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Certificates of Insurance Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE ttOLDER. TttlS CERTIFICA] E IS NO'I AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that I G. A. FOODS SERVICES OF PINELLAS COUNTY, INC. 12200 32ND COURT NORTH ST. PETERSBURG, FLORIDA 33702 Name and address of Insured. LIBERTY Is, at the issue date of this certificate, insured by the Company under the policy(les) listed below. The insurance afforded by the listed policy(les) is subject to all their .terms; exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be I~uea. TYPE OF POLICY WORKERS COMPENSATION EXP. DATE * ~ CONTINUOUS [] EXTENDED ~ POLICY TERM POLICY NUMBER LIMIT OF LIABILITY COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING STATES: tEMPLOYERS LIABILITY Bodilv Injurv BV Accident Each Accidenl Bodily Injury By Disoase Policy Limit I Bodily Injury By Disease GENERAL LIABILITY [] OCCURRENCE [] CLAIMS MADE AUTOMOBILE LIABILITY OWNED NON-OWNED [] HIRED OTHER UMBRELLA EXCESS LIABILITY ADDITIONAL COMMENTS 9-29-97 RETRO DATE 9-29-97 9-29-97 ADDITIONAL INSURED: YY2-151-271854-016 AS7-151-271854-026 TH1-151-271854-036 General Aggreg~e-OtherthanProducts/CompletedOpemfions $2,000,000 Each Person Products/Completed Operations Aggregate $1,000,000 Bodily Injurv and ProDerN Damaqe Uabilitv Per $1,000,000 Occurrence Personal and Advertising Injury Per Person/ $1,000, 000 Organization Other FIRE LEGAL $50,000 Other$5,000 MEDICAL PAYMENTS Each Accident - Single Limit $1,000,000 B.I. and P.D. Combined Each Person Each Accident or Occurrence Each Accident or Occurrence $5,000,000 SINGLE LIMT FOR LIABILITY INJURY FOR BODILY INJURY AND PROPERTY DAMAGE OVER UNDERLYING LIMTS. BOARD OF CO. COMM. MONROE CO. DAT£ L_~~~ ~_,~ If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE Liberty Mutual Group THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SU~-CANCELLATION HAS BEEN MAILED TO: C,~E BOARD OF CO. COMM. MONROE CO. HOLDER WING II, ROOM 207 PUBLIC SERVICE BLDG. AUTHORIZEDREPRESENTATIVE ~ ~' ~ i, : c TAMPA (800) 282-6218 OFFICE PHONE NUMBER DATE ISSUED This certificate is executed by LIBERTY MUTUAL GROUP as respects such insurance as is afforded by 'Iht)se Companies BS 772I, (I:l J · · · Florida : deFa mn ISSUED TO: CERTIFICATE OF INSURANCE Monroe County Senior Nutrition Program-Wing II, Room 207 P S B 5100 Jr. College Road Key West, FL 33040 Board of Trustees W. "Bill" Kundrat, Jr., Chairman, Tallahassee George Sandefer, Vice Chairman, Gainesville Nis Nissen, Lakeland Thomas S. Petcoff, Lakeland William C. Rustin, Jr., Tallahassee Charles R. Wintz, Jacksonville This is to certify that G A Food Service of Pinellas County, Inc. 12200-32nd Court North, St. Petersburg, FL 33716 being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of the compensation by insuring their risk with the Florida Retail Federation Self Insurers Fund COVERAGE NUMBER: 0520-04331 Statutory-State of Florida EFFECTIVE DATE: January 1, 1997 EXPIRATION DATE: January 1, 1998 Employers Liability $500,000 (Each Accident) $500,000 (Disease-Each Employee) $500,000 (Disease-Policy Limit) CANCELLATION: Should the above described policy be cancelled before the expiration day thereof, the issuing company will endeavor to mail 30 days written notice to the above named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or as affording insurance to any insured not named above. Sununit Consulting, Inc., Administrator Florida Retail Federation Self Insurers Fund /aa January 10, 1997 Date Administered and serviced by Summit Consulting, Inc. P.O. Drawer 988 · Lakeland, FL 33802-0988 · Telephone (941) 665-6060 or 1-800-282-7648 · Fax (941) 666-1958 Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that G. A. Foods Services of Pinellas County, Inc. 12200 32nd Court North St. Peterdburg, Florida 33702 Name and address of Insured LIBERTY MUTUAL® ~s, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. .~ERTIFICATE EXP. DATE TYPE OF POLICY · [] CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY [] EXTENDED [] POLICY TERM Coverage Afforded Under WC EMPLOYERS LIABILITY Law of the Following States: ........ , ~,~SK,~,~.~"Jfi~[~[N.T Bodily Injury By Accident Each ~D l~'~ Accident wo.. .s COMPENSATION BY v I~ Limit [')rite I O'(Zg'-~' r),, ~(~.'~ r~, ¢zll~''J'~ Bodily lnjury By Disease Policy ~a'O~. Bodily Injury By Disease Each Person GENERAL LIABILITY w~,~,~: r~,,~ t-, ~1:;) . General Aggregate-Other than Prod/Completed Operations $2,000,000 [] CLAIMS MADE Products/Completed Operations Aggregate $1,000,000 RETRO DATE I 9-29-98 YY7-151-271854-017 Bodily Injury and Property Damage Liability Per I $1,000,000 Occurrence Personal and Advertising Injury Per Person/ [] OCCURRENCE $1,000,000 Organization Other: I Other: $50,000 Fire Legal $5,OOO Medical Payment AUTOMOBILE $1,000,000 Each Accident - Single Limit - LIABILITY B.I. and P. D. Combined [] OWNED 9-29-98 AS7-151-271854-027 Each Person [] NON-OWNED Each Accident or Occurrence [] HIRED Each Accident or Occurrence OTHER 9-29-98 TH 1-151-271854-037 $7,000,000 Single limit for liability injury for bodily injury and Umbrella Excess Liability property damage over underlying limits. ADDITIONAL COMMENTS Additional Insured: Board Of Co. Comm. Monroe Co. *IF THE CERTIFICATE EXPIRATION DATE IS CONTINUOUS OR EXTENDED TERM, YOU WILL BE NOTIFIED IF COVERAGE IS TERMINATED OR REDUCED BEFORE THE CERTIFICATE EXPIRATION DATE. HOWEVER, YOU WILL NOT BE NOTIFIED ANNUALLY OF THE CONTINUATION OF COVERAGE. SPECIAL NOTICE - OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: Board Of Co. Comm. Monroe Co. CERTIFICATE Wing II, Room 207 I HOLDER Public Service Bldg. Key West, FI 33040 Liberty Mutual Group RALPH L. BARNES , .. AUTHORIZED REPRESENTATIVE lC')_,.)/I~..~ Tampa/555 kfm (813)932-2220 September25, 1997 OFFICE PHONE DAlE iSSUED This certificate is executed by LIBERTY MUTUAL GROUP as respects such insurance as is afforded by Those Companies BS 772l_ (FL) Florida Retail Federation Self Insurers Fund Board of Trustees W. "Bill" Kundrat, Jr., Chairman, Tallahassee George Sandefer, Vice Chairman, Gainesville Nis Nissen, Lakeland William C. Rustin, Jr., Tallahassee Charles R. Wintz, Jacksonville ISSUED TO: CERTIFICATE OF INSURANCE Monroe County Senior Nutrition Program-Wing II, Room 207 P S B 5100 Jr. College Road Key West, FL 33040 This is to certify that G A Food Service of Pinellas County, Inc. 12200-32nd Court North St. Petersburg, FL 33716 being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of the compensation by insuring their risk with the Florida Retail Federation Self Insurers Fund COVERAGE NUMBER: 0520-04331 Statutory-State of Florida EFFECTIVE DATE: January 1, 1998 EXPIRATION DATE: January 1, 1999 Employers Liability $500.000 (Each Accident) $500.000 (Disease-Each Employee) $500,000 (Disease-Policy Limit) CANC~.I.ATION: Should the above described policy be cancelled before the expiration day thereof, the issuing company will endeavor to mail 30 days written notice to the above named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or as affording insurance to any insured not named above. WAIVER: N/A_ /'"'~' ' Summit Consulting, Inc., Administrator Florida Retail Federation Self Insurers Fund January 26, 1998 Date /ph8 Administered and serviced by Summit Consulting, Inc. P.O. Drawer 988 · Lakeland, FL 33802-0988 · Telephone (941) 665-6060 or 1-800-282-7648 · Fax (941) 666-1958 Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that G. A. Foods Services of Pinellas County, Inc. 12200 32nd Court North St. Petersburg, Florida 33702 Name and address of Insured LIBERTY MUTUAL® / is, at the issue date of this certificate, insured by the Company under the policy(les) listed below. The insurance afforded by the listed policy(les) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. ':ERTIFICATE EXP.'DATE TYPE OF POLICY · [] CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY [] EXTENDED [] POLICY TERM Coverage Afforded Under WC EMPLOYERS LIABILITY SJ,~, ..... ~. '~ :~JJA ,~l.~w of the Following States: Bodily Injury By Accident Each WORKERS ..... ] .V~ Accident COMPENSATION Bodily Injury By Disease Policy - ' ~ Limit Bodily Injury By Disease Each GENERAL LIABILITY General Aggregate-Other than Prod/Completed Operations $2,000,000 [] CLAIMS MADE Products/Completed Operations Aggregate $1,000,000 I RETRO DATE 9-29-99 YY7-151-271854-018 Bodily Injury and Property Damage Liability Per $1,000,000 Occurrence Personal and Advertising Injury Per Person/ [] OCCURRENCE $1,000,000 Organization Other: I Other: $50,000 Fire Legal $5,000 Medical Payment AUTOMOBILE $1,000,000 Each Accident - Single Limit - LIABILITY B.I. and P. D. Combined [] OWNED 9-29-99 AS7-151-271854-028 Each Person [] NON-OWNED Each Accident or Occurrence [] HIRED Each Accident or Occurrence OTHER Umbrella Excess Liability 9-29-99 I TI41-151-271854-038 Iproperty$7'000 000damageSingleoverlimitunderlyingfOr liability limits.in'ury for bodily iniury and I I ADDITIONAL COMMENTS ~'~I:DG S~'~ ' :'~ Additonal Insured: Monroe County Re: Nutrition Program - Senior ,~;; Citizens & Bayshore Manor U¥., ~ ! ~' ~/,.~/ *IF THE CERTIFICATE EXPIRATION DATE IS CONTINUOUS OR EXTENDED TERM, YOU WILL BE NOTIFIED1F COYEJI~E ¥~¥1:RMII',IAI ED OR REDUCED BEFORE THE CERTIFICATE EXPIRATION DATE. HOWEVER, YOU WILL NOT BE NOTIFIED ANNUALLY OF THE CONTINUATION OF COVERAGE. SPECIAL NOTICE - OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT Liberty Mutual Group CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: CERTIFICATE 5100 College Road HOLDER Key West, FI 33040 %L RALPH L. BARNES AUTHORIZED REPRESENTATIVE Tampa./555 kfm (813) 932-2220 October2, 1998 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL GROUP as respects such insurance as is afforded by Those Cornpanies BS 772L (FL) CERTIFICATE OF PROPERTY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND. OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW This is to Certify that IG. A. Foods Services of Pinellas County, Inc. 12200 32nd Court North St. Petersburg, Florida 33702 Name and address of Insured LIBER2-Y MUTUAL is, at the issue date of this certificate, insured by the Company under the policy(les) listed below. The insurance afforded by the listed policy(les) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of an), contract or other document with respect to which this certificate may be issued. 2ERTIFICATE EXP.'DATE TYPE OF POLICY * [] CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY [] EXTENDED [] POLICY TERM Coverage Afforded Under WC EMPLOYERS LIABILITY ,;- 'ff0VED ~r' ~.J,SK [v:t,C~z~0~M.~. ? Law of the Following States: ' ~' } %.~: /)¢~,' : ('1~,,~,, ~' /' Bodily Injury By Accident ( _i . ~ ~ ~.t,,~.. Each WORKERS ~,y_ '~ ' '~ - ' . ' Accident COMPENSATION ~ :.-- !¢--~ t .-. . t,.; ~.-' ~, Bodily Injury By Disease Policy __ - _ . ,.~ ~., ). Limit )"~ j!',.' }"~'~ ~:~' ~[~4;J~ Bodily Injury By Disease Each ?'"' ';-R. ,:,. ;' .... YES -- ' ' ' Person GENERAL LIABILITY General Aggregate-Other than Prod/Completed Operations $2,000,000 ] CLAIMS MADE Products/Completed Operations Aggregate $1,000,000 RETRO DATE ] 9-29-99 YY7-151-271854-018 Bodily Injury and Property Damage Liability Per I $1,000,000 Occurrence Personal and Advertising Injury Per Person/ [] OCCURRENCE $1,000,000 Organization Other: I Other: $50,000 Fire Lo§al $5,000 Medical Payment AUTOMOBILE $1,000,000 Each Accident- Single Limit- LIABILITY B.I. and P. D. Combined [] OWNED 9-29-99 AS7-151-271854-028 Each Person ] NON-OWNED Each Accident or Occurrence [] HIRED Each Accident or Occurrence OTHER Umbrella Excess Liability 9-29-99 ] TH 1 -I 51-271854-038 property$7'000'000damageSingleoverlimitunderlyingfOr liability limits.injury for bodily injury and I ADDITIONAL COMMENTS Additional Insured: Board Of Co. Comm. Monroe Co. *IF THE CERTIFICATE EXPIRATION DATE IS CONTINUOUS OR EXTENDED TERM, YOU WILL BE NOTIFIED IF COVERAGE IS TERMINATED OR REDUCED BEFORE THE CERTIFICATE EXPIRATION DATE. HOWEVER, YOU WILL NOT BE NOTIFIED ANNUALLY OF THE CONTINUATION OF COVERAGE. SPECIAL NOTICE - OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES Liberty Mutual Group UNTIL AT LEAST 3'-~0 DAYS NOTICE OFSUCH CANCELLATION HAS BEEN MAILEDTO: ~ ~ ~Board Of Co. Comm. Monroe Co. I CERTIFIOATE Wing II, FIoom 207 I HOLDER AUTH oRRi~LEPDH RL~ pB~RE~NSTATiV E Public Service Bldg. Key West, FI 33040 INITIAL ',O ":: Tampa/555 kfm (813) 932-2220 October 2, 1998 OFFICE PHONE DATE ISSUED Th~s certificale is executed by LIBERTY MUTUAL GROUP as respects such ~nsurance as is afforSed by its Companies BS 815L (FL) Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORIVlATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that LIBEKIY G. A. Foods Services of Pinellas County, Inc. Name and 12200 32nd Court North address of St. Petersburg, Florida 33702 Insured is, at the issue date of this certificate, insured by the Company under the policy(les) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of am, contract or other document with respect to which this certificate may be issued. ~ERTIFICATE EXP. DATE TYPE OF POLICY · [] CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY [] EXTENDED [] POLICY TERM Coverage Afforded Under We EMPLOYERS LIABILITY Law o! the Following States: Bodily Injury By Accident Each WORKERS 1-1-00 WC5-151-271854-089 FL 500__.000 Accide.! COMPENSATION Bodily Injury By Disease Policy 500 .~ 000 Limit Bodily Injury By Disease Each 500 ! 000 Person General Aggregate-Other than Prod/Completed Operations GENERAL LIABILITY $2,000,000 ] CLAIMS MADE Products/Completed Operations Aggregate $1,000,000 Bodily Injury and Property Damage Liability Per RETRO DATE 9-29-99 YY7-151-271854-018 $1,00o,o00 Occurrence Personal and Advertising Injury Per Person/ [] OCCURRENCE $1,000,000 Organization Other: I Other: $50,000 Fire Legal $5,000 Medical Payment AUTOMOBILE $1,000,000 Each Accident - Single Limit - LIABILITY B.I. and P. D. Combined [] OWNED 9-29-99 AS7-151-271854-028 Each Person [] NON-OWNED Each Accident or Occurrence [] HIRED Each Accident or Occurrence OTHER Umbrella Excess Liability 9-29-99 1 TH1-151-271854-038 $7,oo0,000property damageSingleoverlimitunderlyingf°r liability limits.injury for bodily injury and I ADDITIONAL COMMENTS *IF THE CERTIFICATE EXPIRATION DATE IS CONTINUOUS OR EXt~'L~II~L~ TEI~,~Y~c4!!LL~hlQ.T,,tFJa=-D IF COVERAGE IS TERMINATED OR REDUCED BEFORE THE CERTIFICATE EXPIRATION DATE. HOWEVER, YOU WILL NOT BE NOTIFIED ANNUALLY OF THE CONTINUATION OF COVERAGE. SPECIAL NOTICE - OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT tS GUILTY OF INSURANCE FRAUD. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT Liberty Mutual Group CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: CERTIFICATE HOLDER Bayshore Manor 5200 W. Jr. College Road Stock Island, FI 33040 RALPH L. BARNES AUTHORIZED REPRESENTATIVE Tamp~555 kfm(813) 932-2220 December15,1998 OFFICE PHONE DATEISSUED This certificate is executed by LIBERTY MUTUAL GROUP as respects such insurance as is afforded by Those Companies BS 772L (FL) Certificate of Insurance HIS CERTIFICATE IS ISSUED AS A MA'I-I'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT N INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that JG OF PINELLAS COUNTY INC A FOOD SERVICES 12200 32ND COURT NORTH ST PETERSBURG FL 33702 Name and address of Insured. LIBERT MUTUAL Is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is sub all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to whic certificate may be issued. TYPE OF POLICY EXP. DATE POLICY NUMBER LIMIT OF LIABILITY WORKERS [] CONTINUOUS COVERAGE AFFORDED UNDER EMPLOYERS LIABILITY COMPENSATION [] EXTENDED WC5-151-271854-089 WC LAW OF THE FOLLOWING STATES: Bodily Injury By Accident [] POLICY TERM $500,000 Each 01/01/2000 FLORI DA Accident Bodily Injury By Disease $500,000 Policy Limit Bodily Injury By Disease $500,000 Each Person GENERAL LIABILITY 09/29/1999 YY7-151-271854-018 General Aggregate - Other than Products/Completed Operatio $2,000,000 Products/Completed Operations Aggregat $1,000,000 ~i;~OCCURRENCE Bodily Injury and Property Damage Liability $1,000,000 Per Occurrence [~CLAIMS MADE Personal Injury Per Person/ RETRO DATE $1,000,000 Organization Other $100,000 FIRE LEGAL Other $5,000 MEDICAL PAYMENTS AUTOMOBILE LIABILIT' 09/29/1999 AS7-151-271854-028 $1,000,000 Each Accident- Single Limit B.I. and P.D. Combined [] OWNED Each Person [] NON-OWNED Each Accident or Occurrence [] HIRED Each Accident or Occurrence OTHER UMBRELLA EXCESS 09/29/1999 TH1-151-271854-038 $7,000,000 SINGLE LIMIT FOR LIABILITY INJURY FOR BODILY LIABILITY INJURY & PROPERTY DAMAGE OVER UNDERLYING LIMITS ~,DDITIONAL COMMENTS Additional Insured: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS * If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced b~lp.r~ ~ certir~?,ate expiratig,w'~3~ SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAI~I~¥'A~ISURL~R,;~UBM'?',~~' Y t' ,'3 ~ AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS: IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER, WHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. NOTICE OF CANCELLATION: (NOTAPPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: CERTIFICATE HOLDER I__ ~ This certificate is executed by LIBERTY MUTUAL INSURANCE GR')UP such insurance as is afforded by Those Compan Monroe County Senior Nutrition Program 555l ~ ;Z ~ Wing II room 207 PSB ,,~_/~j~/~~/// Ralph L. Barnes 5100 Jr. College Road AUTHORIZED REPRESENTATIVE Key West FL 33040 D^~ , Tampa, FL (800) 282-6218 02/23/99 BS1501 ACORD. CERTIFICATE OF LIABILITY INSURANCE ~RODUCER NSURED Acordia SE, Central Fla Divsn P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE iNSURER A: FIREMAN'S FUND INSURANCE CO INSURER B: INSURER C: INSURER D: I 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. INSR POECY EFFECTIVE POUCY EXPIRATION I,TR TYPE OF INSURANCE POUCY NUMBER DATE (MM/DD/YY) DATE ;MM/DD/YYI UMITS A GENERAL UABlUTY DXX80744213 9/29/99 9/29/00 EACH OCCURRENCE $ 1000000 X~ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100000 ,[ CLAIMS MADE . .