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Certificates of InsuranceCERTIFICATE OF INSU NCE PRODUCER Bisbee-Baldwin Insurance Company P. O. Drawer 1050 Jacksonville, Florida 32201 904/353-6411 CODE SUB-CODE INSURED The Children's Home Society of Florida P. O. Box 10097 Jacksonville, Florida 32247-0097 ISSUE DATE (MM/DD/YY) 3/14/90 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 COMPANIES AFFORDING COVERAGE COMPANY LETTER A Insurance Company of North America COMPANY LETTER B Scottsdale Insurance Company COMPANY LETTER C ReceJvec LETTER D D~'rE ~]l~ [ COMPANY LETTER E INITIAL COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO t LTR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR. D 18756651 OWNER'S & CONTRACTOR'S PROT. AUTOMOBILE LIABILITY A X ANYAUTO H 00190354 POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) 5/1/89 5/1/90 5/1/89 5/1/90 ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS GARAGE LIABILITY ALL LIMITS IN THOUSANDS GENERALAGGREGATE $ 2,000 PRODUCTS-COMP/OPSAGGREGATE $ 1 ,000 PERSONAL&ADVERTISINGINJURY $1,000 EACHOCCURRENCE $ 1,000 FIRE DAMAGE (Any one fire) $ MEDICAL EXPENSE (Any one person) $ COMBINED SINGLE $ LIMIT I, 000 BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ EXCESS LIABILITY A X Excess Auto Liab. XUAG 12788368 5/1/89 5/1/90 iB X x°xT~k~xT~UMSRELLAF°RM UMB 051283 5/1/89 5/1/90 WORKER'S COMPENSATION !A A,D NWCC 34367802 1/1/90 5/1/90 J EMPLOYERS' LIABILITY OTHER IA Employee Dishonesty D 18756651 5/1/89 5/1/90 $50,000 Commercial Blanket Bond 5O 5 EACH AGGREGATE OCCURRENCE $ 1,000 $ 1,000 5,000 5,000 STATUTORY $ 500 (EACH ACCIDENT) $ 500 (DISEASE--POLICY LIMIT) $ 500 (DISEASE--EACH EMPLOYEE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS RE' Location at 73 High Point Road, Plantation Key, Florida Loss Payee as Respects To This Property: Ms. Donna Perez, Risk Manager, Monroe County CERTIFICATE HOLDER Ms. Donna Perez, Risk Manager Monroe County Wing L, Room 207 Public Service Building Key West, Florida 33040 ACORD 25-S (3/88) CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPI~A~TION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAILv'' 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 COMPANY, ITS AGENTS OR REPRESENTATIVES. / C~nD CORPORATION 1988i A4, (Ntlt. PRODUCER REGAN INSURANCE AGCY 90144 OVERSEAS HWY TAVERNIER FL INSURED FL KEYS CHILDREN'S SHELTER INC 73 HIGH F'OINT RD TAVERNIER FL 33070 33070 ISSUE DATE (MM/DD/YY) 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. COMPANIES AFFORDING COVERAGE COMPANY LETTER A COMPANY LETTER B RHULEN AGENCY INC COMPANY LETTER C COMPANY LETTER D COMPANY LETTER E COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS AGENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR. OWNER'S & CONTRACTOR'S PROT. GLS12728 1/01/71 1/01/72GENERAL AGGREGATE $ 3,000,000 PRODUCTS-COMP/DP AGG. $ PERSONAL&ADV. INJURY $ i ,000,000 EACH OCCURRENCE $ I ~ 000' 000 FIRE DAMAGE (Any one fire) $ 50 ~' 000 MED. EXPENSE (Any one person) $ ~ ~ 000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ WORKER'S COMPENSATION AND EMPLOYERS'LIABILITY STATUTORY LIMITS EACH ACCIDENT $ DISEASE--POLiCY LIMIT $ DISEASE--EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CHILDREN'S SHELTER CERTIFICATE HOLDER MONROE COUNTY RISK MANAGEMENT ATT DONNA F'EREZ WING II RH207 5100 dR COLLEGE RD WEST STOCK ISLAND KE FL 330q0 ACORD 25.S (7/90) Risk.Mgm[. & Loss Control ,ti I)^'l, t:, ~y'- '"' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAIION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ,1. ~AYS WRITTEN NOIICE TO THE CERTIFICAIE HOLDER NAMED TO THE LEFT, BUI FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGAIION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENIS OR REPRESENTATIVES. AUTHORIZED REPRESE~'~ATIVE ROE:ERT/E~ ./REGAN .