS 100,000 COMBINED SINGLE LIMIT COMMERCIAL AUTO X 02121612-1 04/03/201404/03/2015 BODILY INJURY/PROPERTY DMG. B REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Monroe County Board of County Commissioners is listed as an additional insured as indicated above with an "x" iN003 I98NOW E HULULK `'•" Monroe County Board of County Commissioners Attn: Rick Management 0z =II 14V 8- AvW bla 1100 Simonton Street Key West FL 33040 080338 803 a3113 Fax 305-289-6061 Fax 305-292-4487 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE '& LV IV, LV IY MV vnY vv.. — •..•+..• .- -• ACORD 30 (2014101) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web software. www.FormsBoss.com: 0 Imoressive Publishina 800-208-1977