~-] OCCUR MED EXP (Any one p ..... ) $ S000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $ 1000000 P°L'CY PRO' LOC A AUTOMOBILE UAB, UTY DXA80201 597 9/29/99 9/29/00 COMBINED SINGLE LIMIT $ 1000000 (Re accident) XiANY AUTO _ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS [Per person) X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS ___ PROPERTY DAMAGE $ (Per accident) GARAGE EABIUTY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS EABIETY XYZO0096225909 9/29/99 9/29/00 EACH OCCURRENCE $ ;)0000000 X l OCCUR I I CLAIMS MADE AGGREGATE $ 20000000 DEDUCTIBLE $ RETENTION $ ~' ?/~ ~m~,r~'r~ $ . TORY LIMITS ER ~ E.L. DISEASE - POLICY I DESCRIPTION OF OPERATION$1LOCATIONSlVEHICLE~IEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ADDITIONAL INSURED: MONROE COUNTY RE: NUTRITION PROGRAM - SENIOR CITIZENS & BAYSHORE MANOR CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: MANAGEMENT D^TI~_ - 5100 COLLEGE ROA~iTiAL KEY WEST FL 33040 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CB~TIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR · ~ 4/ e ACORD CORPORATION 1988 ACORD 25-S (7/97) 7- 79 Certificate of Insurance /THIS CERTIFICATE IS ISSUED AS A MA'I-rER OF NFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POL C ES L STED BELOW. This is to Certify that IG A FOOD SERVICES OF PINELLAS COUNTY INC 12200 32ND COURT NORTH ST. PETERSBURG, FL 33702 Name and address of Insured. LIBER Y MUTUAL Is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is sub all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to whic certificate may be issued. TYPE OF POLICY EXP. DATE POLICY NUMBER LIMIT OF LIABILITY COVERAGE AFFORDED UNDER ' EMPLOYERS LIABILITY WORKERS [] CONTINUOUS WC LAW OF THE FOLLOWING COMPENSATION [] EXTENDED WC6-151-271854-080 STATES: Bodily Injury By Accident [] POLICY TERM FLORIDA $500,000 Each Accident 01/01/2001 Bodily Injury By Disease Limit $500,000 Policy Bodily Injury By Disease $500,000 Each Person GENERAL LIABILITY General Aggregate- Other than Products/Completed Operatio Products/Completed Operations Aggregat [--~OCCURRENCE Bodily Injury and Property Damage Liability Per Occurrence I----I IICI_AIMS MADE Personal Injury Per Person/ RETRO DATE Organization Other Other ~/~ [. ~. ~., ( J] j~ .--~. Each Accident - Single Limit AUTOMOBILE LIABILIT' ~ B.I. and P.D. Combined L~,-' _~- 0'~-' ~ Each Person [] OWNED ,-f ......./ [] NON-OWNED ' :" .'~: Each Accident or Occurrence [] HIRED . ~ Each Accident or Occurrence OTHER ~~_..~. ~,DDITIONAL COMMENTS ADDITIONAL INSURED: Monroe County Risk Management * If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS: IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER, WHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: Monroe County Risk Management 5551 CERTIFICATE 5100 College Road HOLDER OFFICE I KeyWest, FI 33040 I This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Compan Ralph L. Barnes AUTHORIZED REPRESENTATIVE Tampa, FL (800) 282-6218 01/17/00 PHONENUMBER DATEISSUED BS1501 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 9~22~00 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INSURANCE COMPANY INSURER B: INSURER C: INSURER D: INSURER E: 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. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYI DATE {MMIOO/YYt LIMITS A GENERAL LIABILITY 630862K4105 9/29/00 9/29/01 EACH OCCURRENCE ~ 1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100000 I CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 1000000 I ~J GENERAL AGGREGATE $ 2000000 ' GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $ 2000000 X I POLICY F~PRO-,ECT ~-'~ LOC A AUTOMOBILE LIABILITY A 10A62K4117 9/29/00 9/29/01 COMBINED SINGLE LIMIT $ 1000000 (Ea accident) X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS LIARILITY CUP862K4129 9/29/00 9/29/01 EACH OCCURRENCE $ 20000000 Xl OCCUR t I CLAIMS MADE AGGREGATE $ 20000000 DEDUCTIBLE ~ $ RETENTION $ ;,iy ~ -- WC STATU- OTH- wo,,,s EMPLOYERS' LIABILITY ~,~TE . .' -~ E.L. EACH ACCIDENT $ ~','~," 'F~: i~:, ~ _/ ~S _ ,. ~ ..... _ ,~_J~_~' [ J_. E.L. DISEASE- POLICY LIMIT OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ADDITIONAL INSURED: MONROE COUNTY RE: NUTRITION PROGRAM - SENIOR CITIZENS & BAYSHORE MANOR INITIAL CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION MONROE COUNTY RISK MANAGEMENT 5100 COLLEGE ROAD KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL . 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR © ACORD CORPORATION 1988 ACORD 25-S (7/97) 7- 79 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S ~7/97) Certificate of Insurance ITHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT lAN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that G A FOOD SERVICES OF PINELLAS COUNTY INC 12200 32ND COURT NORTH ST. PETERSBURG, FL 33702 Name and address of Insured. LIBER I'Y MUTUAL Is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is sub all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to whic certificate ma be issued. TYPE OF POLICY EXP. DATE POLICY NUMBER LIMIT OF LIABILITY WORKERS [] CONTINUOUS COVERAGE AFFORDED UNDER EMPLOYERS LIABILITY WC LAW OF THE FOLLOWING COMPENSATION [] EXTENDED WC6-151-271854-081 STATES: Bodily Injury By Accident [] POLICY TERM FLORIDA $500,000 Each Accident 01/01/2002 Bodily Injury By Disease $500,000 Policy Limit Bodily Injury By Disease $500,000 Each Person GENERAL LIABILITY General Aggregate - Other than Products/Completed Operatio Products/Completed Operations Aggregat E]OCCURRENCE Bodily Injury and Property Damage Liability Per Occurrence IICI.AIMS MADE Personal Injury Per Person/ RETRO DATE Organization Other Other ~,UTOMOBILE LIABILIT~ Each Accident - Single Limit B.I. and P.D. Combined Each Person [--~ ~ Each Accident or Occurrence [] HIRED :: ...... 1'~_~:"~~-- Each Accident or Occurrence )THER cc If the certificate expiration date is continuous or extended term, you will be notified if ¢ ge is terminated or reduced before the certificate expiration date. SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS: IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER, WHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND CORNER OF THIS CERTIFICATE, THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: CERTIFICATE HOLDER County of Monroe 5551 Risk Management 5100 College Road Key West, FL 33040 ~ This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Compan Ralph L. Barnes AUTHORIZED REPRESENTATIVE Tampa, FL (800) 282-6218 01/01/01 OFFICE PHONE NUMBER DATE ISSUED BS1501 IT Certificate of Insurance HIS CERTIFICATE iS iSSUED AS A MA'I-rER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT BY THE POLICIES LISTED BELOW. COVERAGE AFFORDED N INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE This is to Certify that IG A FOOD SERVICES OF PINELLAS COUNTY INC 12200 32ND COURT NORTH ST. PETERSBURG, FL 33716 Name and Liberty. address of Insured. ~ Mutu~,. Is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subj to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to w this certificate may be issued. TYPE OF POLICY EXP. DATE POLICY NUMBER LIMIT OF LIABILITY WORKERS []CONTINUOUS COVERAGE AFFORDED UNDER EMPLOYERS LIABILITY COMPENSATION [] EXTENDED WC6-151-271854-081 wc LAW OF THE FOLLOWING STATES: Bodily Injury By Accident [] POLICY TERM $500,000 Each 01/01/2002 FL, GA Accident Bodily Injury By Disease $500,000 Policy Limit Bodily Injury By Disease $500,000 Each Person GENERAL LIABILITY General Aggregate - Other than Products/Completed Operations Products/Completed Operations Aggregate BY t u I - ~OCCURRENCE DATE ' Ih, I 0 [~) / Bodily Injury and Property Damage Liability .... , Per Occurrence t~i~,LAIMS MADE WAIVER N/A "~ YES Personal Injury Per Person/ RETRO DATE % ~ Other Other O~anization AUTOMOBILE LIABILIT' (~ ~. ~ B.I.EaChandAccidentp. D. Combined- Single Limit [--I OWNED ~.,. ~ Each Person [] NON-OWNED Each Accident or Occurrence [] HIRED Each Accident or Occurrence DTHER ~DDiTIONAL COMMENTS If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. SPECIAL NOTICE-OHIO: ANY PERSON WHO, VVITH INTENT TO DEFRAUD OR KNOW1NG THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUIL'['~ OF INSURANCE FRAUD. IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERSN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCERNHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. C~q~RCA'IE NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: [ Monroe County 5551 Risk Management 5100 College Road Ralph L. Barnes AUTHORIZED REPRESENTATIVE Tampa, FL (800) 282-6218 10/02/01 OFFICE I Key West, FL 33040 This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companie PHONE NUMBER DATEISSUED BS1501 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; Contract tbr: Address of Contractor: Pholle: Scope of Work: G. A. Food Service, Inc. Monroe County Nutrition Program 12200 32nd Court North St. Petersburq, Florida 33716 (800) 852-2211 or (727) 573-2211 Provide meals to Senior Nutrition Program in Monroe County Reason for Waiver: Insurance.company feels that Monroe County has no exposure under the Auto portion of policy Policies Waiver will apply to: Naming Monroe County BOCC as additional insu~red on Auto Portion ONLY of policy Approved r~ Not Approved County Adminis~-ator appeal: Approved: Not Approved: Board of County Commissioners appeal: Approved: Not Approved: Meeting Date: Administration Instruction #4?O9.2 103 ACORD. CERTIFICATE OF LIABILITY INSURANCE OATE; 2M Y' PRODUCER INSURED ACORDIA EAST - TAMPA BAY P,O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS CO-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: INSURER D: 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. INSR POLICY EFFECTIVE POLICY EXPIRATION LTI~ TYPE OF INSURANCE POLICY NUMBER [~,TE IMM/DO/YY} DATE IMM/DD/YYI LIMITS A I GENERAL LIABILITY Y630862K4105 9/29/01 9/29/02 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S 100000 I CLAIMS MADE Ixl OCCUR MED EXP (Any one person} $ 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S ?000000 IPOLICY r~JEcTPRO' I~ LOC A AUTOMOBILE LIABILITY Y810862K4117 9/29/01 9/29/02 COMBINED SINGLE LIMIT S 1000000 (Ea accident} X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S B EXCESS LIABILITY QK06800031 9/29/01 9/29/02 EACH OCCURRENCE S 15000000 X I OCCUR ~ CLAIMS MADE AGGREGATE S 15000000 x R~ENT, O. S ~0000 __..'/~/~.~ ~ L4J, ;,-;~ ~. S wo.._co....,o..o oi TORY L M TS EMPLOYERS' UABI,~ DATE . I ' E.L. EACH ACCIDENT S WAIVER N/A f YES i i Jl (~('~ tv' ~ E.L. DISEASE-EA EMPLOYEES _ . E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: BAYSHORE MANOR MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS INCLUDED AS ADDITIONAL iNSURED WITH REGARD TO GENERAL LIABILITY COVERAGE RE: ABOVE PROJECT. CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION MONROE COUNTY BOARD OF CO COMM ATTN:RISK MANAGEMENT 5100 COLLEGE ROAD KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR UABIUT'Y OF ANY KIND UPON THE INSURER, ITS AGENTS OR e ACORD CORPORATION 1988 ACORD 25-S (7/97) 46- 36 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7197) ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 12/28/01 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 THIS CERTIFICATE IS ISSUED AS A MAII~'R 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. INSURERS AFFORDING COVERAGE INSURER A: Florida Retail Federation INSURER B: INSURER C: INSURER D: INSURER E: ~U Vl=lt/,~' ~'~ 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. POLICY EFFECTIVE ~OMCY EXPiRATION LIMITS INSR LTR TYPE OF INSURANCE POLICY NUMBER DATE ~MMIDD/YY! DATE CMM/DD/YYI GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) I CLAIMS MADE ~'~ OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE EMIT APPLIES PER: PRODUCTS - COMP/Dp AGG $ I POLICY ~---]PRO'JECT [-~ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (La accident) SC.EDULED AUTOS . ... HIRED AUTOS . ,, "O"-OWNEDAUTOS ~TI~ I 0 """""""""'~- ~.,.~... _~,~0~ ,~ (Per accident) .~ PROPERTY DAMAGE ~;~ ~I~: ~/~ ~ ~,, Y[S _ (Per accident) e~eE ~.IL~ aUtO ONLY- EA ACCIDENT  ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG ~CESS UABiL~ EACH OCCURRENCE ' I OCCUR ~ CLAIMS MADE AGGREGATE DEDUCTIBLE . i,=~.~,o. ~ i?. A ~ WO.K;~ COMP;,SAT~O~ A,O 03809300 1/01/02 1/01/03 X ~T~RywC STATU-LiMiTS ~ EMPLOYE~' LIABIL~ E.L. EACH ACCIDENT $ 500000 E.L DISEASE- ~ EMPLOYEE $ ~00000 E.L DISUSE - POLICY LIMIT ~ 500000 OTHER D~CRI~N OF OPE~TIONS~OCAT~NSNEHIC~CLUSIONS ADDED BY ENDORSEM~T/SPEC~ PROVISIONS :ERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION WING II, ROOM 297 BOARD OF CO.COMM.MONROE CTY PUBLIC SERVICE BLDG. KEY WEST, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES RE CANCEU.ED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ~ . AUT ORIZED REP SENTA ~ ACORD CORPORATION 1088 ACORD 25-S {7/97) 46- 36 ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATEIMM,OD Y,6/ l/02 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 1 2200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS CO-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: Florida Retail Federation INSURER D; 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. INSR I POLICY EFFECTIVE POLICY EXPIRATION I,TR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YY) DATE MM/DD/YY) LIMITS A GENERAL UABILITY Y630862K4105 9/29/01 9/29/02 ' EACH OCCURRENCE ! $ 3.000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 3.00000 I CLAIMS t Xl MED EXP (Any one person) $ 5000 MADE OCCUR PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMit APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 I POLICY I~ PRO- I-~LOCJl~(;:T A AUTOMOBILE LIABILITY Y810862K4117 9/29/01 9/29/02 COMBINED SINGLE LIMIT $ 3.000000 Ea accident) X ANY AUTO ALL OWNED AUTOS ~~' ' ~ I :: ,, ~-,;¢' ~.~., ~'~ , , - (PerBODILY INJURYperson) S NON-OWNED AUTOS ;'~ ~ ' ' (Per accident) ~ !"L~ ........ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO ~ ~ ~ ~'~ OTHER THAN EA ACC $  AUTO ONLY: AGG $ B EXCESS LIABILITY QK06800031 9/29/01 9/29/02 EACH OCCURRENCE $ 3.5000000 x RETE.T'O" $ ~0000 ~ ,0.,.. $ C WORKERS COMPENSATION AND 03809300 1/01/02 1/01/03 X TORY L U TS EMPLOYERS' LIABIUTY E.L. EACH ACCl DENT $ 500000 E.L. DISEASE- EA EMPLOYEE $ 500000 E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONAL INSURED RE: GENERAL AND AUTO LIABILITIES. CERTIFICATE HOLDER I ~1 ADDITIONAL INSURED; INSURER LETTER: ~1 CANCELLATION BAYSHORE MANOR 1100 SIMONTON ST.2ND FLOOR KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ~ ACORD CORPORATION 1988 ACORD 25-S (7/97) 46- 36 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7~97) ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31 666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 THIS CERTIFICATE IS ISSUED AS A MAI i,-R 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS C0-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: Florida Retail Federation INSURER D: I 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. INSR POLICY EFFECTIVE I POLICY EXPIRATION I I~TR TYPE OF INSURANCE POLICY NUMBER DATI~ II~II~/DD/YY) DATE {MM/DD/YY) LIMITS I I A GENERAL LIABILITY Y630862K41 05 9/29/01 9/29/02 EACH OCCURRENCE 8 Z000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (An,/one fire) $ 3.00000 I CLAIMS MADE I Xl OCCUR (Any one person) 5000 MED EXP $ PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 I POLICY [~PRO- wl E(~T [-~ LOC A AUTOMOBILE LIABILITY Y810862K4117 9/29/01 9/29/02 COMBINED SINGLE LIMIT $ 1000000 X ANY AUTO {La accident) i ALL OWNED AUTOS M (Per person) SCHEDULED AUTOS X HIRED AUTOS BY 9 I/ I ~ J.~] ~i.~' BODILY INJURY $ X NON-OWNED AUTOS DATE I~ i7~ /~ (Per accident)  PROPERTY DAMAGE $ WAIVER N/A _YES (Per accident) ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ B EXCESS LIABILITY QK06800031~"~'~'*,~--'~° ] ,~, 9/29/01 9/29/02 EACH OCCURRENCE $ 3.5000000 ×l OCCUR CLAIMSMAOE AGGBEGATE $ 3.S000000 $ DEDUCTIBLE X RETENTION ?~ 10000 -- S WC STATU- OTH- C WORKERS COMPENSATION AND 03809300 1/01/02 1/01/03 X TORY L M TS ER EMPLOYERS' LIABILITY E,L, EACH ACCIDENT $ 500000 E.L. DISEASE- EA EMPLOYEE $ 500000 E.L. DISEASE- POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: BAYSHORE MANOR CERTIFICATE HOLDER IS ADDITIONAL INSURED RE: GENERAL LIABILITY AND AUTO LIABILITY CERTIFICATE HOLDER I X lADD'T'°NAL ,NSURED: INSURER LETTER: _~ CANCELLATION MONROE COUNTY BOARD OF CO COMM ATTN: RISK MANAGEMENT 1100 SlMONTON ST.2nd FLOOR KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR R E P R E S~r=I~LT..~IV E S. ~ ~ AUT ORIZED REP~SENTA O ACORD CORPORATION 1988 ACORD 25-S (7~97) 46- 36 .4CORD,,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 6/11/02 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS CO-01812 iNSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: Florida Retail Federation INSURER D: I 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. INSR POLICY EFFECTIVE I POLICY EXPIRATION I~TR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYI, DATE (MM/DD/YY! LIMITS I A GENERAL LIABILITY Y630862K4105 9/29/01 ! 9/29/02 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE {Any one fire} $ 100000 I CLAIMS MADE I Xl OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 I POLICY ~PRO'O I~q:T ~]LOC A AUTOMOBILE LIABILITY Y81 0862K411 7 9/29/01 9/29/02 COMBINED SINGLE LIMIT $ 1000000 X ANY AUTO A~.~,~1,~a {La accident) ALL OWNED AUTOS APPR~E~) ~R~. K MT-~ EIIT BODiLY(Per person)INJURY $ SCHEDULED AUTOS BY_ ~1 '~ ~ ~J=--~'~ - xX NON-OWNEDHIRED AUTOSAuTOS ~ ~ DATE ~ BODILY INJURY $ ~ (Per accident} WAIVER N/AZ--YES-------- 'r ',~(.~.~ PROPERTY DAMAGE $ /'.-*' ~. %' ~ (Per accident) GARAGE LIABILITY .~"-~ "'~ ~..