-~ ~ ~, ©ACORD CORPORATION 1990 ~ 09~08~2003 PRODUCER Serial # 621722 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Marsh USA HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 44 Whippany Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Morristown, NJ 07962 ; COMPANIES AFFORDING COVERAGE I COMPANY A AMERICAN HOME ASSURANCE COMPANY INSURED COMPANY EPIX I INC. L/C/F B INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA FLORIDA KEYS CHILDREN'S SHELTER, INC 1480 ROUTE 9 NORTH, COMPANY ASPEN CORP. PARK 1 C ILLINOIS NATIONAL WOODBRIDGE, NJ 07095 COMPANY I D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY H~VE BEEN REDUCED BY PAID CLAIMS. LC&' '=POLICY EFFECTIVE [ POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MNVDD/YY) LIMITS GENERAL LIABILITY . GENERAL AGGREGATE $ MERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG $ ~ cLA'us MADE L__J OCCUR I PERSONAL & ADV,NJU.Y [-|~ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ L~ FIRE DAMAGE (Any one fire) $ , i MHD EXP (Any one person) $ ! I ALL OWNED AUTOS ' ~J SCHEDULED AUTOS I ~[ y ~_~.~_ ~j~ (Z_er BODILY INJURY person)  HIRED AUTOS I .,:)ATE ' -~ BOO,LY INJURY NON-OWNED AUTOS i (Per accident) $ 'WAIVER N/A. YES .---.... ~ PROPERTY DAMAGE $ GARAGE LIABILITY ~ /~.' A~U~TO ONLY- EA ACCIDENT $ I ANY OTHER THAN AUTO ONLY; AUTO ~,~ *., ~ : ,~ EACH ACCIDENT $ I , AGGREGATE $ I EXCESS LIABILITY EACH OCCURRENCE [ $ UMBRELLA FORM I AGGREGATE 1 $ ! OTHER THAN UMBRELLA FORM I | $ B 'WORKER'S, COMPENSAT ON AND RMWC 5897449 9/01/2003 9/01/2004 X IwC STATU'TORY LIMITS I EMPLOYERS' LIABILITY -- EL EACH ACCIDENT 1,000,000 THE PROPRIETOR/ k~ INCL EL D,SEASE-POUOY L,M,T $ 1,000,000 PARTNERS/EXECUTIVE _ OFFICERS ARE:I I EXCL EL DISEASE- EA EMPLOYEE$ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS COVERAGE IS PROVIDED FOR LEASED EMPLOYEES BUT NOT SUBCONTRACTORS OF: FLORIDA KEYS CHILDREN'S SHELTER, INC ;CERTIFIC~ E SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY CONSTRUCTION-BOCC EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1100 SlMONTON STREET 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, KEY WEST, FLORIDA 33040 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~ ACORD 25~S (1/95) .~ = ~pC~ATiON ~988 C:\FMPRO\CERTPROS 2004 FPS ACORD. CERTIFICATE OF LIABILITY INSURANCF o DATEIMM,DD ) 09/12/03 PRODUCER Greg Roe Insurance, Inc. 9851 State Road 54 New Port Richey FL 34655 Phone:727-376-0030 Fax:727-376-2262 INSURED Florida Kgys Children's Shelter, ±nc. 73 Hig~point Road Tavern~er FL 33070 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 INSURERA: Nonprofits Ins. Association INSURER B: 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 ~=~-t-u~¥iVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ i, 000,000 A X COMMERCIAL GENERAL LIABILITY NIA1810761 09/15/03 09/15/04 FIRE DAMAGE (Any one fire) $ 50, 000 ,I CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5, 000 PERSONAL & ADV INJURY $ i, 000 ~ 000 GENERAL AGGREGATE $ 3, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3 ~ 000 · 000 I POLICY ~PRO' JECT ~] LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANYAUTO NIA1810761 09~5/03 09/15/04 (Eaaccident) $ 500,000 SCHEDULED AUTOS ~ N~ (Per person) $ A X HIRED AUTOS AP · ,. A X NON-OWNEDAUTOS BY~~i-'j~ ~ (Per accident) $ DATE .......... -------~?~ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY WAIVER Nj`A` ......... AUTO ONLY- EA ACCIDENT $ ANY AUTO ~.~0 'fo~ ~ OTHER THAN EAAOC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ i, 000, 000 A I OCCUR ~ CLAIMS MADE NELl803436 09/15/03 09/15/04 AGGREGATE $ 1, 000, 000 $ RETENTION $ i $ WORKERS COMPENSATION AND I WC STATU- CITH- TORY L M T8 ER EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT j $ OTHER A NIA NIA1810761 09/15/03 09/15/04 PROF LIAB 1,000,000 AGGRE 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS WORKERS COMPENSATION APPLIES TO FLORIDA OPERATIONS ONLY * CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED UNDER GENERAL LIABILITY. CERTIFICATE HOLDER J Y J ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION MONROE COUNTY BOCC ATTN:RISK MANAGEMENT 1100 SIMONTON ST. KEY WEST FL 33040 MONR001 ACORD 25-S (7/97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOh DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 0 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. ©ACORD CORPORATION 1988 ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER OP ID ~ DATE (MMIDD/YYYY) FL~YSC I 09/14/04 Greg Roe Insurance, Inc. 9851 State Road 54 New Port Richey FL 34655 Phone: 727-376-0030 Fax: 727-376-2262 INSURED Florida Keys Children's Shelter, Inc. 73 Hig~point Road Tavernler FL 33070 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: Nonprofits Ins. Association INAIC # 04377 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LiS¥1::U BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLA MS MADE [~ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRt=m La. LIABILITY ~ OCCUR [] CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER NIA POLICY NUMBER NIA1812591 POLICY DATE {MMIDD/YY) 09/15/04 NIA1812591 &PP~'~! ~AIx~AGEMF-NT OAi L: ~ WAIVER N/A ._ f .... YES_ ~L1804135 ~ 09/15/0~ 09/15/04 09/15/04 NIA1812591 POLICY EXPIRATIOi~ DATE {MMIDD/YY) 09/15/05 o9/15/o5 o9/15/o5 09/15/05 LIMITI EACH OCCURRENCE I $ 1,000,000 PREMISES (Ea occurence) $ 50 · 000 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ I, 000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS- COMP/DP AGG $ 3 t 000 t 000 COMSINED SINGLE LIMIT (Ea accident) $11000,000 SODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per ar~'Jdent) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE 1,000,000 AGGREGATE $ i, 000 · 000 $ $ W6 ~,TATU- I OTH- $ ITORYLIMITSI r ER I E.L EACH ACCIDENT J $ E.L. DISEASE- EA EMPLOYEE/ $ E.L DISEASE - POLICY LIMIT r $ PROF LIAB 1,000,000 DESCRi~-HuN OF O~'t:I~ATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS WORKERS COMPENSATION APPLIES TO FLORIDA OPERATIONS ONLY * CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED UNDER GENERAL LIABILITY. CE~[iPIC~TE HOLDER CANCELLATION AGGRE 3r000~000 MONROE COUNTY BOCC ATTN:RISKM~NAGEMENT 1100 SIMONTON ST. KEY WEST FL 33040 MONR001 ACORD 25 (2001108) 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 FAJLURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. L © ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) TM. 09124/2007 PRODUCER Phone: (360)697.3611 Fax: (360)697-3688 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NATIONAL INSURANCE PROFESSIONALS CORP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE A DIVISION OF RISK PLACEMENT SERVICES, INC. HOLDER. THIS CERTIACATE DOES NOT AMEND, EXTEND OR 1040 NE HOSTMARK ST #200 1 PO BOX 834 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POULSBO W A 98370.Q834 ! INSURERS AFFORDING COVERAGE NAIC# ------ ---- ----.--. -- --- --_0'0 -- --- - -- -- - ----- I INSURED INSURER A: DIAMOND STATE INSURANCE COMPANY FLORIDA KEYS CHILDREN'S SHELTER, INC. INSURER B: --------- ---- 73 HIGHPOINT ROAD ---- -- TAVERNIER FL 33070 INSURER C: --..-- ----------- INSURER D: ---- ---- .. 