~ /j: AUTO ONLY - EA ACCIDENT $ ANY AUTO , OTHER THAN EA ACC $ ~_ _ ~, ~k~TO ONLY: AGG $ B EXCESS UABIMTY QK06800031 9/29/01 9/29/02 EACH OCCURRENCE $ 15000000 ×loccuR I ICLAIMSMADE AGGREGATE $ 5000000 $ DEDUCTIBLE $ X RETENTION $ 10000 $ WOSTATU-I- C WORKERS COMPENSATION AND 03809300 1/01/02 1/01/03 X TORY LIMITS t EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500000 E.L. DISEASE- EA EMPLOYEE $ 500000 E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONL INSURED RE: GENERAL AND AUTO LIABILITIES. CERTIFICATE HOLDER I ~1ADD,T,ONAL ,NSURED; ,NSURER LETTER: A CANCELLATION MONROE COUNTY BOARD OF CO COMM RISK MANAGEMENT 1100 SIMONTON ST. 2ND FLOOR KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRES~VES. ~ -- AUT ORIZED REP SENTA O ACORD CORPORATION 1988 ACORD 25-S (7/97} 46- 36 ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE.MM,DD.Y.9/23/02 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 THIS CERTIFICATE IS ISSUED AS A MAI I,-H 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS C0-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: Florida Retail Federation INSURER D: 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. INSR POLICY EFFECTIVE POLICY EXPIRATION i. Tfl TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY! DATE (MMIDD/YY) LIMITS A GENERAL LIABILITY Y630862K4105 9/29/02 9/29/03 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100000 I CLAIMS MADE I XI OCCUR (An,/one person) 5000 MED EXP $ PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 I POLICY ~PRO'jFCT r~LOc A AUTOMOBILE UABILITY Y810862K411 7 9/29/02 9/29/03 COMBINED SINGLE LIMIT $ 1000000 X ANY AUTO {La accident) ALL OWNED AUTOS BODILY INJURY p,~ ~)~S.} .~G (Per person) SCHEDULED AUTOS A O EMEN'F X HIRED AUTOS ,y~ [ -- /~.¢:~ = BODILY INJURY $ X NON-OWNEDAUTOS B--~=~r~ - t ~ \(~-~Z~ (Per accident) DA~'~ ' ' q ~r~ . - PROPERTY DAMAGE ~,' I A 'J ._YES - (Per accident) GARAGE LIABILITY WAIVER ....... AUTO ONLY- EA ACC,DENT  ' AUTO ONLY: i - AGG $ B EXCESS LIABlUTY QK06800242 9/29/02 9/29/03 EACH OCCURRENCE $ 1S000000 x I occu. J JCLAIMS MADE AGGREGATE $ 15000000 DEDUCTIBLE X RETENTION $ 10000 $ C WORKERS COMPENSATION AND 03809300 1/01/02 1/01/03 X I WC STATU- I OTH- TORY LIMITS, ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500000 E.L. DISEASE- EA EMPLOYEE $ 500000 E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONL INSURED RE: GENERAL AND AUTO LIABILITIES. 10 DAYS NOTICE OF CANCELLATION APPLIES FOR NON PAYMENT EXCEPT WORKERS' COMPENSATION CERTIFICATE HOLDER J J ADDITIONAL INSURED; INSURER LETTER: CANCELLATION MONROE COUNTY BOARD OF CO COMM RISK MANAGEMENT 1100 SIMONTON ST. 2ND FLOOR KEY WEST ~FL.33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBEGATION OR LIABIMTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESSES. ~ . AUT~Q~ORIZED RE~SENTA e ACORD CORPORATION 1988 ACORD 25-S (7~97) 46- 36 ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 THIS CERTIFICATE IS ISSUED AS A MAI I,-R 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. INSURERS AFFORDING COVERAGE ~NSURER A: TRAVELERS INS CO-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: Florida Retail Federation INSURER D: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO'I'~NITHSTANDING 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. INSR POUCY EFFECTIVE POUCY EXPIRATION i~Tfl TYPE OF INSURANCE POLICY NUMBER PATI[ (MM/DD/YY) DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY Y630862K4105 9/29/02 9/29/03 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ ].00000 I CLAIMS MADE I X! OCCUR MED EXP (Any one person) 5000 $ PERSONAL & ADV INJURY $ 3,000000 G EN ERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 ] POLICY [~PRO'~iE(~T ~'~ LOC A AUTOMOBILE LIABILITY Y810862K4117 9/29/02 9/29/03 COMBINED SINGLE LIMIT $ 1000000 X ANY AUTO (EM accident} ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS APPF~ B~'LI~MANA~"ENT __~ (Per accident) X NON-OWNED AUTOS _-- -- U .- ~ ~ ~ ~:~ ~'~ BODILY INJURY $ BY DATE (Per accident) ANY AUTO WAIVER N 'A YES-.~ ~ OTHER THAN EA ACC $ B EXCESS LIABILITY QK06800242 9/29/02 9/29/03 EACH OCCURRENCE $ 3.5000000 X I OCCUR I t CLAIMS MADE AGGREGATE $ 15000000 $ DEDUCTIBLE $ X RETENTION $ 10000 $ C WORKERS COMPENSATION AND 03809300 1/01/02 1/01/03 X I WC STATU- OTH- TORY LIMITS ~ ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500000 E.L. DISEASE- EA EMPLOYEE $ 500000 E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: BAYSHORE MANOR CERTIFICATE HOLDER IS ADDITIONAL INSURED RE: GENERAL LIABILITY AND AUTO LIABILITY 10 DAYS NOTICE OF CANCELLATION APPLIES FOR NON PAYMENT EXCEPT WORKERS' COMPENSATION CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION MONROE COUNTY BOARD OF CO COMM ATTN: RISK MANAGEMENT 1 100 SIMONTON ST.2nd FLOOR KEY WEST FL/33040 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESSES. ~ . AUT ORIZED REP SENTA e ACORD CORPORATION 1988 ACORD 25-S (7/971 46- 36 This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 I Certificate of Insurance I This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policies listed below. This istocertifythat(Nameandaddressoflnsured)I G.A. Food Services of Pinellas County, Inc I 12200 32nd Court North is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and conditions and is not altered b uirement, term or condition of any contract or other document with respect to which this certificate may be issued. Expiration Type Expiration l~ate(s) Policy Number(s) Limits of Liability Continuous* 01/01/2004 WA6-15D-271854-093 Coverage afforded under WC law of Employers Liability -- Extended the following states: Bodily Injury By Accident X Policy Term FL $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate _ Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence Retro Date Personal and Advertising Injury Per Person / Organization Other Liability Other Liability Each Accident - Single Limit - B. I. and P. D. Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence ~, WAIVER N/A T $ *If thc certificate expiration date is continuous or extended term, you will be notified if coverage is tem'duated or reduced before the certificate expiration date. However, you will not be notified annually of the continuatinu of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or fi]es a claim coutaiuing a false ur deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whose name and telephone number appears in the lower left comer of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Notice of cancellation: (not applicable unless a number of days is entered below). Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policias until at least 30 days notice of such cancellation has been mailed to: Office: Tampa, Fl Phone: 800-282-6218 Certificate Holder: Ralph L. Barnes Risk Management Authorized Representative Expiraho; T~pe Continuous* Extended X Policy Term Monroe County Board of County Commissioners 1100 Simonton Street 2nd Floor Key West, FL 33040 Date Issued: 12/17/02 Prepared By: TT This cerfficate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance ] This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policies listed below. This is to certify that (Name and address of Insured) G.A. Food Services of Pinellas County, Inc 12200 32nd Court North St. Petersburg, FL 33716 Liberty. MutuJL ts, at the issue date of this certificate, insured by the Company under the policy(les) listed below. The insurance afforded by the listed policy(les) is subject to all their terms, exclusions and conditions and is not altered E term or condition of a~ contract or other doc,]ment with respect to which this certificate may be issued. Expira~io~ T~pe Continuous* Extended X Policy Term Expiration Type Expiration Date(s) Policy Number(s) Limits of Liability Continuous* 01/01/2004 WA6-15D-271854-093 Coverage afforded under WC law of Employers Liability -- Extended the following states: Bodily Injury By Accident X Policy Term FL $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate H Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence Retro Date Personal and Advertising Injury Per Person / Organization Other Liability I Other Liability Each Accident - Single Limit - B. I. and P. D. Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence C T WAIVER S *If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, yo[~ will not be notified annually of the continuation of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whose name and telephone number appears in the lower leR comer of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Notice of cancellation: (not applicable unless a number of days is entered below). Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days notice of such cancellation has been mailed to: Office: Tampa, Fl Phone: 800-282-6218 Certificate Holder: Ralph L. Barnes Risk Manaqement Authorized Representative Monroe County 5100 College Road Key West, FL 33040 Date Issued: 12/17/02 Prepared By: TT This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance This certificate is issued as a matter of inforrnation only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policies listed below. This is to certify that (Name and address of Insured) G.A. Food Services of Pinellas County, Inc 12200 32nd Court North St. Petersburg, FL 33716 Libertx Expira~io; T~pe Expiration l~ate(s) Policy Number's) Limits of Liability Continuous* 01/01/2004 WA6-15D-271854-093 Coverage afforded under WC law of Employers Liability Extended the following states: Bodily Injury By Accident X Policy Term FL $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate  Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence Retro Date Personal and Advertising Injury Per Person / Organization Other Liability Other Liability Each Accident - Single Limit - B. I. and P. D. Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence T S *If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of the continuation of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whose name and telephone number appears in the lower let~ corner of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Notice of cnncellation: (not applicable unless a number of days is entered below). Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days notice of such cancellation has been mailed to: Office: Tampa, FI Phone: 800-282-6218 ~ ~ ~ Certificate Holder: Ralph L. Barnes W±ng II, Room 297 Authorized Representative ~s, at the issue date of this certificate, insured by the Company under the poliey(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. Expiration Type Continuous* Extended X Policy Term Board of County Comm., Monroe County Public Services Bldg. Key West, FL 33040 Date Issued: 12/17/02 Prepared By: TT ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) PRODUCER ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 INSURED G.A.Food Services of Pinellas 12200 32nd Ct., North St, Petersburg FL 33716 9/26/03 THIS CERTIFICATE IS ISSUED AS A MAI m,-R 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS CO-01812 INSURER a: ST PAUL FIRE & MARINE-01470 INSURER C: INSURER D: 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. POUCY r.~-;-~CTIVE POUCY EXPIRATION UMITS INSR LTR TYPE OF INSURANCE POUCY NUMBER DATE (MM/DD/YY! DATE (MM/DD/YY! A GENERAL UABIUTY Y630862K4105 9/29/03 9/29/04 EACH OCCURRENCE $ 1000000 X [ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100000 I ! ~ .... MEO EXP {Any one person) $ 5 (3 0 (3 C~IMS MADE O.-~R, ' PERSONAL & ADV INJURY $ 1000000 t GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $ 2000000 I POLICY [~-1PRO'JECT ~---~ LOC A AUTOMOBILE UABIMTY Y810862K4117 9/29/03 9/29/04 COMBINED SINGLE LIMIT $ 1000000 (Es accident) X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident) AUTO ONLY. EA ACCIDENT $ GARAGE MABIUTY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS MABIUTY QK06800538 9/29/03 9/29/04 EACH OCCURRENCE $ 15000000 AGGREGATE 15000000 X I OCCUR I I CLAIMS MADE $ X RETENTION $ 10000 ~9 ~' I TORY LIMITS J J ER WORKERS COMPENSATION AND '~1 -~. .~ WC STATU- OTH- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONL INSURED RE: ALL POLICIES EXCEPT WORKERS~ COMPENSATION CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: MONROE COUNTY BOCC RISK MANAGEMENT 1100 SIMONTON ST. 2ND FLOOR KEY WEST FL 33040 ACORD 25-S (~ 46- 36 CANCI=/~ATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR e ACORD CORPORATION 1988 This certificate is executed b~ Libext~ Mutual Insurance Grou? as respects such insurance as is afforded by lhose companies. BM0068 Certificate of Insurance This cealificate is issued as a mailer of information only and cotrtErs no riglxts upon you the certRlcate holdex. This certificate is not an in~!~anee policy and does not amend, extel, or a~r the coverage afforded by the policies listed below. This is to certify that (Nme and address of Insured) 12200 32nd Court North Li St. Petel~ourg, FL 33716 NtutuaL is, at the i~suc date of tim certificate, imured liy the Company und~ the policy(ies) listed below. The imurance afforded by the li~d policy~ies) is subject to all diei~ terms, exclusiom and conditions and i~ not al~ed by a~y reqnir~tont, term or condition of any commct or other docum~t with re~ct to which fl~, cerOficate may be issued. Expira~io~ T~pe Continuous* Extended X Policy Term Expira~io~ T~pe Expiration I~ate(s) Policy Number(s) Limits of Liability Continuous* 01/01/2005 WA6-15D-271854-094 Coverage afforded under WC law of Employers Liability Extended the following states: Bodily Injury By Accident X Policy Term FL, TX $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate H Claims Made Occurrence Bodily Injury and_Property Damage Liability Per Occarreace I Retro Date Personal and Advertising Injury Per Person / Organization Other Liability [ Other Liability Each Accident - Single Limit - B. L and P. D. Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence "S[fth¢ certificate expiration date is contim~ous or extended term, you will ~ff~cL~ge is~i, reduced before the certificate expiration dam. However, you willnot be noffied an~ua,y oftl~ con6mmtion of cove~4~. Special Notice - O~io: A~y pe~on wl~. wi~ inte~ to deffm~t or lmo~r~gdu~e / ~ is fa~i/~tk~g a fi"aud agaieat an i~,~. subn'~ts an application or files a dalm c.m~a/~m~g~ IAise or 6~ep6ve staSemem is guilty ofimuranoe fraud. ~ ~e~ te Flofi~, po~icy~olde~ and cenifmaSe ~olders: i, tim ev~t youlmv~ any ques6mt~ or ~ i~formatiun ~ ~ ce~ifica~ for a~y maso~ pt~e comuct ye~ local sales Notice ofcanoella~: (not ,~[k~bte ~ess a nm~bex of days is e~ below). Before the slated expixation date the e~any will nm ca~ce[ or rede t~ insurance affol~ied under the above policies until at l~ast 30 days no6ce o£such cancellation ~ been mailcdto: Certi/icate HoMer: Ralph L. Bar~es R± sk Management Authorized Representative Monroe County Board of County Co~nissioners 1100 Simonton Street 2nd Floor Key West, FL 33040 Date Issued: 12/30/2003 Prepared By: VJ This cexlificate is executed by Libe~ Mutual Insurance Group as respecls such imura~ce as is 'afforded by those companies. BM0068 Certificate of Insurance This cett~ate is issued as a matter ofinfozmafion only and confers no rights upon you the c~ holder. This certificate is not an imumnce policy and does not amend, exteml, or alter the coverage afforded by the policies listed below. This is to certify that (Name and address of Insured) 12200 32nd Court North Libertv st. Petexsburg, FL 33716 Mutu~.':~ is, at the issue date of this cerlificate, insured by the Company under the policy(ies) listed below. The insurance affon~d by ~e listed policy(les) is subjec~ to all their terms, exclus~om and conditions and is not altered by any tec~uire~nent, term or condition of an}' contract or other document with respect to which this certificate may be issued. Expira'tio~l T~pe Continuous* Extended X Policy Term Expira'tio~ T~pe Expiration l~ate~s) Policy Number(s) Limits of Liability Continuous* 01/01/2005 WA6-15D-271854-094 Coverage afforded under WC law of Employers Liability Extended the following states: Bodily Injury By Accident X Policy Term FL, ~X $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate _q Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence Retro Date Personal and Advertising Injury Per Person / Organization Other Liability ] Other Liability I Each Accident - Single Limit - B. I. and P. D. Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence N *If the certificate expiration date is continuom or extended term, you will be nofif~d if coverag~is tm or reduced befo~the cea~itleate expimtiun date. However, ~'~u wil~uot b~ notified annually ofO~ comim~ation of eov~-.mge. ~ Nolice - Otfio: m who, wi~ ime~t to d~fiaa~:l or Imowi~g that he / she is facilitaling a ~ ~i~t aniuam~ subna2 an application or files a claim contafiaing a false or d~c'~ive stelt~a~t is guilty ofln,nwarw~ Important iafermation to Florida policylmlders and c~ficam hnld~s: in lt~ ev~t ~ have any. q~stiuns orne~d infommtun about ~is ce~ifica~ tbr ~ reason, please comact your local sales No~ee of cancellation: (not applicable unles~ a numb~ of days is entered below). Befor~ thc stated expiration da~e the company will not cancel or reduce th~ insurance affot, ded under the above policies until a~ ~ 30 days notice of such cancellation has bee~ mailed lo: Certificate llolder: Ralph L. Barnes W±ng II, Room 297 Authorized Representative Board of County Comm., Monroe County Public Services Bldg. Key West, FL 33040 Date Issued: 12/30/2003 Prepared By: VJ This certificate is executed by Libe~ Mutual Iusurancc Group as respects such imuzance as is afforded by those companies. BM0068 Certificate of Insurance I This cm.tfm~te is issued as a matter ofinfom~io~ only and co~fers no rights upo~ you the certificate holder. This certiBcate is not an iusurance policy and does not amea~ extel, or alter the coverage ] afforded by the polici~ li~d ~low. This is to certif.v that (Name aad address o! Insured) 12200 32nd Court North is, at the i~ue da~ of this c~dficate, imured by tl~ Comply under the policy(i~) li.m~l l~ow. The insurance afforded by It~ listed policy~ies) is subject to all their terms, exclusions and conditious and is not alte~d by any requir~aont, ~rm or condition of any cortUact or other doc~aem with respect to which this cer6ficat¢ may be issued. Expiraho~ T~pe Continuous * Extended X Policy Term Expiraho~ T~pe ] Expirati6n l~ate(s) Policy Number(s) Limits of Liability Continuous* 01/01/2005 WA6-15D-271854-094 Coverage afforded under WC law of Employers Liability Extended ! the following states: Bodily Injury By Accident X Policy Term I ~L, TX $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate H Claims MadeI Occurrence Bodily Injury and Property Damage Liability Per Occurrence Retro Date I Personal and Advertising Injury Per Person / I Organization Other Liability I Other Liability Each Accident - Single Limit - B. L and P. D. Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence T S *Il'the c.e~ificate expiration date is continuous or extemded term, you will be notified if coverage is terminated o~ reduced befo~e the certificate cxpixation dale. However, you will not be notified annually of the contiml~ion of coverage. Sp~Axl ~ - Ohio: Any pe~ou who, ~ imem to defraud ex knowing that he / slie is facilitating a fxand agaiml an insult, submits.an application or files a claim cma~iniag a false or deeepfve statemem is guilty of insurmce fred. h~ infexmatio~ to Florida poticyho~ and cerfif~a/~ holders: in the evem you have any qn~tinw ex ueed infoxma6o~ al~out ~ ee~ificate roi- a~y r~-ason, please c~t yom- local pmdx~r, who~ ~ a~l It°,vph~e mmab~r appe~n ia t~e lower lett cc~er of this certificate. The ~ local sal~ office mailing address may al~ be obtained by calling ~ number. Notice of cancellation: (not applicable unless a uumb~ ofdays is ~nte:~d b¢tow). Before tl~ stated expiration date the company wiil not cancel or reduce the insurance affonted trader thc above policies u~fil at least 30 days notice of snob ca~cetlalion has been mailed to: Ofllee: Tampa, F1 Phoue: 800-282-6218 Certificate HoMer: Ralph L. Barn~ ~ayshore Manor Authorized Representative 1100 Simonton Street 2nd Floor Key West, FL 33040 / Date Issued: 12/30/2003 Prepared By: VJ ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) PRODUCER NSURED 9/23/04 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 1 2200 32nd Ct., North St. Petersburg FL 33716 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURER A: INSURERS AFFORDING COVERAGE TRAVELERS INS CO-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: INSURER D: 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. POMCY EFFECTIVE POMCY ExPIRATION LIMITS  TYPE OF INSURANCE POLICY NUMBER ~ ~ EACH OCCURRENCE $ 1000000 A GENERAL UABIUTY Y630862K4105 9/29/04 9/29/05 FIRE DAMAGE (Any one fire) $ 3.00000  CO~,IMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 5000 CLAIMS MADE ~-~ OCCUR PERSONAL & ADV INJURY $ 3.000000 GENERAL AGGREGATE $ 2000000 =RODUCTS - COMP/DP AGG $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY I I PRO- ~ LOC JI~CT A AUTOMOBILE LIABILITY Y810862K4117 9/29/04 9/29/05 COMBINED SINGLE LIMIT $ 1000000 (Fa accident) X ANY AUTO BODILY INJURY $ ALL OWNED AUTOS IPer person) SCHEDULED AUTOS BODILY INJURY $ X HIRED AUTOS Per accident) X NON-OWNED AUTOS -- PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY EA ACC $ .N OTHER THAN Y AUTO AUTO ONLY: AGG $ B EXCESS LIABILITY QK06800836 9/29/04 9/29/05 EACH OCCURRENCE $ 3.5000000 AGGREGATE $ 15000000 X I OCCUR [~ CLAIMS MADE RETENTION $ 10000 ~ TORY LIMITS ER WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE I $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOOATIONSNENIOLES/EXOLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE BAYSHORE MANOR : IS ADDITIONAL INSURED RE GENERAL LIABILITY CERTIFICATE HOLDER : AND AUTO LIABILITY , ~)~j ~. V,,~ i \! ':: ;", ~.~ '?~ · CERTIFICATE HOLDER t I ADDITIONAL INSURED; INSURER M-I Il;K: CANCI=I LATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANe;I I I:n BEFORE THE EXPIRATION MONROE COUNTY BOARD OF CO COMM DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRI'FrEN ATTN: RISK MANAGEMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FNLURE TO DO SO SHALL I I 00 SIMONTON ST.2nd FLOOR IMPOSE NO OBUGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUT ORIZED REP~SENTA I __ ~.~ v e ACORD CORPORATION 1988 ACORD 25-S (7/~) o ~,c,: ~ 46- 36 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 2/28/05 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 COVERAGES 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS CO-01812 iNSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO~I'WITHSTANDING 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. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYI DATE IMMIDD/YYI UMITS A GENERAL LIABILITY Y630862K4105 9/29/04 9/29/05 EACH OCCURRENCE $ Z000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ ~_00000 I CLAIMS MADE [] OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 I POLICY ~PRO~ JE(~T J~ LOC A AUTOMOBILE EABILITY Y81 0862K411 7 9/29/04 9/29/05 COMBINED SINGLE LIMIT X ANY AUTO {Ea accident) $ 1000000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG B EXCESS LIABILITY QK06800836 9/29/04 9/29/05 EACH OCCURRENCE $ 3.5000000 X I OCCUR [-~ CLAIMS MADE AGGREGATE $ -15000000 $ DEDUCTIBLE ,,, -,,,i; ~ X RETENTION $ ZOO00 APP~.t~A~' ~(""¢I .., ~ WORK 'RS CO M PENSAT' O N AN DEMPLOYERS. UA''UTY ~Y .... ~ '-- ~ '~ '~ ' ~~' , . ' ~__~ ....... ToRyWC STATU' L, M ,TS "OTH--ER ,---------' E.L. EACH ACCIDENT $ ~,/.~\(i;:i~ ~{~J'~ '-,(~...Cj ..../,~,~ ,/~ E'L'DISEASE'EAEMPLOYEE $ OTHER ' , /'~r jr ~ ~t ~ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESlEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~ ( _ ~' ~ ^. MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONAL INSURED~ GENERAL LIABILITY - BROAD FORM VENDORS ENDORSEMENT AND AUTO LIABILITY IFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON ST. 2ND FLOOR KEY WEST FL 33040 ACORD 25-S (7~9 · 46- 36 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR MABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESSES. ~ _ ~ @ ACORD CORPORATION 1988 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YY) 9/22/05 ~RODUCER INbu~IED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS CO-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: INSURER D: 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. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/'DDIYY) DATE (MM/DDfYY} LIMITS A GENERAL LIABILITY Y630862K41 05 9/29/05 9/29/06 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY FiRE DAMAGE (Any one fire) $ 100000 CLAIMS MADE ~j OCCUR MED EXP (Any one person)$ 5000 PERSONAL & ADV INJURY $ ~-000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $ 2000000 IPOLICY ~PRO' ~LOCJECT A AUTOMOBILE LIABILITY Y810862K4117 9/29/05 9/29/06 COMBINED SINGLE LIMIT $ ].000000 X ANY AUTO (La accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS LIABIUTY QK06800836 9/29/05 9/29/06 EACH OCCURRENCE $ 15000000 X OCCUR CLAIMS MADE AGGREGATE $ 1S000000 $ DEDUCTIBLE X RETENTION $ 10000 $ WORKERS COMPENSATION A.D ~'~i~ ~j/~l~ ~MEt~'I TORY LIMIT~ EMPLOYERS° UABILITY .~/ .~.:_ L-.~'~ ' ~"-'~'~ E'L' EACH ACCIDENT $ DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSION$ ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONAL INSURED GENERAL LIABILITY - BROAD FORM VENDORS ENDORSEMENT ('"'~. FL STATUTE MANDATES 10 DAY NOTICE OF CANC FOR NONPAYMENT OF PREMIUM CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON ST. 2ND FLOOR KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHAU- IMPOSE NO OBLIGATION OR EABIUTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR ~) AC_ORD COBPDRATION 1988 AC.ORD 25-S (7/97) 46- 36 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYY) 9/22/05 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS CO-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: INSURER O: INSURER E: IVERAGES 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. POUCY EFFECTIVE i POLICY EXPIRATION INSR~.TR TYPE OF INSURANCE POLICY NUMBER DATE IMMIDD/YY) DATE (MM/DDIYY) UMITS A GENERAL LIABILITY Y630862K41 05 9/29/05 9/29/06 EACH OCCURRENCE ~ 1000000 X~MMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100000 ] CLAIMS MACE ~i OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 3.000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 [ POliCY [~PRO- ~E~T ~ LOC A AUTOMOBILE LIABILITY Y81 0862K4117 9/29/05 9/29/06 COMBINED SINGLE LIMIT $ 1000000 (La accident) X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ -- (Per person) SCHEDULED AUTOS X HIRED AUTOS ~ ,~ ~ ~I,'i~i~ I' BODILY INJURY $ (Per accident) X NON-OWNED AUTOS ~ ~ ,_~[,,4L~.,-,~.~ ,.~.~., T- ~ ............. PROPERTY DAMAGE $ '? !~;'i , , .... (Per accident) GARAGE LIABILITY ~j AUTO ONLY - EA ACCIDENT :.,,,,,, i: ;!,:~ .__yE;: ............ EAACC $ ANY AUTO ...... OTHER THAN -- AUTO ONLY: AGG $ B EXCESS LIABILITY QK06800836 9/29/05 9/29/06 EACH OCCURRENCE $ 3_5000000 WORKERS COMPENSATION AND/.~ C TORY LIMITS ER i EMPLOYERS' LIABILITY (~ ~ ,,.~~"r~' '~' E.L. EACH ACCIDENT I E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: BAYSHORE MANOR,~ ~ · CERTIFICATE HOLDER IS ADDITIONAL INSURED RE: GENERAL LIABILITY (-- ~-' ' AND AUTO LIABILITY FL STATUTE MANDATES 10 DAY NOTICE OF CANC FOR NONPAYMENT OF PREMIUM CERTIFICATE HOLDER I ]ADDITIONAL INSURED: INSURER LETTER: CANCELLATION MONROE COUNTY BOARD OF CO COMM ATTN: RISK MANAGEMENT 1100 SIMONTON ST.2nd FLOOR KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITYOF ANY KINDUPON THE INSURER,ITSAGENTS OR REPRESENTATIVES. -- AUT ORIZED REP~SENTA O ACORD CORPORATION 1988 ACORD 25-S (7/97) 46- 36 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 9/22/05 PRODUCER INSURED ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 G.A.Food Services of Pinellas 12200 32nd Ct., North St. Petersburg FL 33716 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. INSURERS AFFORDING COVERAGE INSURER A: TRAVELERS INS C0-01812 INSURER B: ST PAUL FIRE & MARINE-01470 INSURER C: INSURER D: I 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. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE {MM/DD/YY) DATE {MM/'DI~/YY) LIMITS A GENERAL LIABILITY Y630862K4105 9/29/05 9/29/06 EACH OCCURRENCE $ ].000000 X COMMERCIAL GENERAL LIABILITY F~E DA~M_A~E~(A_n~y once fire) I?_ ...... ~00000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $ 2000000 I POLICY ~1PRO- ~JE(~T ~ LOC A AUTOMOBILE LIABILITY Y810862K4117 9/29/05 9/29/06 COMBINED SINGLE LIMIT $ 1000000 X ANY AUTO (La accident) SCHEDULED AUTOS ' ~' '~ ~ 'r ~ ~'~ ~~t~' (Perp ) ..... X HIRED AUTOS "~ ~._~. ~ '~ ~.~~ ~ BODILY iNJURY X NON-OWNED AUTOS ~.~./~i[T~.~ ..~...~.~~ (Per accident) PROPERTY DAMAGE t~ y (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ AUTO ONLY: AGG $ B EXCESS LIABILITY QK06800836 9/29/05 9/29/06 EACH OCCURRENCE $ ].5000000 WORKERS COMPENSATION AND ~ TORY LIMITSrER EMPLOYERS' MABIUTY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE * POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSlVEHICLESIEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONAL INSURED GENERAL LIABILITY - BROAD FORM VENDORS ENDORSEMENT AND AUTO LIABILITY CC. ~ "~"~ FL STATUTE MANDATES 10 DAY NOTICE OF CANC FOR NONPAYMENT OF PREMIUM CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON ST. 2ND FLOOR KEY WEST FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER.ITSAGENTS OR REPRESSES. ~ ~ AUTI~RIZED REPROS ENTA, J~'~'~f~ ~ @ ACORD CORPORATION 1988 ACORD 25-S (7/97) 46- 36 This c~fifi~te is cxec'~m'4 b~ Liberty M,mml Imm'aue~ G~ ~ ~ s~h i~ ~ ~ a~o,d~ ~ ~ comtes. '. BMUg Ce~ificate of Insurance ~ ~e ~ifi~te hdi~r. T~s ccnifi~ is not an i~cc ~licy ~d d~s not ~d, exten~ or al~r ~e core,ge ~fi~ I you ~ ~Toi~ ~ ~ ~lici~ li~ ~low. 12200 32nd Court North St. Petersburg, FL 33716 LU~J. TU is, at the issue date of this certificate, inaur~ by the Company under ~e policy(i~s) listed below. The insurance afforded by the listed policy(ie~) is subje, I to all their terms, exclusions and conditions and issued. is'not altered by any rCcluirrment, t~m or co~di6on of any contract or ottwr dueo~c~.t wlta ~.~lr..~t to wm~a uu~ ~.~lu.~ ,,mI ~ ...... Expiration Type Expiration Date(s) Policy Number(s) l,imits of Liability Continuous* 01/01/2007 WC5-151-271854-096 Coverage afforded under WC law of Employers Liability __ the following states: Bodily Injury By Accident Extended ~- Policy Term I FL $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Bodily Injury By Disease Workers Compensation $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate H Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence I Retro Date Personal and Advertising Injury Per Person / Organization Other Liability I Other Liability Each Accident - Single Limit - B. I. and P. D. Combined Automobile Liability Each Person ' Owned Non-Owned Each Accident or Occurrence :Hired Each Accident or Occurrence T S *If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced befo~ the certi[cate expiration date. However, you w~ll not be nodfied annually Of the continuation of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an ~,~urer, submits an application or 51es a claim containing a false or deueptive statement is guilty of insurance fraud. Impotnant information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for aay reason, please contact your local sales producer, whose name and telephone number appears in the lower lei~ comer of this certificate. Thc appropriate local sales office mailing address may also be obtained by calling this numben Notice ofcancellatinn: (not applicable unless a number of days is entered below). Before the stated expiration date the company will not cancel or reduce the insurance afforded u~der the above Expiration Type Continuous* Extended X Policy Term Office: T;m?:~. F1 Phone: ?00 ?R2 621S Certificate Holder: Risk Management Monroe County Board of County Commissioners 1100 Simonton Street 2nd Floor Key W~t, FL 33040 AUDREY ACCETTA Authorized Representative Date Issued: 01/11/2006 Prepared By: LS Certificate of lnsurnnce IThis ce~ificat~ is issmxi a~ a mater of information only and confers no rights upon you the c~'tifiuate hold~'. This ce~fic, ate is not an insurance policy a~i do~ not amend, ext~ or alter th~ coverage This is to certify that (Name and address of Insured) St. 3716 Expiration Type Expiration Date(s) Policy Number(s) Limits of Liabilit~ Continuous* 01/01/2007 WC5-151-271854-096 Coverage afforded under WC law of Employers Liability -- 'the following states: Bodily Injury By Accident - Extended ~ " FL $500,000 Each Accident X Policy Term Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $$00,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate H Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence i RetroDateI Personal and Advertising Injury Per Person / Organization Other Liability [ Other Liability Each Accident - Single Limit - B. I. and P. D. Combined Automobile Liability Each Person Owned -- Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence S *If the certificate expiration date is continuous or extended term. you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified nn..nlly of ~ continuation of coven~e. . ............ Special Notice - Ohio: Any poson who, with intent ~o defraud or knovang that he / she ts factl~tanng a fraud against an insurer, submits an apphcat~on or files a claim contmnmg a false or deceptive statement is guilty of insunuge f~ud. Imporiant information to Florida policyholders and certificate hold,rs: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whuse nsrn~ and te!,~pht*~ number ~_~ ~n?.ar~ in th~ lower left comer of ~ c~ficate. The appropriate local sales office mailing address may also be obtained by calling this number. No!icc of canccl!ation:' .(n~t applicabl~.unl~ss a number o..f da? !~ Cnt~ below). Before the s~ted expiration date thc company will not cancel or reduce thc insurance afforded under the above Expiration Type Continuous* Extended X Policy Term Off;Ce: Tamp; F! DhoPe: ~na 2q?-~? ~ Ce~ifica~ Holder: Wing II, Room 297 Board of County Comm., Monroe County Public Services Bldg. Key West, FL 33040 ',. t r "':1. AUDREY AcCETTA Authorized Representative Date Issued: 01/11/2006 Prepared By: LS I DATE (MMIDDNYYY) 09/25/2006 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, r' om ;d,~ \"' J,' ., f', ._.:\ '.: \; '.', ',I ~~URERS AFFORDING COVERAGE INSURER A St. paul/Travelers CnVERAGE~ ; f\1Sh :vti'd'UI.Gf!viENT i 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. ~ = TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE GENERAL UABIUTY Y630862K4105 09/29/2006 X COMMERCIAL GENERAL LIABILITY I CLAIMS MADE [!J OCCUR AmRa, CERTIFICATE OF LIABILITY INSURANCE PROOUCER (813)637-8877 FAX (813)637-8484 Insurance Office of ~nerica, Inc. 4915 W. Cypress Street Sui te 100 Tampa, FL 33607 INSURED G.A. Food Services of Pinellar 12200 32nd Ct., North I St. Petersburg, FL 33716 i INSURER B: INSURER c: INSURER I?: "'n",ne ,.""UI\ISURERE. r ..', SEP ~ I P~~!f.r,EXPlRATION 09/29/2007 . . . . . PRODUCTS - COMP/OP AGG $ EACH OCCURRENCE DAMAGE TO RENTED MED EXP (Anyone person) A PERSONAL & ADV INJURY GENERAL AGGREGATE A GEN'L AGGR,.EnGATE. LIMIT AP rilPLlES PER: ----, PRO- X I POLICY JECT LOC AUTOMOBILE LIABILITY X ANY AUTO -'-'- ALL OWNED AUTOS ~ X HIRED AUTOS K NON-QWNED AUTOS - Y810862K4117 09/29/2006 09/29/2007 COMBINED SINGLE LIMIT (Eaaccident) BODILY INJURY (Per person) BODILY INJURY (Peraccidenl) PROPERTY DAMAGE (Peraccidenl) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG QK06800836 09/29/2006 09/29/2007 EACH OCCURRENCE AGGREGATE SCHEDULED AUTOS A ~~GE LIABILITY I ANY AUTO ~~SSIUMBRELLA. LIABILITY -.!J OCCUR D CLAIMS MADE I DEDUCTIBLE I RETENTION $ 10 I 00 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ~~E6I~tS~~bJv~~1~~s below OTHER E.l. DISEASE - POLICY LIMIT I T'XSJT~T.