1'NSURER E: . COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FDA THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OA 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. INSRiADO'lr---~YPE OF INSURAN~~ ~. ._~;~~;CV NUMBER POLICY EffECTIVE LTA IINSAq I DATE MMJD GENERAL L1ABIUTV PGAOOO0381 09/19/07 X COMMERCIAL GENERAL LIABILITY j I--J CLAIMS MADE [!J OCCUR I COMBINED SINGLE LIMIT Not Included (Eaaccident) " BODILY INJURY r- (Per person) I' Not Included ---- BODILY INJURY Not Included (Per accident) " PROPERTY DAMAGE " Not Included {Per accident) i_~_IfI"O ONLY: _EA~_9.Q~DENT_ , Not Included OTHER THAN _.EMCC , Not Included AUTO ONLY: - - Not InClUded AGG , EACH OCCURRENCE JI- Not Included AGGREGATE Not Included 1--- .~. Not Included " Not Included 1$ Not Included ; we STATU. OTHER iTO-'~YLlM!!S E.L. EACH ACCIDENT , Not Included E.l. DISEASE-EA EMPLOYEE " Not Included -._------- r--- E.L. DISEASE-POLICY LIMIT , Not Included 09/19/08 1$1,000,000 EACH CLAIM '$3,000,000 AGGREGATE pOLICYExPlRATI;;;;r-- DATE MM/tl 09/19/08 A Yn. , ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE UABILITV L_I ANY AUTO PGAO000381 09/19/07 LIMITS EACH OCCURRENCE ,$ DAMAGETORENfED-~i PREMJSES(Eaoocurenoe) __,_ MED. EXP (Anyone person) i $ .1: . _ 2,000,000 100,000 Excluded 2,000,000 4,000,000 4,000,000 PERSONAL & ADV INJURY I - ---------- 1 GENERAL AGGREGATE PRODUCTS-COMPIOP AGG. _..1$ DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED UNDER THE ABOVE POLICY BUT ONLY AS THEIR INTERESTS MAY APPEAR AND ONLY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED, PER FORMS EPA-1084(10/05) AND SL-12(02/97). MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1100 SIMONTON STREET EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE KEY WEST FL 33040 TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, Irs AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE b;;;1C.~ Attention: Ba . Clipsham Q..c. : t=; '^--o.. VI c. L CERTIFICATE HOLDER CANCELLATION ACORD 2S (2001/08) Certificate # 50320 @ACORD CORPORATION 1988 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder other than those provided by this policy. This certificate does not amend, extend, or alter the coverage afforded by the policies described herein. Named Insured(s): Gevity HR, Inc and its wholly owned subsidiaries including but not limited to Gevity HR, LP; Gevity HR II, LP; Gevity HR III, LP; Gevity HR IV, LP; HR V, LP; gevity HR VI, LP; gevity HR Vii, LP; gevity HR VIII, LP; ~/~ ~ r~) q ~.~ Gevity Gevity HR IX, LP; Gevity HR X, LP; Gevity HR XI, LLC; Gevity HR XII Corp. 600 301 Boulevard West Insurer Affording Coverage Bradenton, Florida 34205 American Home Assurance Co., Member of Amertcan International Group,lnc.(AIG) Coverages: This is to certify that the policy(les) of insurance described herein have been issued to the insured named herein for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which the Certificate may be issued or may pertain, the insurance afforded by the policy(les) described herein is subject to all the terms, conditions and exclusions of such policy(les). (Aggregate) Limits shown may have been reduced by paid claims. Type of Insurance Certificate Exp. Policy Number Limits Date Employers Liability RMWC0330470 Bodily Injury By Accident Workers' 1-1-2006 RMWC0330495 $2,000,000 Each Accident Compensation Bodily Injury By Disease $2,000,000 Policy Limit Bodily Injury By Disease $2,000,000 Each Person Other: ~~_~-~ ' Ef~T~~, Employees Leased To: ~ .-~~ , 44538.Florida Keys Childrens Shelter, Inc. ~'~, .i i .~.~i ', :'ii/- ,~._'~ __. ~:.