~~ I IOJb'- \\), \....' (/,. . (L . Zh;t~Oio. V . E.L DISEASE - EA EMPLOYE $ . E.L EACH ACCIDENT NAIC# LIMITS 1,000,000 100,000 5,OO~ l,OOO,OO~ 2,OOO,OO~ 2,000,00~ . l,OOO,OO~ . . . . . . . 15,OOO,00~ . . . . .... ()I'0f' C e((~ '(" , {' ,....,. )0 ",/\ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS t 11/1 I A C. n....,..,...-. ~ r I E: Bayshore Manor i:~~~ ertificate holder is additional insured RE: General Liability and Auto Liability s per form#CGD1871103 ~ c...C: (-, haJ1Cf2- ddendum to cancellation: 10 days notice applies for non-payment of premium. C\ T 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE D R Monroe County Board of Co Comm Risk Management 1100 Simonton St. 2nd Floor Key West, FL 33040 Herman Peer BUCKNN @ACORDCORPORATION 1988 n ACORO 25 (2001/08) SEP 2 7 DATE (MMIDDIYYYY) 09/25/2006 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 OVERAGE AFFORDED BY THE POLICIES BELOW, ACORO,. CERTIFICATE OF LIABILITY INSURANCE PRooueER (813)637-8877 FAX (813)637-8484 Insurance Office of America, Inc. 4915 W. Cypress Stree,t Suite 100 Tall1la, FL 33607 INSURED G.A. Food Servic:es 0 Pinella 12200 32nd Ct., North St. Petersburg, FL 33716 SA ORDING COVERAGE St.,PaulfTravelers NAIC# MONROE CO CnVERAGES 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. I~~ ~'l;~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PQ~CY EXPIRATION GENERAL LIABIUTY Y630862K4105 09/29/2006 09/29/2007 X COMMERCIAL GENERAL LIABILITY I CLAIMS MADE [:g] OCCUR A - - GEN'L AGGREGATE LIMIT A.P~S PER: I POLICY n ~~C?T I X I LOC AUTOMOBILE LIABILITY ~ X ANY AUTO -'-'- ALL OWNED AUTOS - X HIRED AUTOS X NON-OWNED AUTOS - - LIMITS $ $ $ PERSONAL & ADV INJURY $ $ PRODUCTS - COMPIOP AGG $ 1,000,00U 100,00U 5,00U 1,000,00U 2,000,00U 2,000,00~ EACH OCCURRENCE DAMAGE TO RENTED MED EXP (Anyone person) A GENERAL AGGREGATE SCHEDULED AUTOS Y810862K4117 09/29/2006 09/29/2007 COMBINED SINGLE LIMIT (Eaaccident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG QK06800836 09/29/2006 09/29/2007 EACH OCCURRENCE AGGREGATE A ~RAGE LIABILITY I ANY AUTO ~ESS/UMBRELLA LIABILITY -.!J OCCUR D CLAIMS MADE I DEDUCTIBLE I RETENTION $ 10, OO( WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OI-FICER/MEMBER EXCLUDED', ~~tl~Ls~~JVI~1~~s below OTHER 'OI.C{), "OJ-- q ;}q;-{)p "'f... __~n' (( n V'TV..'? CL"'1. vc.:,- (OJ\ ^ .~_ I T,:(~.;'T~Jg;, I IOJii- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ - V1U -t ,t..tV1 DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS on roe County Board of County Commissioners is additional insured general liability - broad form endors endorsement and auto liability as per form CGD1871103 ddendum to cancellation: 10 days notice applies for non-payment of premium. C:C,'~.t."1c..~ ,un,n~D ~ ..,~~, , Monroe County Board of County Commissioners 1100 Simonton St. 2nd Floor Key West, FL 33040 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE J I /"'\ Herman Peerv /BUCKNN ,,'- J( ;Z---... @ACORDCORPORATION 1988 ACORD 25 (2001/08) ACORQ. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDfYYYY) 09/25/2006 PRODUCER (813)637-8877 FAX (813)637-8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4915 W. Cypress Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 Tampa, FL 33607 INSURERS AFFORDING COVERAGE NAIC# INSURED G.A. Food Services of Pinellas INSURER A: St. PaulfTravelers 12200 32nd Ct., North INSURER B: Travelers Insurance Companies St. Petersburg, FL 33 716 INSURER c: INSURER 0: INSURER E: _COVERA"F'S 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. I~~: r..~'l:i TYPE OF INSUFU~CE POLICY NUMBER POL.ICY EFFECTIVE P~~!fY EXPIRATION LIMITS GENERAL LIABILITY Y630862K4105 09/29/2006 09/29/2007 EACH OCCURRENCE $ 1,000,00C ~ X COMMERCIAL GENEHAl LIABILITY DAMAGE TO RENTED $ 100,0~ I CLAIMS MADE [!] OCCUR MED EX? (Anyone person) $ 5,00C A PERSONAL & ADV INJURY $ l,OOO,OOC f--- GENERAL AGGREGATE $ 2,000,00~ f--- GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/QP AGG $ 2,000,00~ j POLICY n j~i !Xl LOe ~TOMOBILE LIABILITY Y810862K4117 09/29/2006 09/29/2007 COMBINED SINGLE LIMIT }, (Eaaccident) $ 1,000,OllC ~ ANY AUTO ~, CZn ,;/ . ALL OWNED AUTOS BODilY INJURY f-- $ SCHEDULED AUTOS .-.. (Per person) A "x . (d-.-l9::C f. HIRED AUTOS 80DIL Y INJURY f-"- u. $ ~ NON-OWNED AUTOS (Per accident) ..} - ((L I~=u PROPERTY DAMAGE - ,& (Peraccidenl) $ ~RAGE LIABILITY vr ( ')..,'00 AUTO ONLY - EA ACCIDENT $ ANY AUTO C -, OTHER THAN EA ACe $ 'bib 'Jr'" AUTO DNL Y: AGG $ tKJ~SSlUMBRELLA L1ABILIITY QK06800836 09/29/2006 09/29/2007 EACH OCCURRENCE $ 15.000,00~ X OCCUR 0 CL"'IMS MADE AGGREGATE $ 15 ,OOO,OO~ A $ q DEDUCTIBLE $ RETENTION $ 10,001 $ WORKERS COMPENSATION AND YVYAN-UB-8465C43-5-07 01/01/2007 01/01/2008 X I WCSTATU;,I 10TH- EMPLOYERS' LIABILITY 500,00~ B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 500,00~ ~~~r~iS~~~vj~ro~s below E.L DISEASE - POLlCY LIMIT $ 500,0~ OTHER DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS onroe County Board of County Commissioners is additional insured general liability - broad form endors endorsement and auto liability as per form CGD1871103 ~ddendum to cancellation: 10 days notice applies for non-payment of premium. Monroe County Board of County Commissioners 1100 Simonton St. 2nd Floor Key West, FL 33040 N 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD2~(2201ro~ c..c:.~ Mark Sheffield/CURTIF ~ ~ @ACORD CORPORATION 1988 PRODUCER (813)637-8877 Insurance Office of America, 4915 W. Cypress Strl!et Suite 100 Tampa, Fl 33607 INSURED G. A. Food Serv'; ces of 12200 32nd Ct." North St. Petersburg" Fl 33716 I DATE (MMfDDIYYYY) 09/25/2006 FAX (813)637-8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I ONltDEY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ne. .. ... - - "ff6l: . THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ~( f' i": i: ! 'Ii E 0 ALTER HE COVERAGE AFFORDED BY THE POLICIES BELOW. ,. --~::::_::':"--IN- UREA AFFORDING COVERAGE NAIC # INS RERA: St. paul/Travelers INS RERB: Travelers Insurance Con.,anies cnv 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. 11f".;s:~~~! TYPE OF IN5UR.j~CE POLICY NUMBER POUCY EFFECTIVE p~~~ EXPIRATION ~NERAL LIABILITY Y630862K4105 09/29/2006 09/29/2007 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I CLAIMS MADE [[] OCCUR .A.mRQ. CERTIFICATE OF LIABILITY INSURANCE i Pine las ~18'~(~ MONROE COUNTY RISK MANAGEMENT INS RER C: INSURER D: INSURER E: LIMITS A $ $ $ $ $ PRODUCTS - COMP/OP AGG $ MED EXP (Anyone person) PERSONAL & ADV INJURY GENERAL AGGREGATE A GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY n ~f8T rxl LOC ~TOMOBILE LIABILITY --.! ANY AUTO _ ALL OWNED AUTOS _ SCHEDULED AUTOS --.! HIRED AUTOS .!. NON-OWNED AUTOS Y810862K4117 09/29/2006 09/29/2007 OMBINED SINGLE UMIT . (11 aa,ccident) '(Y"t "~",(J? .~ ,: ";?~~';;~;)URY 1-.. t \ ,.~.- ~- C l ~-+- ( BODILY INJURY . . .... '.'\0 Jq~P_ ". f... ..5<v.. (peT;"Ofld,"') ,,; ," ~...,..:: _",,__ _,.~., (P~~:;c~~;~gAMAGE V'ii\i"J:; i hRAGE LIABILITY H ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ 09/29/2007 EACH OCCURRENCE $ AGGREGATE $ $ $ $ 01/01/2008 X I T~"H~T.~~ I IOJ.\" E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ EL DISEASE. POLICY LIMIT $ A ~ESSJUMBRELLA LIABILITY L!J OCCUR D CLAIMS MADE h DEDUCTIBLE H RETENTION $ 10 , OO( WORKERS COMPENSATION AN[I EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ~~~I~tS~~~VI~16~s below OTHER QK06800836 09/29/2006 YVYAN-UB-8465C43-5-07 01/01/2007 B DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS E: Bayshore Manor ertificate holder is additional insured RE: General liability and Auto liability s per form#CGD187110J ddendum to cancellat";on: 10 days notice applies for non-payment of premium. TC ..~. n~R I LATION 1,000,001 100 , 001 5,001 1,000,001 2,000,001 2,000,001 $ 1,000,001 $ $ $ 15,000, OO~ 15,OOO,OO~ 500,OO~ 500,OO~ 500 OO~ 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /7 /7 II . ~ __ Mark Sheffield/CURTIF .~~- @ACORDCORPORATION 1988 Monroe County Board of Co COI1ll1 Risk Management 1100 Simonton St. 2nd Floor Key West, Fl 33040 ACORD 25 12001/.08) Coc. :~ ACORQ, CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) 09/28/2007 PRODUCER (813)637-8877 FAX (813)637-8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4915 W. Cypress Street I' ALTER T E COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 i -- INSU\-ERS r<FFORDING COVERAGE NAIC# Tampa, FL 33607 INSURED G.A. Food Services of Pinelllas I INSURE RA' T avelers 12200 32nd Ct. , North ~ 1 INSUR RB: N rth River Insurance Company L:.~ , St. Petersburg, FL 33 716 INSUR RC' T e Phoenix Ins. Co 25623 D r'/1nr\'HnE Glf!.!;'!! INSURER E: Ci' . "i" . COVERAGES u , 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. INSR ~,9'2:~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PRk!fJ EXPIRATION LIMITS GENERAL LIABILITY Y630862K4105 09/29/2007 09/29/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00( n pOllcD~~8T rxl LOC AUTOMOBILE LIABILITY Y810862K4117 09/29/2007 09/29/2008 COMBINED SINGLE LIMIT 'x (Eaaccident) $ 1,000,000 ANY AUTO C- ALL OWNED AUTOS /'\ BODrL Y INJURY - $ SCHEDULED AUTOS t-v (Per person) A 'x (Ot~ HIRED AUTOS ..) BODrL Y INJURY X $ NON-OWNED AUTOS r0-o ., (Per accident) r- ID ~ PROPERTY DAMAGE $ 'v' (Per accident) GARAGE LIABILITY \~ OJI(J~ ((jj, AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY 5530904451 09/29/2007 09/29/2008 EACH OCCURRENCE $ 15,000,000 ~ OCCUR 0 CLAIMS MADE \l:Q, AGGREGATE $ 15,000,000 B CC $ ~ ,DEDUCTIBLE fiT -- $ RETENTION $ I -"- $ WORKERS COMPENSATION AND YVYAN-UB-8465C435 07 01/01/2007 01/01/2008 X I, WC STATU-_ I I OJ~- EMPLOYERS' LIABILITY 500 , OO( C ANY PROPRIETORlPARTNERlEXECUTIVE El. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? ~~~SEASE - EA EMPLOYEE $ 500,001 If yes, describe under ---~-'--~~ SPECIAL PROVISIONS below E.l. DISEASE - POLICY LIMIT $ 500,000 r~THER . Y810862K4117 09/29/2007 09/29/2008 $500 Deductible comprehenslve Coverage A Collision Coverage $500 Deductible DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS E: Bayshore Manor ertificate holder is additional insured RE: General Liability and Auto Liability ~s per form#CGD1871103 ~C' ~\ "'-c:U'\ C e... ~ddendum to cancellation: 10 days notice applies for non-payment of premium. C E L R Monroe County Board of Co Comm Risk Management 1100 Simonton St. 2nd Floor Key West, Fl 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAil .JL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) Mark Sheffield KURINJ ~ ~ @ACORDCORPORATION 1988 ACORQ, CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 09/28/2007 PRODUCER (813)637-8877 FAX (813)637-8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Office of America, Inc. -- ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ~DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4915 W. Cypress Street RAGE AFFORDED BY THE POLICIES BELOW. Sui te 100 .. .'Cfl'r'l Taqla, FL 33607 IN -AFFORDING COVERAGE NAIC # INSURED G.A. Food Services of Pinellas INSURER A: Travelers 12200 32nd Ct., North 'INSURER B: North River Insurance Co~any St. Petersburg, FL 33 716 INSURER C The Phoenix Ins. Co 2S623 .....-.- 1 lNSURER D: -------- 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. INSR DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY Y630862K41OS 09/29/2007 09/29/2008 EACH OCCURRENCE $ l,OOO,Ooe ex COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100, ooe I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ s,ooe A PERSONAL & ADV INJURY $ l,OOO,Ooe r- GENERAL AGGREGATE $ 2,OOO,Ooe ~N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG $ 2,OOO,Ooe n POLICY n jf-g,: rxlLOC AUTOMOBILE LIABILITY Y810862K4117 09/29/2007 09/29/2008 COMBINED SINGLE LIMIT rx- (Eaaccident) $ 1,000,Ooe ANY AUTO [l.C - ALL OWNED AUTOS rn)5 BODILY INJURY - ~ (Per person) $ SCHEDULED AUTOS A X a-() l HIRED AUTOS )D BODILY INJURY X $ NON-OWNED AUTOS (Per accident) - "- PROPERTY DAMAGE $ . '" (Per accident) GARAGE LIABILITY O~IJ ~L---' AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO OTHER THAN EAACC $ AUTO ONLY. AGG $ EXCESSfUMBRELLA L1ABIUTY 55309044S1 09/29/2007 09/29/2008 EACH OCCURRENCE $ lS,OOO,ooe J=KJ OCCUR D CLAIMS MADE (J'. \.' 00 AGGREGATE $ 15,000,00( B $ R DEDUCTIBLE ?J...P. ~RV) $ RETENTION $ ( $ WORKERS COMPENSATION AND YVYAN-UB-846SC43S-07 01/01/2007 01/01/2008 X I T';!:~ sr~JN;d I OJ~' EMPLOYERS' UABILlTY SOO,OOI C ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $ OFFICERfMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ SOO, 001 If yes, describe under soo,ooe SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ OTHER Y810862K4117 09/29/2007 09/29/2008 $SOO Deductible o~rehensive Coverage A ollision Coverage $SOO Deductible ~~ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS onroe County Board of County Commissioners is additional insured general liability - broad form wendors endorsement and auto liability as per form CGD1871103 ~C... \= \ Y\Q VI C ~ ~ddendum to cancellation: 10 days notice applies for non-payment of premium. T Monroe County Board of County Commissioners 1100 Simonton St. 2nd Floor Key West, FL 33040 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) Mark Sheffield KURINJ ~ ~ @ACORDCORPORATION 1988 ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDfYYYY) 12/20/2007 PRODUCER (813)637-8877 FAX (813)637-8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Office of An~rica, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4915 W. Cypress Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 ",;,_. .'j, " i . . AFFO DING COVERAGE NAIC# Tampa, FL 33607 - INSURED G.A. Food Services of Pinellas INSURER A rave ers 12200 32nd Ct., North DEe 2 R-<SQ~, ~ brth River Ins. Co. St. Petersburg, FL 33 716 i INSURER C, Iltri dgefi e 1 d Employers Ins. Co. 10701 I i...-_ -..-.-..--. IN.SllBEB.D~ ~usau .. " :,"y- 1>\.O"EH 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 INSR DO' TYPE OF INSURAN(:E POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS 09/29/2008 EACH OCCURRENCE $ 1,000,OOC DAMAGE 19r~ENTED $ 100,000 MED EXP (Anyone person) $ 5,OOC PERSONAL & ADV INJURY $ n t~~~: ~~1 GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ 2,000,00C GENERAL LIABILITY ~ X COMMERCIAL GENERJl.L LlABILlTY I CLAIMS MADE [~ OCCUR Y630862K4105-TIL 07 09/29/2007 IA I--- I--- GEN'LAGGR;-EnGAT-E, LlMIT A.P ~PLl:,EfS, PER h PRO- POLlCY JECT lOC A AUTOMOBILE LIABILITY I--- ~ ANY AUTO I--- SCHEDULED AUTOS X HIRED AUTOS -.! NON"OWNED AUTOS ALL OWNED AUTOS Y810862K4~1 1.7-T L-O( /29/~~7 .09../29/2008 l'J",~ - . '-:::;h-- . \~JJ-:~IL- ). COMBINED SINGLE LlMIT (Eaaccident) $ 1,000,OOC SOOIL Y INJURY (Per person) $ .. BODILY INJURY ___,,___ (Per accident) tVi" (' ,1 IIIYROPERTY DAMAGE LI , UnIU~ (Per accident) $ $ B GARAGE LIABILITY ~'ANY AUTO EXCESS/UMBRELLA LIABILITY ~ OCCUR D CLAIMS MADE I DEDUCTIBLE 'I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 1 ANY PROPRIETORlPARTNERlEXECUTIVEO 9 OFFICER/MEMBER EXCLUDED? ""WC If yes, describe unCler SPECIAL PROVISIONS below OTHER omprehensive Cover-age ollision Coverage ^ 'l, )J /AJ Arb" ;,. (')ftnh\ '};r;~ (./ 5530904451 09/29/2007 109/29/2008 AUTO ONLY - EA ACCIDENT EACH OCCURRENCE AGGREGATE $ EA ACC $ $ $ $ $ $ $ AGG OTHER THAN AUTO ONLY: 15,OOO,OOC 15,000,OOC C 0830-38608 FL -06953-AR,GA,KY,SC,TN -Z91-447877-018 PA,TX *INSURER LETTER - 0 Y810862K4117-TIL-07 01/01/2008 01/01/2008 01/01/2008 01/01/2009 01/01/2009 Oli01/2009 I TVX'i,:!':eT~~ liD'!"" 09/29/2007 09/29/2008 EL EACH ACCIDENT $ ~~ nISEASE' - F.A FMPlOYff': $ E.l. DISEASE - POLlCY LIMIT $ $500 Deductible $500 Deductible 500,OOC ~OO;OO~ 500,00C A DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS on roe County Board of County Commissioners is additional insured general liability - broad form endors endorsement and auto liability as per form CGD1871103 ddendum to cancellation: 10 days notice applies for non-payment of premlum. ICATE HnLD"" CANC"L AT'^. Monroe County Board of County Commissioners 1100 Simonton St. 2nd Floor Key West, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~ ~~ Mark Sheffield/BARRES ACORD 25 (~oo1l08) . C(...~~ @ACORD CORPORATION 1988 A CORa, CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDOlYYYY) 12/20/2007 PRODUCER (813)637-8877 FAX (813)637-8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 4915 W. Cypress Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Su ite 100 REeE ~}JJD~RS AFFO~DING COVERAGE Tampa, FL 33607 NAIC# INSURED G.A. Food Services of Pinellas ~ INSURER A: Trave l!ers 12200 32nd Ct., North , ,lNSURERB: North 'River Ins. Co. St..Petersburg, FL 33716 INSURERC Bridgefield Employers Ins. Co. 10701 INSURER D Wausau .. INSURER E COVERAGES . THE POLICIES OF INSURANCE U$TED 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. Il~~: ~i1,'1:! TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P~k!fi, EXPIRATION LIMITS GENERAL LIABILITY Y630862K4105-TIL-07 09/29/2007 09/29/2008 EACH OCCURRENCE $ 1,000,00< X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,OO( I CLAIMS MADE [~OCCUR MED EXP (Anyone person) $ 5,000 A j PERSONAL & ADV INJURY $ I,OOO,O()O GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT P,PPLlES PER PRODUCTS - COMP/OP AGG $ 2,000,000 II 'II PRO- n POLICY JECT LOC AUTOMOBILE LIABILITY Y810862K4117-TIL-07 09/29/2007 09/29/2008 COMBINED SINGLE L1MlT X (Eaaccident) $ I,OOO,OO( ANY AUTO - C ~J Slr_ - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS {Per person) A X .~-~ HIRED AUTOS ~dl {) ") BODILY INJURY X $ NON-OWNED AUTOS (Per accident) -'-'- . - '1\ 'J., IL,/ PROPERTY DAMAGE $ . ,n~'( {Per accident) GARAGE LIABILITY IJ?~.: ~;6iQ~ AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO OTHER THAN EAACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA L1ABIl.ITY 5530904451 09/29/2007 1&29/2008 EACH OCCURRENCE $ 15,000,000 tJ OCCUR 0 CLAIMS MADE ~.. . (ti.l.[M1 AGGREGATE $ B $ 15,OOO,oor R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 0830-38608 FL 01/01/2008 01/01/2009 I_IX" STtJ,~;, I 10J~ C EMPLOYERS' LIABILITY 019 -06953-AR,GA,KY,SC,TN 01/01/2008 01/01/2009 E,L EACH ACCIDENT $ 500,00< ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? 1rWC -Z91-447877-018 PA,TX 01/01/2008 01/01/2009 E L DISEASE - EA EMPLOYEE $ 500.00C If yes, describe under *INSURER LETTER - D ~,L. DISEASE - POLICY LIMIT 'I $ 500;001: SPECIAL PROVISIONS below II""~THER Y810862K4117-TIL-07 09/29/2007 09/29/2008 $500 Deductible ,-ol11lrehensive Covelrage A Collision Coverage $500 Deductible IlDtSCRlPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS .E: Bayshore Manor ~ertificate holder is additional insured RE: General Liability and Auto Liability ~s per form#CGDI87110J ~ddendum to cancellarion: 10 days notice applies for non-payment of premium. CERTIFIC 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE ~ ~ Monroe County Board of Co Comm Risk Management 1100 Simonton St. 2nd Floor Key West, FL 33040 Mark Sheffield/BARRES ACORD 25 (~Olf08) Gc.:~ @ACORDCORPORATION 1988 ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYJ 7/22/08 PRODUCER 727-796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo In,;urance Services 1:\~emR. THISJ FERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. REC ERTIFICATE DOES NOT AMEND. EXTEND OR THE CO RAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 316fi6 ...-----_.. I IN Tampa, FL 33631-3666 pURERS AFFORDING COVERAGE INSURED JUL ~JLRIt\>MV I Zuric American Ins G.A.Food Services of Pinellas 12200 32nd Ct., North INSURER B: 1 Brid9 field Employers Ins. Co. --' Waus U St. Petersburg FL 33716 fN'~;!( - P1S!:, 1\:' ~T - ---- INSURER E: 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II~~: TYPE OF INSURANCE POUCY NUMBER ~9.';I.~Y EFFECTIVE POUCY EXPIRATION UMITS A _~ERAL L1ABIUTY CP09671871-00 7/19/08 7/19/09 EACH OCCURRENCE . 1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire} , 100000 1-. _ j CLAIMS MADE W OCCUR MED EXP (Any one person~ , 5000 I-- PERSONAL & ADV iNJURY $ 1000000 I-- GENERAL AGGREGATE $ 2000000 rl'L AGGR,En LIMIT AP~l PER: PRODUCTS - COMP/OP AGG . 2000000 POLICY ~~,9.;. LOC A ~TOMOBILE UABIUTY CP09671871-00 7/19/08 7/19/09 COMBINED SINGLE LIMIT (Eaaccidentl , 1000000 el5. ANY AUTO I-- ALL OWNED AUTOS BODILY INJURY "fi\c ~o. -< $ - SCHEDULED AUTOS (Per person) ..x H\REO AUTOS BODILY INJURY " $ ..x NON~OWNED AUTOS (Peraccidentl 7- d-fyc t PROPERTY DAMAGE . (Peraccidentl ~AGE UABIUTY " (fl~ AUTO ONLY - EA ACCIDENT $ OVa', {" ANY AUTO OTHER THAN EA ACC . AUTO ONLY: AGG $ A EXCESS UABILlTY UMB9671947-00 7/19/08 _0;19/09 EACH OCCURRENCE . 15000000 ~l OCCUR 0 CLAIMS MADE . ~ AGGREGATE $ 15000000 CC' " , R DEDUCTIBLE 31., \ ......./J , RETENTION $ $ B I WORKERS COMPENSATION ANO 0830-38608 FL 1/01/08 1/01/09 X ! ~~~T ~\~S \ I Ol~- I EMPLOYERS' LIABILITY 0196-06953 - AR. 1/01/08 1/01/09 I E.L. EACH ACCIDENT , 500000 GA.KY,SC,TN E.L. DISEASE - EA EMPLOYEE , 500000 INS C-PA TX WCKZ91447877018 1/01/08 1/01/09 E.L. DISEASE - POLICY LIMIT $ 500000 A OTHER CP09671871-00 7/19/08 7/19/09 PHYSICAL DAMAGE COMPREHENSIVE DED: $500 COLLISION DED: $500 DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MONROE COUNTY BOCC IS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY 10 DAYS CANCELLATION NOTICE FOR NONPAYMENT OF PREMIUM CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MONROE COUNTY BOCC DATE THEREOF. THE ISSUINQ INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN RISK MANAGEMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL 1100 SIMONTON ST, 2ND FLOOR IMPOSE NO OBUGATION OR LIABILITY OF ANY KINO UPON THE INSURER. ITS AGENTS OR KEY WEST FL 33040 REPRESENTATIVES. AUTHORIZA R;:"RUT;Vj h- L , ACORD 25-S 17/97Y. . 46- 38 @ AC"1lRD CORPORATION 1988 COVERAGES c.c.:~~ ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE tMMIDD/VYJ 7/22/08 PRODUCER 727-796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo Insurance Services ~~~Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. .- ERTIFICATE DOES NOT AMEND, EXTEND OR HLC\ . Hnr:r<'A THE CO ERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 316Ei6 .'-'-'=:'- - Tampa, FL 33631-3666 ,------- - , I SURERS AFFORDING COVERAGE INSURED G.A.Food Services of Pinellas JUL i If~SURER A; Zuri h American Ins 12200 32nd Ct., North E?U~EitB:' Brid efield Employers Ins. Co. St. Petersburg FL 33716 INSURER c: Wa' au MONRO ' lNAUReWD: , RISK MA ~~. 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. Ilr-'~!' TYPE OF INSURANCE POUCY NUMBER ':.~';!p EFFECTI~~ POLICY EXPIRATION UMITS A _~ERAL UABILlTY CP09671871-00 7/19/08 7/19/09 EACH OCCURRENCE . 1000000 X COMMERCIAL GENERAL L1i~BILlTY FIRE DAMAGE (Anyone fire] $ 100000 ! CLAIMS MADE W OCCUR MED EXP (Anyone parson) $ 5000 - PERSONAL & ADV INJURY $ 1000000 - GENERAL AGGREGATE $ 2000000 r-l'L AGG~En LIMIT AP~l PER: PRODUCTS - COMP/OP AGG $ 2000000 POLICY , ~~9T LOC A ~TOMOBILE LlABIUTY CP09671871-00 119/08 7/19/09 COMBINED SINGLE LIMIT \:'{\ 0. ( (Eaaccidentl $ 1000000 ~ ANY AUTO I-- ALL OWNEO AUTOS BODILY INJURY . - SCHEDULED AUTOS =t -J~- 0'8 (Perpersonl ~ HIRED AUTOS BODILY INJURY $ ~ NON-OWNED AUTOS lPeraccidentl "i. fl& : fQuil -- r PROPERTY DAMAGE $ (Per accident) ROE UABIUTY ',~Oa AUTO ONLY. EA ACCIDENT . ANY AUTO Lc OTHER THAN EA ACC $ [\;;.. < 1 __ AUTO ONLY: AGG $ A EXCESS UABIUTY UMB9671947-00 7/19/08 >-'~ 7/19/09 EACH OCCURRENCE $ 15000000 Q' OCCUR D CLAIi'o'1S MADE AGGREGATE $ 15000000 $ R ~EDUCTIBLE $ RETENTION . $ B I WORKERS COMPENSATION AND 0830-38608 FL 1/01/08 1/01/09 X 1 iX~,;>Ir}Ig;:, I 1 oJ~- ---- EMPLOYERS' UABIUTY 0196-06953 - AR, 1/01/08 1/01/09 E.L. EACH ACCIDENT . 500000 GA,KY,SC,TN E.l. DISEASE - EA EMPLOYEE $ 500000 INS C-PA TX VVCKZ91447877018 1/01/08 1/01/09 E.L. DISEASE - POLICY LIMIT $ 500000 A OTHER CP09671871-00 7/19/08 7/19/09 PHYSICAL DAMAGE COMPREHENSIVE DED: $500 COLLISION DED: $500 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES1EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: BA YSHORE MANOR CERTIFICATE HOLDER IS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY 10 DAYS CANCELLATION NOTICE FOR NONPAYMENT OF PREMIUM CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION MONROE COUNTY BOCC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN RISK MANAGEMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1100 SIMONTON ST, 2ND FLOOR IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR KEY WEST FL 33040 REPRESENTATIVES. AUTHORIZA REPRESnTIIV, , ,.... t kL ACORD 25-SP/9.7) 46- 38 Ii> AcllRD CORPORATION 1988 COVERAGES CC-:~K- GA37550 ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MMfDDIYYYY) 12/18/2008 PRODUCER Wells Fargo Insurance Servicess THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 31666 Tampa, FL 33631-3666 J! - INSURERS AFFORDING COVERAGE NAIC# INSURED , Zurich American Insurance Co 16535 G. A. Food Services of Pinellas - - INSURER A: 12200 32nd Court, North INSURER B' AIG Dr r INSURER c: t INSURER D: St. Petersburg. FL 33716 , INSURER E' COVERAGES . ~I\ONRC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS lNSURED 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. LT. " TYPE OF INSURANCE POLICY NUMBER PDOAL~SY EFFECTIVE p~~fJ,i.~~~~N LIMITS A ~NERAL LIABILITY CP09671871-00 7/19/08 7/19/09 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DA~AGE TO RENTED $ 100,000 I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000,000 - ~'L AGG~EnE LIMIT APPlS PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY ~~RT LOC A ~TOMOBILE LIABILITY CP09671871-00 7/19/08 7/19/09 COMBINED SINGLE LIMIT $ X (Eaaccidenl) 1,000,000 - ANY AUTO - ALL OWNED AUTOS fY0', @/l BODILY INJURY $ SCHEDULED AUTOS (Per person) - ..2.. HIRED AUTOS '[rl-'~~( [ BODILY INJURY I $ ..2.. NON-OWNED AUTOS (Per accident) - !:;j( L.) jJk PROPERTY DAMAGE $ (Peraccidenl) ~~GE LIABILITY \o-'V' I , ~k AUTO ONLY - EA ACCIDENT $ ANY AUTO 'l OTHER THAN EA ACC $ , AUTO ONLY: AGG $ A ~~SSJUMBRELLA LIABILITY UMB967194700 7/19/08 7/19/09 EACH OCCURRENCE $ 15,000,000 X OCCUR D CLAIMS MADE AGGREGATE $ 15,000,000 $ =1 ~EDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND 6506573 01/01/09 01/01/10 X I.,.~~,?!~T.~;.I IDJ~ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $ 500,000 II yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS {VEHICLES {EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS MONROE COUNTY BOCC IS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN MONROE COUNTY BOCC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL RISK MANAGEMENT IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 SIMONTON ST, 2ND FLOOR REPRESENTATIVES. KEY WEST FL 33040 AUTHORIZED REPRESENTATIVE 1/ '\. ~. Il--r.-_____ ACORD 25 (29!l1/08l1 of 2 315280 c.c.:~ @ ACORD CORPORATION 1988 GA37550 ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYVYj 12/18/2008 PRODUCER Wells Fargo Insurance Servicess THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 31666 , - Rf' rf:"l; Tampa, FL 33631-3666 INSURERS ,j.FFORDING COVERAGE NAIC# INSURED G. A. Food Services of Pinellas "-..- INSURER A: ZJrich American Insurance Co 16535 12200 32nd Court, North INSURER B AIJ:; DEe 2 r. L INSURER c: INSURER D' , St. Petersburg, FL 33716 I INSURER E: COVERAGES -~ '''' , THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN~URED NAMED ABO'\lE 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 BYTHE 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. POLICY NUMBER Pt?;~~~J~r68~\E POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE A GENERAL LIABILITY CP09671871-00 7/19/08 7/19/09 EACH OCCURRENCE $ 1,000,000 ex COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000 I- PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 f-- n'L AGG~EnE LIMIT APnS lPER: PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY ~~9T LOC A ~TOMOBILE LIABILITY CP09671871-00 7/19/08 7/19/09 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO (Eaaccidenl) - c- ALL OWNED AUTOS BODILY INJURY Q $ SCHEDULED AUTOS ''oi\.~ ~ II (Per person) - ...2C. HIRED AUTOS BODILY INJURY {Peraccidenlj $ ...2C. NON-OWNED AUTOS -06 - - \O~O .. PROPERTY DAMAGE $ . (Peraccidenl) ~RAGE LIABILITY !)fY, (a VL AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ A iJESS/UMBRELLA LIABILITY UMB967194700 ~j, G 7/19/08 7/19/09 EACH OCCURRENCE $ 15,000,000 X OCCUR 0 CLAIMS MADE ~ AGGREGATE $ 15,000,000 J~/:~ hi} 0\\ 0 (()/ $ ~ DEDUCT,"'E $ RETENTION $ $ B WORKERS COMPENSATION AND 6506573 " 01/01/09 01/01/10 x I T~~-7r~L~.~ I IOJ~- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500.000 ANY PROPRIETORfPARTNERfEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under 500,000 SPECIAL PROVISIONS below E.L. DISEASE. POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS RE:RE: BAYSHORE MANOR CERTIFICATE HOLDER IS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE SSSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN MONROE COUNTY BOCC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL RISK MANAGEMENT IMPOSE NO OBl.IGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 SIMONTON ST. 2ND FLOOR REPRESENTATIVES. KEY WEST FL 33040 AUTHORlZED REPRESENTATIVE If '" ~. Il--r_______ ACORD 26 (2001/08) 1 of 2 315279 @ ACORD CORPORATION 1988 10412 A CORDTM CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 12/17/2009 PRODUCER Wells Fargo Insurance Servicess THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 31666 Tampa, FL 33631-3666 INSURERS AFFORDING COVERAGE NAIC # INSURED G. A. Food Service of Pinellas County, Inc. INSURER A: Zurich American Insurance Co 16535 12200 32nd Court, North INSURER B: Granite State Insurance Company 23809 INSURER C: INSURER 0: St. Petersburg, FL 33716 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. t TR NSR TYPE OF INSURANCE POLICY NUMBER PJ>l-{~Y :~F~CTIVE LIMITS 7/19/08 03/15/10 EACH OCCURRENCE $ DAMAGE TO RENTED $ MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ A GENERAL LIABILITY CP09671871-00 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [8] OCCUR A GEN'L AGGREGATE LIMIT APPLIES PER: ~~8T LOC AUTOMOBILE LIABILITY CP09671871-00 X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS 7/19/08 03/15/10 GARAGE LIABILITY ANY AUTO A UMB967194700 7/19/08 03/15/10 EXCESS/UMBRELLA LIABILITY X OCCUR D CLAIMS MADE B DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS. LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER Auto Physical Damage o WC006506573 A CP09671871-00 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) OTHER THAN AUTO ONLY: $ EA ACC $ $ $ $ $ $ $ 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 $ 1,000,000 AUTO ONLY - EAACCIDENT AGG EACH OCCURRENCE AGGREGATE X $ $ $ 15,000,000 15,000,000 500,000 500,000 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE:RE: Bid-SSD Food Services & Meal Catering For Monroe Co Nutrition Program Monroe County Board of County Commissioners are named as additional insured regarding general liability and automobile liability. E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ Comprehensive Oed: 500 Collision Oed: 500 CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Monroe County Purchasing Office 1100 Simonton Str et, Room 1-213 Key West FL 3 40 c.c., -: ACORD 25 (2001/08) 1 of 2 1032389 4,/.1. Jt-.~ @ ACORD CORPORATION 1988 10412 A CORDTM CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 12/17/2009 PRODUCER Wells Fargo Insurance Servicess THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 31666 Tampa, FL 33631-3666 INSURERS AFFORDING COVERAGE NAIC # INSURED G. A. Food Service of Pinellas County, Inc. INSURER A: Zurich American Insurance Co 16535 12200 32nd Court, North INSURER B: Granite State Insurance Company 23809 INSURER C: INSURER D: St. Petersburg, FL 33716 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. t TR NSR TYPE OF INSURANCE POLICY NUMBER PJ>,t{~Y :~~~8TIVE LIMITS A GENERAL LIABILITY CP09671871-00 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 0 OCCUR 7/19/08 03/15/10 EACH OCCURRENCE $ DAMAGE TO RENTED $ MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COM PlOP AGG $ A GEN'L AGGREGATE LIMIT APPLIES PER: jr8-r LOC AUTOMOBILE LIABILITY CP09671871-00 X ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) 03/15/10 7/19/08 COMBINED SINGLE LIMIT (Ea accident) SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS .lJ{\~ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO $ EA ACC $ $ $ $ $ $ $ AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: AGG A UMB967194700 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ EACH OCCURRENCE AGGREGATE EXCESS/UMBRELLA LIABILITY X OCCUR D CLAIMS MADE DEDUCTIBLE RETENTION $ B WORKERS COMPENSATION A~!D EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER WC006506573 x DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE:RE: BAYSHORE MANOR CERTIFICATE HOLDER IS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 $ 1,000,000 $ $ $ 15,000,000 15,000,000 500,000 500,000 500,000 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _. 4 "" J..l. Jl--r~ @ ACORD CORPORATION 1988 MONROE COUNTY soce RISK MANAGEMENT 1100 SIMONTON ST, 2ND FLOOR KEY W~ST ~ 33040 L'-'~ ACORD 25 (2001/08) 1 of 2 1032257 10412 PRODUCER Commercial Unes '. (127) 796-6666 Wells Fargo Insurance Services USA, Inc. 311 Park Place Boulevard, Suite 400 Clearwater, FL 33759-3923 G. A. Food Service of Pinellas County, Inc. 12200 32nd Court, North INSURERS AFFORDING COVERAGE INSURER A: Zurich American Insurance Co INSURER s: Moo mery Mutual Insurance Company INSURER INSURER 0: Granite State Insurance Company INSURER E: INSURED St. Petersburg, FL 33716 CP09671871-02 $ $ $ $ GENERAL AGGREGATE $ PRODUCTS. COMPIOP AGG $ B B 02CE216187-1 (FL) 02CE216188-1 (NY) 03/15/2010 03/1512010 0311512011 03/1512011 SINGLE LIMIT ) ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTC)S X HCPD - $70.000 JURY ) OTHER SODIL Y INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY. EA ACCIDENT $ EA ACC $ AGG $ $ $ $ $ $ o A THAN ONLY: C 553-093202-7 03/1512011 EACH OCCURRENCE AGGREGATE WC006506573 0110112011 NAlC# 16535 14613 23809 1,000,000 . 1'00,000 5,000 1,000,000 2,000,000 2,000,000 $ 1,000,000 $ $ $ 15,000,000 15,000,000 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATlOIilS I LOCATIONS I VEHICLES I EXCLUSIOIilS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE:RE: BAYSHOREMANOR CERTIFICATE HOLDER IS ADDITIONAl INSURED RE GENERAL LlABILlTY & AUTO' LIABILITY (! C : h iur n t!Jl.-- . CERTIFICATE HOLDER MONROE COUNTY BOCe RISK MANAGEMENT 1100 SIMONTON ST, 2ND FLOOR KEY WEST FL 33040 SHOULD: ANY OF IES BE CANCELLED BefORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ OAYSWRITTEN NOTICE TO THE CERTIFICATE HOLOER NAMeD TO THE LEFT, BUT FAILURE TO DO SO SHALL tMPOSE NO OBUGATIOIil OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 9(~ ACORD 25 (2001/08) 1 of 2 1256141 @ ACORD CORPORATION 1988 10412 Ac o °' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `� 12/23/2011 THIS CERTIFICATE 1S 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 ADD es mus, be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pdicies may ement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT E : Lisa l/ollin g sworth NAM Commercial Lines - (813) 639 -3000 JA Tam,. EXU; (AM 81 I- 636 5476 (A FAI No C, No): Wells Fargo Insurance Services USA, Inc. E-MAIL SS: ciw.certrequest @wellsfargo.com ADDRE 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC # Tampa, FL 33607 MONROE CO R A : A nerican Zurich Insurance Company 40142 INSURED a ��PISK MANAu Mt J' l R o A.nencan Economy Insurance Co. 19690 G. A. Food Service of Pinellas County, Inc. INSURER C : North River Insurance Company 21105 DBA G.A. Food Service Inc INSURER D : Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E : St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 3702549 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POUCY EFF POUCY EXP TYPE OF INSURANCE LTR INSR WVD POUCY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) UNITS A GENERAL UABIUTY CP09671871-03 03/15/2011 03/15/2012 EACH OCCURRENCE $ 1,000,000 X DAEAG TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2, 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY SrPrf LOC $ COMBINED S INGLE LIMIT g AUTOMOBILE UABIUnY 02CE216187 1 2011 03/15/2012 (Ea accdent> 3 1,000,000 X ANY AUTO B P • • , B �� B y (�� BODILY INJURY (Per person) $ ALL OWNED SCHEDULED D ' . -INV BODILY INJURY (Per accident) $ AUTOS _ AUTOS W . a , , „ 1 PROPERTY DAMAGE $ X HIRED AUTOS X NON -OWNED A V `6 (/�{ir t , , (Per accident) x HCPD - $70,0 X $1,000 C(.'