~ The above referenced workers' compensation policy(les) provide(s) statutory beneffis only to employees of the Named~ ~sur ~(s) on such policy(les), not to the employees of any other employer. Notice of Cancellation: Should any of the policies described herein be cancelled before the expiration date thereof, the insurer affording coverage will endeavor to mail 3~0 days written notice to the certificate holder named herein, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer affording coverage, its agents or representatives. Certificate Holder Monroe County Board of County Commissioners 1100 Simonton Street Key Wes~ FL 33040 Michael C. Weiss Authorized Representative of Marsh USA Inc. (866)443-8489 0 8 - FEB - 2 0 0 5 Phone Date Issued Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder other than those provided by this policy. This certificate does not amend, extend, or alter the coverage afforded by the policies described herein. Named Insured(s): Gevity HR, Inc and its wholly owned subsidiaries including but not limited to Gevity HR, LP; Gevity HR II, LP; Gevity HR III, LP; Gevity HR IV, LP; Gevity HR V, LP; Gevity HR VI, LP; Gevity M A R S H HR VII, LP; Gevity HR VIII, LP; Gevity HR IX, LP; Gevity HR X, LP; Gevity HR XI, LLC; Gevity HR XII Corp. 600 301 Boulevard West I Insurer Affording Coverage Bradenton, Florida 34205 American Home Assurance Co., Coverages: Member of American International Group, Inc. (AIG) This is to certify that the policy(les) of insurance described herein have been issued to the insured named herein for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which the Certificate may be issued or may pertain, the insurance afforded by the policy(ies)described herein is subject to all the terms, conditions and exclusions of such policy(ies). (Aggregate) Limits shown may have been reduced by paid claims. Type of Insurance Certificate Exp. Date Policy Number Limits Employers Liability Workers' 1-1-2007 RMWC9426922 Bodily Injury By Accident Compensation RMWC9431313 $ 2,000,000 Each Accident Bodily lnjury By Disease $ 2,000,000 Policy Limit Bodily Injury By Disease $ 2,000,000 Each Person Other: Employees Leased To: Effective Date: 1/1/06 44538 Flodda Keys Chlldrens Shelter, Inc. The above referenced workers' compensation policy(ies) provide(s) statutory benefits only to th~ ~n/pl6y~ of the Nanledi~r-e~s~} imf.ch ?h~y0&s), not to the employees of any other employer. Notice of Cancellation: Should any of the policies described herein be cancelled before the expiration date thereof, the insurer affording coverage will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer affording coverage, its agents or representatives. Certificate Holder: Monroe County Board of County Commissioners 1100 Simonton St Key West, FL 33040-3110 I,,11,,,11,11,,,,i,,111,,,,,11,,,,11,,,1111,,,!1,,,11,,,,I,1,1 Michael C. Weiss Authorized Representative of Marsh USA Inc. (866) 443-8489 12/15/2005 Phone Date Issued ACORD. PRODUCER CERTIFICATE OF LIABILI'I ------- Greg.Roe Insurance, Inc. 9851 State Road 54 New Port Richey FL 34655 Phone: 727-376-0030 Fax: 727-376-2262 INSURED ~or~da K~ys Children,s el=er, Inc. 73 Hig~oint Road Tavernier FL 33070 COVERAGES rY INSURANCE OP,D DATE,M D 7--, 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 _RI=LOW. INSURERS AFFORDING COVERAGE NAIC # INSURERA: R/verport Insurance Company 04377 INSURER B: INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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 POMCY NUMBER GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY NIA1812591 09/15/05 09/15/06 __ CLAIMS MADE [] OCCUR LIMITS EACH OCCURRENCE 0,000 i (La occurence $ 5 0 , 0 0 0 MED EXP (Any one person) $ 5~000 PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE PRODUCTS - COMP/DP AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO NIA1812591 09/15/05 09/15/06 (La accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) NON-OWNED AUTOS ~- BODILY INJURY ~ ? (Per accident) PROPERTY DAMAGE GARAGE LIABILITY (Per accident) ANY AUTO t,.