. Comprehensive Deductible $ $1,000 X UMBRELLA LIAB X OCCUR 553 - 094083 -8 CO C CLAIMS -MADE A / 03/15/2011 03/15/2012 EACH OCCURRENCE $ 15,000,000 C EXCESS UAB 5N v AGGREGATE $ 15,000,000 DED X RETENTION $ 0 $ WORKERS COMPENSATION X WC STATU- OTH- D AND EMPLOYERS' LIABILITY Y / N 201200- 0298901 01/01/2012 01/01/2013 TORY LIM(TS ER ANY PROPRIETOR/PARTNER/EXECUTIVE I N / A E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $• If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT E • DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE:RE: BAYSHORE MANOR CERTIFICATE HOLDER IS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RISK MANAGEMENT , ACCORDANCE WITH THE POLICY PROVISIONS. 1100 SIMONTON ST, 2ND FLOOR KEY WEST FL 33040 AUTHORIZED REPRESENTATIVE 9 «is— I 0011110 The ACORD name and logo are registered marks of ACORD © 1988 ACORD CORPORATION. All rights reserved. ACORD 25 (2010!05) 1111111111111011111111111111 111111111111111 'CYBO7A23/000545+02/02ror0/0/O• 10412 Ac o °' CERTIFICATE OF LIABILITY INSURANCE DA y o"�YY) 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 • ■ - TRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND T • ' , IMPORTANT: If the certificate holder is a ADDITIO r - 9 1, e policy(le - must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ce in policies may require an endorseme t. A statement on this certificate does not confer rights to the certificate holder In IIeu of such endorseme t(s). PRODUCER AN XO12 NEE CT isa Hollingsworth Commercial Lines - (813) 639 -3000 PHONE 813- 636 -5476 r 813- 636 -7192 (A/C. No. E (AIC, No►: d w.certr uest Wells Fargo Insurance Services USA, Inc. EMAIL MO1`TROE COUNTY ADDRESS: e1 g o.com @ w ellsfar 2502 N. Rocky Point Drive, Suite 400 T INSURER(S) AFFORDING COVERAGE NAIC N INSURER A : Tampa, FL 33607 RISK MANAGEMEr A Company Zurich Insurance Com an 40142 INSURED INSURER B : American Economy Insurance CO. 19690 G. A. Food Service of Pinellas County, Inc. INSURER c : North River Insurance Company 21105 DBA G.A. Food Service Inc INSURER D : Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E : St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 3702386 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSR SUER POUCY NUMBER (MMIDD (MM/OD/YYY() UNITS LTR INSR WVD A GENERALUABIUTY CP09671871 - 03 03/15/2011 03/15/2012 EACH OCCURRENCE $ 1.000,000 DAMAGE COMMERCIAL GENERAL LIABILITY PR RENTED SES (Eaoccurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO- JFCT LOC $ COMBINED SINGLE LIMIT g AUTOMOBILE LIABILITY 02CE216187 -2 dVItIVi /2011 03/15/2012 (Ea accident) $ 1,000,000 X ANY AUTO By V BY MANAG BODILY INJURY (Per person) $ ALL OWNED SCHEDULED DA 1 BODILY INJURY (Per accident) $ AUTOS — NON OWNED WAIV- --- PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ x HCPD - $70,0 X $1,000 ' c ti, l,(' Comprehensive Deductible $ $1,000 ( 01 03/15/2011 03/15/2012 _ 15,000,000 SP' AGGREGATE $ 15,000,000 DED X RETENTION $ 0 8 WORKERS COMPENSATION x WC STATU- OTH- D AND EMPLOYERS' UABIUrY Y / N 201200 01/01/2012 01/01/2013 TORY LIMITS ER ANY PROPRIETOR/PARTNER /EXECUTIVE I I N 1 A E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 M 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) RE:RE: Bid -SSD Food Services & Meal Catering For Monroe Co Nutrition Program Monroe County Board of County Commissioners are named as additional insured regarding general liability and automobile liability. CERTIFICATE HOLDER CANCELLATION Monroe County Purchasing Office SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street, Room 1 -213 Key West FL 33040 AUTHORIZED REPRESENTATIVE 9« 4 I t The ACORD name and logo are registered marks of ACORD © 1988 ACORD CORPORATION. All rights reserved. 003526 ACORD 25 (2010105) 11111111111011 V Ill VIII 111111111 11111 *cveOSA23/001616/02J02/0/0r0/0• 10412 ACG ° ® CERTIFICATE OF LIABILITY INSURANCE DAT Z YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Li Hollingsworth NAME: Commercial Lines - (813) 639 -3000 PHONE FAX (A1c. No__ . Ext 813- 636 -54 J (A/C, No): 813- 636 -7192 Wells Fargo Insurance Services USA, Inc. E-MAIL g ADDRESS: clw.certrequest @wellsfargo.com 2502 N. Rocky Point Drive, Suite 400 INSURERS S J AFFORDING COVERAGE NAIC # - — - - -.. - -- ---------...--- -- Tampa, FL 33607 INSURERA: Liberty Insurance Corporation 42404 INSURED INSURER B : American Economy Insurance Co. 19690 G. A. Food Service of Pinellas County, Inc. INSURER c : North River Insurance Company 21105 — — — DBA G.A. Food Service Inc INSURER D : Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North - - INSURER E : St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 4034722 REVISION NUMBER: See below 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 - -- — -------- ADDLSUBR - ----- POLICYEFF --- POLICYEXP -�_ -- _ -- - - - -- -- LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DD/YYYY) (MM /DD /YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A --- TB7Z91458863012 03/15/2012 03/15/2013 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY 300,000 _ PREMISES jEa occurrence) $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY JECT LOC $ 1 B AUTOMOBILE LIABILITY 02CE216187 -3 03/15/2012 03/15/2013 COMBINED SINGLE LIMIT 1,000,000 ( Ea accidence____ $ X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS NON -OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Jeer accident) X HCPD - $70K X $1,000 Comp /Coll Deductible $ $1,000 C X UMBRELLA LIAB X OCCUR 553 - 095019 -8 03/15/2012 03/15/2013 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000 ■ DED XJRETENTION $ 0 $ WORKERS COMPENSATION [ WC STATU- I OTH- D AND EMPLOYERS' LIABILITY Y / N 201200- 0298901 01/01/2012 01/01/2013 — X-- TORY LIMITS 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N / A AP • • • /.:. sy • y (Mandatory in NH) Aug", - E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under �' -��>h DESCRIPTION OF OPERATIONS below w � _ E.L. DISEASE SE - POLICY LIMIT $ 500,000 sow 4 I - 0C4a -t Sr/ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE:RE: BAYSHORE MANOR CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY IF REQUIRED BY WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISK MANAGEMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1100 SIMONTON ST, 2ND FLOOR KEY WEST FL 33040 AUTHORIZED REPRESENTATIVE C 9` �- 002 120 The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) Mill I IIIII111111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII •CYB01A23 /000806 /02/02/0 /0 /0 1 3 10412 AC cR / D CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) L..-- 3/14/2012 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 CONT ACT Lisa Hollingsworth N Commercial Lines - (813) 639 -3000 PHONE 813-636-5476 Extl: 813- 636 -5476 FAX - - _ 1 JA/C, No): 813- 636_7192 —_ Wells Fargo Insurance Services USA, Inc. EMAIL l cw.certre llfo.com uest wesar ADDRESS: clw.certrequest@wellsfargo.com g 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC # Tampa, FL 33607 INSURERA: Liberty Insurance Corporation 42404 INSURED INSURER B : American Economy Insurance Co. 19690 G. A. Food Service of Pinellas County, Inc. INSURER C : North River Insurance Company 21105 DBA G.A. Food Service Inc INSURER D : Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E : _ St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 4034723 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DD/YYYY) 1 (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A — TB7Z91458863012 03/15/2012 03/15/2013 — X COMMERCIAL GENERAL LIABILITY DAMAGE S ( a occurrence) RENTED 300,000 PREMISES (Ea occurrence) $ _ CLAIMS -MADE r)--(1 OCCUR AP- • E . • + • N M MED EXP (Any one person) $ 5,000 DA e ra∎ - PERSONAL 8 ADV INJURY $ 1,000,000 /_M. ' GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. / • i � L • PRODUCTS - COMP/OP AGG $ 2,000,000 X I POLICY IF LOC CC SOS t• *iv • $ B AUTOMOBILE LIABILITY 02CE216187 -3 03/15/2012 03/15/2013 COMBINED SINGLE LIMIT 1,000,000 x I ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ _ AUTOS AUTOS X X NON -OWNED PROPERTY DAMAGE $ _ HIRED AUTOS _ AUTOS (Per acciden[L - __ X HCPD - $70K X $1,000 Comp /Coll Deductible $ $1,000 C X UMBRELLA LIAB X OCCUR 553- 095019 -8 03/15/2012 03/15/2013 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 15,000,000 DEDTX RETENTION $ 0 $ WORKERS COMPENSATION I WC STATU- OTH- D AND EMPLOYERS' LIABILITY Y / N 201200- 0298901 01/01/2012 01/01/2013 _- x ...I._TORY - LiM!T _ ER ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N / A -- - -- - — - -- - - - -- --- -- -- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 II ' DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Bid -SSD Food Services & Meal Catering For Monroe Co Nutrition Program Monroe County Board of County Commissioners are included as additional insured regarding general liability and automobile liability if required by written contract. CERTIFICATE HOLDER CANCELLATION Monroe County Purchasing Office SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1100 Simonton Street, Room 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Key West FL 33040 , AUTHORIZED REPRESENTATIVE CG• 1 The ACORD name and logo are registered marks of ACORD © 1988 - 2010 ACORD CORPORATION. All rights reserved. 0021a2 ACORD 25 (2010/05) 1 11E110 IIII VIII VIII VIII VIII VIII VIII VIII 1110 111111111 'crao1A23/000837/02/02/0/0/0/0• 10412 ® ACCORD W CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YY) L..---- 12/21/2012 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Cnrtoln nr.IIt I 9: ma., '''„Ir.. an ..nanr A statement on this certificate does not confer rights to the certifcate holder In lieu of such endorsrament(s). RECE PRODUCER NAME...CT Lisa Hollingsworth Commercial Lines - (813) 639 -3000 PHONr 813- 636 -5476 FAX 813 - 636 -7192 (A/C. 1o, Exit: --_ -- _ -- _(A/C, No): Wells Fargo Insurance Services USA, Inc. JAN - 2013 E -MAII ciw.certre uest welisfar o.com ADDR SS: _ 4 g 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC # Tampa, FL 33607 INSUIR A : Liberty Insurance Corporation 42404 INSURED MONROE COUNTY INSURER B : American Economy Insurance Co. 19690 G. A. Food Service of Pinellas County, Inc. RISK MANAGEMENT , North Ri ver Insurance Company 21105 Y 1 Fi c : P Y ____ - -- -- DBA G.A. Food Service Inc INSURER D : Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E : St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 5339368 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP • LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A TB7Z91458863012 03/15/2012 03/15/2013 DAMAGE TO RENTED - - -- X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 _ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 X f POLICY PRO LOC $ JECT A UTOMOBILE LIABILITY COM SINGLE LIMIT B 02CE216187 -3 03/15/2012 03/15/2013 {Ea accidenBINED g__ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ _ AUTOS AUTOS - NON -OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ X HCPD - $70K X $1,000 Comp /Coll Deductible $ $1,000 X I UMBRELLA LIAB X OCCUR E ACH OCCURRENCE 15,000,000 C 553 - 095019 -8 03/15/ 03/15/2013 EXCESS LIAB CLAIMS -MADE AGGREGATE _ $ 15,000,000 DEDJ X I RETENTION$ 0 $ WORKERS COMPENSATION x WC STATU- I OTH- D AND EMPLOYERS' LIABILITY Y/ N 201375 - 0298901 01/01/2013 01/01/2014 TORY LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA - - -- _ -- - (Mandatory In NH) AP- • •VE to : , GE E.L. DISEASE - EA EMPLOYEE $ 500,000 It yes, describe under BY DESCRIPTION OF OPERATIONS below L A W _ E L. DISEASE - POLICY LIMIT $ 500,000 . alt i14 Cc. 1.12, TYig h.$ - DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) RE:RE: BAYSHORE MANOR CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED RE GENERAL LIABILITY & AUTO LIABILITY IF REQUIRED BY WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISK MANAGEMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1100 SIMONTON ST, 2ND FLOOR KEY WEST FL 33040 AUTHORIZED REPRESENTATIVE 9 I..._ The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. 001799 ACORD 25 (2010/05) 1 1111101 111011111 V 'CYe05A21/000891/02/02A/0/010' 10412 ACOR[� DATE (MM/DD/YYYY) �, CERTIFICATE OF LIABILITY IN SURANCE 1/4/2013 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Li Hollingsworth NAME Commercial Lines - (813) 639 -3000 PHONE 813- 636 -5476 FAX (A/C. No. Ext): (A/C, No): Wells Fargo Insurance Services USA, Inc. E-MAIL ues clw.certre t�lwellsfar o.com ADDRESS: q L% g 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC # Tampa, FL 33607 INSURER A : Liberty Insurance Corporation 42404 INSURED INSURER B : American Economy Insurance Co. 19690 G. A. Food Service of Pinellas County, Inc. INSURER C : North River Insurance Company 21105 DBA G.A. Food Service Inc INSURER D : Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 5450971 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH $ 1,000,000 A TB7Z91458863012 03/15/2012 03/15/2013 DAMAG OCCURRENCE E TORENTED © COMMERCIAL GENERAL LIABILITY 300,000 PREMISES (Ea occurrence) $ ■■ CLAIMS -MADE X OCCUR A 1 • , .: ISK I ' GEMENT // /�/' MED EXP (Any one person) $ 5,000 DA Snk�� Orf( �C . PERSONAL B ADV INJURY $ 1,000,000 III W . . \ . _ cam C / � (,� GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: \ t.r•J.�. PRODUCTS - COMP /OP AGG $ 2,000,000 © POLICY ■ PRO LOC ^, r $ B AUTOMOBILE LIABILITY 02CE216187 -3 03/15/2012 03/15/2013 CEa OMaccident) BINED SINGLE LIMIT 1,000,000 { © ANY AUTO BODILY INJURY (Per person) $ ■ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X NON -OWNED PROPERTY DAMAGE $ © HIRED AUTOS AUTOS (Per accident) X HCPD - $70K X $1,000 Comp /Coll Deductible $ $1,000 C X UMBRELLA LIAR X OCCUR 553 - 095019 -8 03/15/2012 03/15/2013 EACH OCCURRENCE $ 15,000,000 ■ EXCESS LIAB ■ CLAIMS -MADE AGGREGATE $ 15,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION x WC STATU- OTH- D AND EMPLOYERS' LIABILITY VIN 201375- 0298901 01/01/2013 01/01/2014 TORY LIMITS ER ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Bid -SSD Food Services & Meal Catering For Monroe Co Nutrition Program Monroe County Board of County Commissioners are included as additional insured regarding general liability and automobile liability if required by written contract. CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1100 Simonton Street, Room 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Key West FL 33040 / AUTHORIZED REPRESENTATIVE f � /fir , G `..41./V1--1K vim` r % The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) (This cerbficate replaces certficate# 5339369 issued on 12/2112012) ■ 1 10412 � - '� DATE Imm/oo/vwvl fa CERTIFICATE OF LIABILITY INSURANCE 3n2/2015 THI CERTIFICATE IS ISSUEC AS A MATTER OF INFORMATION ONLY ANU 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 BETW THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, tho policy(les) 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). PROOV CER Ns ivIF: T Lisa Klbbey _ OOmmerOial Lines - (813) 639 -3000 PRONE 813- 639 -3000 ' FAX rvo 855 - 299 -7117 (A/C, No, Exq, la ( Wells Fargo Insurance Services USA, Inc. noDAIIESS clw- certroq uest well sfa rgo -com 2502 N. Rocky Point Drive. SUMO 400 INSURER(S) AFFO ROING COVERAGE _ NAIC # • Tampa. FL 33607 INSUR A : Liberty Mutual Insurance Co- -- 23043 INsuREO INSURER e : Liberty Insurance Corporation _ 42404 G. A. Food Services of Pinellas County, Inc. INURER C North River Insurance Company 21105 S OBA G.A. Food Services Inc w o : Manufacturers Alliance Insurance Company _ 36897 12200 32nd Court, North INSURER F : St. Petersburg, FL 33716 INSORER F : COVERAGES CERTIFICATE NUMBER 8848777 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUCD 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 1 HIS 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. 'POOL :sVBR - OLIO' ." - POLICY EXP L SR TYPE OF INSU RANCE gyp POL (MM I IMM ICY NUMBER /OUGYYY/OO/YYVVI I LIMITS IN A X COMMERCIAL GENERAL LIABILITY TR2291458863015 1 03/15/2015 03/15/20161 EACH OCCURRENCE $ 1.000.000 CI AIMS -MAnF X OCCUR OHMAGE TO RENTED PREMISES R c. ocunoncc] - `- ppp UUU LU EX., IAn _ y one peresre - _5 5,000 - PERSONA- 8 'SO INJURY 5_ 1 UUU.UUU AOO.000 GFN'1 ACiORCGATE LIMIT APPLIES PER. r 3ENE RAI AC.GREG ATF 5 2 X POLICY JE T LOG 1 P ROD p 0 UCTS - ROMP /OF AGG 5 0U 0 so OTHER _ I I I 5 g TONIOBILE uABlurY AS77914 58863025 03/ 1 5/2015 03/15/2016 I cE ad�,ti eR SINGLE UMI r $ - loon 000 X BOYS V INJURY (Per person) S K ANY AV TO - ALL OWNED SCFICRULER BODILY I iNJIIRY (Per accident) 5 - - AUTOS AUTOS - - [l NON -OWNER _PERTY A AG MC S K HRFOAUTOS AUTOS (Pei aeSldant, _. • X HC PD - ACV $1.000 i, comp/,$,, Rea.,orble $ C x UMBRELLA LIAR X OCOUR 581 1045075 I I I 03/15/2015 03/15/2016 EAGFI or_r_LIRRFNCF - $ 1s 000 000 • EXCESS L I NM MA A CLS DE GGR A FGTE _ • 5 - REI K j RETENTION S 0 _ S WORKERS COMPENSATION 2015750298901 1 01/01/2015 01/01/2016 x S ER rIJTF ER D EMPLOYERS' LIABILITY / N - - - - SOq UUt1 A NY PROPRIETOR / ede L N _ E L EACH ACCIRCNT _ S OFFICER/MEMdER UUEU+ r'UTIVF I Y V� /A 500.000 (M In NMI - E L RISEASE - CA EMPLOYEE_ S 0, SESCRIP I ION OF OPERA. b00 O RA I IONS below _ EL LJISEASE - POLICY LIMIT S . DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES IACORO 101, Additional Remarka Sy00001e, may be aR00000 if more apace la re ulre01 RE'. Bid -SID Food Services S Meal Catering For Monroe Co Nutrition Program Monroe County goes a of Count •missioners is included as an additional insured as it relates tD the General and Automobile Liability in accordance with the policy ,, rm -nd PPf2O : O =. 1. - ..----- - - -F FNT � OA ' �b'.�i� t�.L_� WAIVE TN /Ay __— C.-1C-1 L"-e (tc X.-) (J -- li - l\Yl CERTIFICATE HOLDER GA NCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION GATE THEREOF, NOTICE WILL BE OELIVEREO IN 1100 Simonton Street, Room 1 -213 ACCOROANCE WITH THE POLICY PROVISIONS. Key West FL 33040 AUTRORIZEO REPRESENTATIVE ^ 9� The ACORO name and logo are registered marks of ACORD © 1988 -2014 AGORD CORPORATION. All rights reserved. ACORD 25 (2014401 ) 10912 -----% ® OATE(MM /OO/YYYY) Ac-cOUO CERTIFIC OF LIABILITY INSURANCE I 3 /12/2015 THIS CERTIFICATE IS ISSUE. AS A MATTER OF INFORMATION ONLY ANU 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 HOLOER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed_ If SUBROGATION IS WAIVE., subject to the terms and conditions of the policy, certain policies may require an endorsement_ A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lisa Klbbey _ Commercial Lines - (813) 639 - 3000 HONE 813 639 - 3000 AX - 855 A (/O. No. Extl: (A /C, Nol Wells Fargo Insurance Services USA, Inc. E-MAIL ciw. certreguest @wcllefargo.com - 2502 N. Rocky Point []rive, Suite 400 INSURER(S) AFFOROING COVERAGE epec 4 Tampa. FL 33607 wsu R _ Liberty Mutual Insurance Co. 23043 I SURER B _ Liberty Insurance Corporation 42404 GS w A_ Services of Pinellas County. Inc. w RER c : North River Insurance Company 21105 OSA GA_ Food Service Inc If1sUR o , Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North _ INSURER E - • St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER. 8848776 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BE ISSUE. TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INOICATEO NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON.ITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE. OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBE, HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AN. CON.ITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCE. BY PAI. CLAIMS I i_TR TYPE OF INSURANCE INS- wyn POLICY POLICY XX POLICY EXP gO r SUM, NUMBER I ( POLICY IMM/OO/ EX, __ LIMITS A X COMMERCIAL GENERA 1 000,000 L LIABILITY TB2Z9l45SS63o15 03/l 5/2015 1]3/15/2016 EACH (J(. C.VRRF F - CLAIMS' -MADE X CX :ER 1 PREMISIE ,Ea EN� S 300 .000 MFr SO (AnY P r+on) $ 5.000 - PFR NAI. BAUV INJURY $ c¢ l LN c. L AGGREGATE LIMIT APFI IFS ,ER AGGREGATE AGGREGATE I.5 I 2 g00000 X POLICY JL ■ LOC PROSUCTS CCJMFVOV AGG S 2 000.000 OTHFR _ c O V — -- g OUTOMOeILE LIABILITY AS729 1 4 5686302 5 (F acCNr., n II I 03/15/2015 03/15/2016 F SwGI F LIMIT S 1 00 .000 nNV nuTO ROSILY' INJURY tear parson) $ - x, L OwNES I SCI IEOULES 000ll INJURY (Per EEEdor, S X AIRES X A UTOS NCS (,+oor ac MACE S X HCPO - ACV x 51,000 Corn,Goll God0EtiOla S C X UMBRELLA LIAB '--1 X GGGUR 5811045075 03/15/2015 03/15/2016 CAC, OCCVRRENCC $ 1, 000 000 EXCESS LIAR CLAIMS -MADE 1 AGGREGATE $ 15000000 OE, X , RET O 'I - - - S WORKERS COMPENSATION Ol /ol /2015 Ol/01/2016 X R OTII D ON. EMPLOYERS' LIABILITY Y / N I 20157550298901 STATUTE I FR p00 UUU ANY ,ROPRIETOR /PARTNER /EXtCUI SZE I N/A EL EACH ACUIUENT 5 _ OF ICER /MEMN±R CLLJSEG rY 500.000 (Mandatory In ) ` E L OISFASE - EA LMP YFE LO $ y decribe untlo PC)LI so DESCRIP OF O PERA 7IONS below I F 1 OISE A - CY LIMIT S 0 000 DsCRIPTION OF OPERATIONS / T (. D LOCATIONS / VEHICLES COR 1 d Rmd , Additional eae. Sc00001a, may ta a atc e , m ir nra spaces Is ra uad) RERE BAYSHORE MANORMONROE COOnil`, BOCC Is included as an additional I nsured as it rel_ es t the �'. ... -z I and Automobile Liability in accordance with the policy terms and conditions. AppR at • CC NT F F BY . rt ��� � - IL V JAI _ 1Y' A. YEA__ -_ Gc ' !_ 1,--C SLR — �.Ccf S 61 A , r .: CERTIFICATE HOLDER CANCELLATION ,./ ATION MONROE COUNTY ROC. SHOULD ANY OF THE ABOVE OESGRIBEO POLIOIES BE OANCELLEO BEFORE THE EXPIRATION GATE THEREOF. NOTICE WILL BE OELIVEREO IN RI MANAGEM ACCORDANCE WITH THE POLICY PROVISIONS. 1100 SIMONTON ST, 2ND FLOOR KEY WEST FL 33040 AUTHORIZE. REPRESENTATIVE °i"•' 9� The ACORO name and logo are registered marks of ACORO C31988-201.4 .CORD CORPORATION. All rights reserved. ^CORD 25 (2014/01) -----"°"""", 1'0412 C DATE (MM /DD /YYYY) ,acoR CERTIFICATE OF LIABILITY INSURANCE 12/18/2015 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). CONTACT Li K PRODUCER NAME: y Commercial Lines - (813) 639 -3000 PHONE 813 639 -3000 FAX 855 - 299 7117 (A /C. No. Ext): (A /C, No): Wells Fargo Insurance Services USA, Inc. E ADDRESS: tt we clw uest llsfar g o.com 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC if Tampa, FL 33607 INSURERA: Liberty Mutual Insurance Co. 23043 INSURED INSURER B : Liberty Insurance Corporation 42404 G. A. Food Services of Pinellas County, Inc. INSURERC: North River Insurance Company 21105 DBA G.A. Food Service Inc INSURER D: Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 9900771 REVISION NUMBER: See below 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X TB2Z91458863015 03/15/2015 03/15/2016 EACH OCCURRENCE $ 1,000,000 RENTED DAMAGE TO CLAIMS - MADE OCCUR X PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC _PRODUCTS - COMP /OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY AS7Z91458863025 03/15/2015 03/15/2016 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ — — ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS — NON -OWNED PROPERTY DAMAGE $ X HIRED AUTOS x AUTOS (Per accident) x HCPD - ACV X $1,000 Comp/Coll Deductible $ C x UMBRELLA LIAB X OCCUR 5811045075 03/15/2015 03/15/2016 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 15,000,000 DED X RETENTION $ 0 $ WORKERS COMPENSATION PER H D AND EMPLOYERS' LIABILITY 201675 0298901 01/01/2016 01/01/2017 X STATUTE ER ANY PROPRIETOR /PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 500,000 OFFICER /MEMBER EXCLUDED? Y N / A 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Monroe County BOCC is named as additional insured as it , L.lC ov relates to general liability in accordance with the terms and conditions of the policy. 'PR,' ;� E'MENT B DA . r!Ililti111b Ir ` : L(.Q.- A, C ti WAVER N/A S_ C[ 'Pt * ,-i i s1, Glc� Ow'O CERTIFICATE HOLDER �� PtfIIJ - � 7.f)r! CANCELLATION v a ') Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 1111 12th St. Suite 408 91 :1 ` „/ r ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 `� i I? 330 Si Q 4 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 10412 ,----"." ® DATE (MM /DDIYYYY) A CERTIFICATE OF LIABILITY INSURANCE 12/22/2015 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 INSURA [ A O P TRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND T CERTIFIRECIVED IMPORTANT: If the certificate holder is an DDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certz in policies may require an endorsemef t. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemef t(s). DEC 2 2 O CONTACT isa Kibbey PRODUCER - NAME: Commercial Lines - (813) 639 -3000 PHONE g13- 639 -3000 FAx 855- 299 -7117 (A/C. No. Ex1 (A/C, No): Wells Fargo Insurance Services USA, Inc- E - MAIL O.GOm ll t ertre i MONROE COUNTY ADDRESS: c w.c Ues wesfar q @ g 2502 N. Rocky Point Drive, Suite 400 RISK MANAGEMENT INSURER(S) AFFORDING COVERAGE NAIC # Tampa, FL 33607 INSURER A : Liberty Mutual Insurance Co. 23043 INSURED INSURER 8 : Liberty insurance Corporation 42404 G. A. Food Services of Pinellas County, Inc. INSURER c : North River Insurance Company 21105 DBA G.A. Food Service Inc INSURER D : Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E : St Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 9914891 REVISION NUMBER: See below 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 FAIL) CLAIMS. INK - - -- '— ATSGI §U8R POLICY EFF POLICY EXP LIMITS L1R TYPE OF INSURANCE INSD WVD POLICY NUMBER SMMIDDIYYYYL(MMIDDIYYYYj X I COMMERCIAL GENERAL LIABILITY TB2Z91458863015 03/15/2015 03/15/2016 EACH OCCURRENCE $ 1,000,000 ■ A I -- D AMAGE TO RENTED CLAIMS -MADE I X I OCCUR PREMISES (Ea occurrence) $ 300,000 1 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENE AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X I POLICY 1 PRO JECT i 1 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 i ED OTHER T.— CO MBIN SI NGLE LIMIT B AUTOMOBILE LIABILITY AS7Z91458863025 03/15/2015 03/15/2016 (Ea BIN EDl $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS PROPERTY DAMAGE i x NON -OWNED (Peraccidenf)- $ X HIRED AUTOS _ AUTOS X HCPD - ACV 1 X $1,000 Comp /Coll Deductible $ C X i UMBRELLA LIAB X OCCUR 5811045075 03/15/2015 03/15/2016 EACH OCCURRENCE $ 15,000,000 - EXCESS LIAB i CLAIMS -MADE AGGREGATE $ 15,000,000 I GED 1 X ! RETENTION $ 0 $ _ ' D WORKERS COMPENSATION 201675 0298901 01/01/2016 01/01/2017 X I STATUTE ER ANO EMPLOYERS' LIABILITY Y / N I 500,000 ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. ACCIDENT $ OFFICER /MEMBER EXCLUDED? I Y j1 N / A I E L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory In NH) 500,000 If es, - Inscribe under E.L DISEASE - POLICY LIMIT l $ DESCRIPTION OF OPERATIONS below • DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Bid -SSD Food Services & Meal Catering For Monroe Co Nutrition Program Monroe County Board of County Commissioners is included as an additional insured as it relates to the General and Automobile Liability in accordance with the policy terms and condi r s , a Z��I AG NT L WAI . YL� r %O ��. CERTIFICATE HOLDER CANCELLATION X113 'AIM 30dNOi4 Monroe County BOCC ' 1 ') . 813 • f 1I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street, Room 1 -213 ACCORDANCE WITH THE POLICY PROVISIONS. Key West FL 33040 1 1: I Wd O C 330 S1Ol AUTHORIZED REPRESENTATIVE 9€,1-. _ 1 :. :10 -d t30i a31Li Tne ACORD name and logo are registered marks of ACORD © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 1111 1111111 0131111111111111111 HMI II III I ll •CYBO1A22/000540/02/02J0/0/0/0' 10412 ACO DATE (MM /DD /YYYY) C CERTIFICATE OF LIABILITY INSURANCE 3/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: ACT Lisa Kibbey Commercial Lines - (813) 639 -3000 PHONE 813 639 -3000 FAx 855-299-7117 Wells Fargo Insurance Services USA, Inc. (A/C. Io. EMI: 813 No): ADDRESS: clw.certrequest @wellsfargo.com 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC R Tampa, FL 33607 Liberty Mutual Insurance Co. 23043 INSURERA: rtY INSURED INSURER B: Liberty Mutual Fire Insurance Co 23035 G. A. Food Services of Pinellas County, Inc. Liberty Insurance Corporation 42404 INSURER C : rtY rP DBA G.A. Food Service Inc INSURER D: Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E ; Liberty Insurance Underwriters, Inc. 19917 St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 10246313 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM /DO/YYYY) (MM /DD /YYYY) A X COMMERCIAL GENERAL LIABILITY TB2Z91458863 03/15/2016 03/15/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO R CLAIMS -MADE X OCCUR PREMISES (Ea $ 300,000 MED EXP (My one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X POLICY JET LOC PRODUCTS - COMP /OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY • ' AS2Z91458863 03/15/2016 03/15/2017 COMBINED SINGLE LIMIT $ 1,000,000 CO ccident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS NON -OWNED PROPERTY DAMAGE X HIRED AUTOS x AUTOS (Per accident) $ X HCPD - ACV 1 X $1,000 Comp/Coll Deductible $ C X UMBRELLA LIAB X OCCUR TH7 - 458863 - 036 03/15/2016 03/15/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 1 DED X RETENTION $ 10,000 $ D WORKERS COMPENSATION 2016750298901 01/01/2016 01/01/2017 X STATUTE ER AND EMPLOYERS' LIABILITY Y / N 500,000 ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? Y N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTIOLLQ.F OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 E Excess Litt/ay `� 1000198927 - 01 03/15/2016 03/15/2017 $1o,00o,000 each occurrence 10,000,000 aggregate N t,+ l DESCRIPTOR) OF c .RATIONS CLOG 4TIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: BidMSD Fpg_d Servicj 3vleal Catering For Monroe Co Nutrition Program Monroe County Board of County Commissioners is included as an addition nsur ..as it relatet -to the General and Automobile Liability in accordance with the policy terms and conditions. / • `5 c r' PPR -1(i 1fr aV AGEMENT �r w "': 4, � , .OY �+jL --.1 mac-) C? /A - . WAIVER �A�V' S C 1.:'1( e c.,. �� ' 4.1...KL-A - I110-1-r∎-1' 6Y) CERTIFICATE HOLDER CANCELLATION ' Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street, Room 1 - 213 ACCORDANCE WITH THE POLICY PROVISIONS. Key West FL 33040 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD © 1988 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 10412 ` V ® A DATE (MM /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Li Kibbe NAME: y _ Commercial Lines (813) 639 -3000 PHONE 813-639-3000 Fax 855- 299 -7117 (A/C. No, Extl: (A /C, No): Wells Fargo Insurance Services USA, Inc. E -MAIL clw uest wellsfar o.com ADDRESS: q g 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC # Tampa, FL 33607 INSURERA: Liberty Mutual Insurance Co. 23043 INSURED INSURER B: Liberty Mutual Fire Insurance Co 23035 G. A. Food Services of Pinellas County, Inc. INSURER C: Liberty Insurance Corporation 42404 DBA G.A. Food Service Inc INSURER D: Manufacturers Alliance Insurance Company 36897 12200 32nd Court, North INSURER E : Liberty Insurance Underwriters, Inc. 19917 St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 10246314 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ! ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR i TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM /DDIYYYY) (MMIDD /YYYY) A X COMMERCIAL GENERAL LIABILITY X TB2Z91458863 03/15/2016 03/15/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETE CLAIMS -MADE X OCCUR PREMISES (Ea occur ence) i $ 300,000 _MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO JECT LOC PRODUCTS - COMP /OP AGG j $ 2,000,000 I OTHER: $ B AUTOMOBILE LIABILITY AS2Z91458863 03/15/2016 03/15/2017 COMBINED SINGLE LIMIT $ 1,000,000 CO accident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) j $ AUTOS _ AUTOS x NON -OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS (Per accident) X HCPD - ACV X $1,000 Comp /Coll Deductible $ C x UMBRELLA LIAB X OCCUR TH7 -Z91- 458863 -036 03/15/2016 03/15/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 $ D 1WORKERSCOMPENSATION 2016750298901 01/01/2016 01/01/2017 X STATUTE OTH- AND EMPLOYERS' LIABILITY I ANY PROPRIETORiPARTNER /EXECUTIVE YIN E. L. EACH ACCIDENT � $ 500,000 OFFICER /MEMBER EXCLUDED? Y N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yyes escribe cruder 500,000 DESCIPTIONL61FjOPERATIONS ]below E.L. DISEASE - POLICY LIMIT $ E Excess Liability ---; 1000198927-01 03/15/2016 03/15/2017 $10,000,000 each occurrence C - 10,000,000 aggregate L t_! 2E ,-,) Y- a_ Cl.- I -- DESCRIPTIMOF OPERATIONS / OCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Monroe unt PCC is a r Ee d as additional insured as it /' relates t�'e :Y - 4r ene �► liability tdargordance with the terms and conditions of the policy. :PPRO D :> . G =t _ /� I ' -A LLJ 2c -) ._ ��= r v'� �v,L'- 4.,., C c: 0 Ll- o 17-1'5h- Faishoft, CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1111 12th St. Suite 408 ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE 9 /�- The ACORD name and logo are registered marks of ACORD © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 10412 � ® A DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/ M/DD/Y 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 NAME: Lisa Kibbey Commercial Lines - (813) 639 -3000 PHONE (A /C, No, Eat): 813-639-3000 FAX 855-299-7117 (A / C No Wells Fargo Insurance Services USA, Inc. E-MAIL clw.certrequest@wellsfargo.com uest wellsfar ADDRESS: q 9 2502 N. Rocky Point Drive, Suite 400 INSURER(S) AFFORDING COVERAGE NAIC R Tampa, FL 33607 INSURER A : Liberty Mutual Insurance Co. 23043 INSURED INSURER B : Liberty Mutual Fire Insurance Co 23035 G. A. Food Services of Pinellas County, Inc. INSURER c : Liberty Insurance Corporation 42404 DBA G.A. Food Service Inc INSURER o Manufacturers Alliance Insurance Company 36897 ' 12200 32nd Court, North INSURER E : Liberty Insurance Underwriters, Inc. 19917 __ St. Petersburg, FL 33716 INSURER F : COVERAGES CERTIFICATE NUMBER: 10246312 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD VD (MM /DD /YYYY) (MM /DD /YYYY) A X COMMERCIAL GENERAL LIABILITY TB2Z91458863 03/15/2016 03/15/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETE CLAIMS -MADE j X j OCCUR PREMISES (Es o e nce) $ 300,000 ` MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X POLICY JE� LOC PRODUCTS - COMP /OPAGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY AS2Z91458863 03/15/2016 03/15/2017 COMBINED SINGLE LIMIT $ 1,000 _ (E a accident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ 'AUTOS AUTOS NON -OWNED PROPERTY DAMAGE X HIRED AUTOS AUTOS (Per accident) $ x HCPD - ACV x $1,000 Comp /Coll Deductible $ C X UMBRELLA LIAB X OCCUR TH7 - 458863 - 036 03/15/2016 03/15/2017 EACH OCCURRENCE $ 5,000,000 1 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 $ D WORKERS COMPENSATION 201675 0298901 01/01/2016 01/01/2017 X STATUTE O ER H AND EMPLOYERS' LIABILITY Y1 N 500,000 ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? Y N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 E Excess Liability 1000198927-01 03/15/2016 03/15/2017 $10,000,000 each occurrence 10,000,000 aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE:RE: BAYSHORE MANOR MONROE COUNTY BOCC is included as an additional insured as it relates to the General and Automobile Liability in accordance with the policy terms and conditions. ! — TV (i r f 7 t SIA-OrC---- CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RISK MANAGEMENT ACCORDANCE WITH THE POLICY PROVISIONS. 1100 SIMONTON ST, 2ND FLOOR KEY WEST FL 33040 AUTHORIZED REPRESENTATIVE 9(.44 The ACORD name and logo are registered marks of ACORD © 1988 -2014 ACORD CORPORATION. Al! rights reserved. ACORD 25 (2014/01)