~J ~! (~,i~.~ [~. AUTO ONLY - EA ACCIDENT NELl804135 OTHER THAN EAACC $ AUTO ONLY: AGG $ EACH OCCURRENCE EXCESS/UMBRELLA LIABILITY OCCUR ~ CLAIMS MADE 09/15/05 09/15/06 AGGREGATE DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ Ifyes, describe under SPECIAL PROVISIONS below E.L. DISEASE - EA $ 000 000 )0,000 $ 1,000,000 $ E.L. DISEASE - POLICY $ 10,000 000 NIA NIA1812591 09/15/05 09/15/06 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS WORKERS COMPENSATION COVERAGE IS PROVIDED UNDER LEASING ARRANGEMENT WITH GEVITY. CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AND CO~4ERCIAL AUTO LIABILITY AS REQUIRED BY CONTRACT. PROF LIAB 1,000,000 AGGRE CERTIFICATE HOLDER COUNTY OF MONROE BOCC ATTN:RISKM~NAGEMENT PO BOX 1026 KEY WEST 33 33040 MONR001 ACORD 25 (2001108) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 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. © ACORD CORPORATION 198; Certificate of Insurance This certificate is issued as a matter of information only and confers no fights upon the Certificate Holder other than those provided by this policy. This certificate does not amend, extend, or alter the coverage afforded by the policies described herein. Named Insured(s): Gevity HR, Inc and its wholly owned subsidiaries including but not limited to Gevity HR, LP; Gevity HR II, LP; Gevity HR III, LP; Gevity HR IV, LP; Gevity HR V, LP; Gevity HR VI, LP; Gevity HR VII, LP; Gevity HR VIII, LP; Gevity HR IX, LP; Gevity HR X, M A R S H LP; Gevity HR XI, LLC; Gevity HR XII Corp. 600 301 Boulevard West [ Bradenton, Florida 34205 ] Insurer Affording Coverage American Home Assurance Co., Coverages: Member of American International Group, Inc. (AIG) This is to certify that the policy(ies) of insurance described herein have been issued to the insured named herein for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which the Certificate may be issued or may pertain, the insurance afforded by the policy(ies)described herein is subject to all the terms, conditions and exclusions of such policy(ies). (Aggregate) Limits shown may have been reduced by paid claims. Type of Insurance Certificate Exp. Date Policy Number Limits Employers Liability Workers' 1-1-2007 RMWC9426922 Bodily Injury By Accident Compensation RMWC9431313 $ 2,000,000 Each ^ccident Bodily Injury By Disease $ 2,000,000 Policy Limit Bodily Injury By Disease $ 2,000,000 Each Person Other: Employees Leased To: Effective Date: 1/1/06 44538 Florida Keys Childrens Shelter, Inc. The above referenced workers' compensation policy(ies) provide(s) statutory benefits only to the employees of the Named Insured(s) on such policy(ies), not to the employees of any other employ'er. Notice of Cancellation: Should any of the policies described herein be cancelled before the expiration date thereof, the insurer affording coverage will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer affording coverage, its agents or representatives. /\f~' ' ' ~ ~: '~ vi~ ,, -'Z~~:: , Certificate Holder: ~.~.(-~ ~ Monroe County Board of County Commissioners 1100 Simonton St Key We,st, F~ 33040-3110 Michael C. Weiss Authorized Representative of Marsh USA Inc. (866) 443-8489 12/15/2005 Phone Date Issued Certificate of Insurance This certificate is issued as a matter of information only and confers no rights This certificate does not amend, extend, or alter the coverage afforded by the olicies desc . e provided by this policy. Named Insured(s): Gevity HR, Inc and its wholly owned subsidiaries including but not limited to Gevity HR, LP; Gevity HR II, LP; Gevity HR III, LP; Gevity HR IV, LP; Gevity HR V, LP; Gevity HR VI, LP; Gevity HR VII, LP; Gevity HR VIII, LP; Gevity HR IX, LP; Gevity HR X, LP; Gevity HR XI, LLC; Gevity HR XII Corp. 9000 Town Center Parkway Bradenton, Florida 34202 DEe 2 2 2006 MONROE COUNlY RISK MANAGEMENT MA SH Coverages: American Home Assurance Co., Member of American International Group, Inc. (AIG) This is to certify that the policy(ies) of insurance described herein have been issued to the insured named herein for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which the Certificate may be issued or may pertain, the insurance afforded by the policy(ies)described herein is subject to all the terms, conditions and exclusions of such policy(ies). (Aggregate) Limits shown may have been reduced by paid claims. T e of Insurance Certificate Exp, Date Polic Number Limits Em 10 ers Liabili Workers' Compensation 1-1-2008 RMWC9719932 RMWC9719957 Bodily Injwy By Accident $ 2,000,000 Each Accident Bodily Injwy By Disease $ 2,000,000 Policy Limit Ai.'[.:::;~ ;,iElj Bodily Injury By Disease $ 2,000,000 Each Person Employees Leased To: c......- ,,,;::: 1~~-07 c)1J;.,', '. 'CC . Other: tj'( '. ElleCIlve Date: 1/1107 44538 Florida Keys Childrens Shelter, Inc. The above referenced workers' compensation policy(ies) provide(s) statutory benefits only to the employees of the Named Insured(s) on such policy(ies), not to the employees of any other employer. Notice of Cancellation: Should any of the policies described herein be cancelled before the expiration date thereof, the insurer affording coverage will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer affording coverage, its agents or representatives. G C', ~\ V'\.o.. (', C. ~ Certificate Holder: /Jr(~e.~~1- Monroe County Board of County Commissioners 1100 Simonton St Key West, FL 33040-3110 1,,11,,,11,11,,,,1,1111,,,,,11,,,,11,,11111,,111,1,11,1,,1,1,1 Michael C. Weiss Authorized Representative of Marsh USA Inc. (866) 443-8489 Phone 01/01/2007 Date Issued ACORD CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MMlDDIYYYY) TM 10/20/2006 PRODUCER Phone: (360)697-3611 Fax: (360)697-3688 THIS CERTIFICATE IS ISSUED AS A MA TIER OF INFORMATION NATIONAL INSURANCE PROFESSIONALS CORP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE A DIVISION OF RISK PLACEMENT SERVICES, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1040 NE HOSTMARK STREET #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POULSBO WA 98370-7454 I ;;:;r.. RS AFFORDING COVERAGE NAIC# INSURED 1'{1"1,r1VLU INSURE A UNITED NATIONAL INSURANCE COMPANY FLORIDA KEYS CHILDREN'S SH LTER, I SURE B: 73 HIGH POINT ROAD 1 SURE c: TAVERNIER FL 33070 JAN "r Z007 I SURER 0 I I SURER E: COVERAGES ~ THE POLICIES OF INSURANCE LISTED BE W HAVE BEE NSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED, N01W1THSTANDING ANY REQUIREMENT, TERM OR CONDlTlO-rJ OF ANY CON RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDE 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 ADD' TYPE OF INSURANCE POLICY NUMBER Pg;~~~~~~E P~i~lif~~~N LIMITS m INSR ~ERAL LIABILITY NGAOOO0318 09/15/06 09/15/07 EACH OCCURRENCE . 1,000,000 DAMAGE TD RENTED X COMMERCIAL GENERAL L1ABILtTY PREMISES (Ea occurence\ . 100,000 I CLAIMS MADE [!] OCCUR MED. EXP (Anyone person) , EXCLUDED A PERSONAl & ADV INJURY , 1,000,000 - GENERAL AGGREGATE , 3,000,000 - GEN'L AGGREPl LIMIT APPn ~ER PRODUCTS-COMP/OP AGG , 3,000,000 Xl PRO- X POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - (Eaaccident) , Not Included ANY AUTO - ALL OWNED AUTOS BODILY INJURY - (Per person) , Not Included - SCHEDULED AUTOS HIRED AUTOS BODILY INJURY 1 f---- I, Not Included NON-OWNED AUTOS f\i1.\1 L '(J_ (Per accident) '-- I-- PROPERTY DAMAGE $ Not Included .. (Per accident} GARAGE LIABILITY -jIO/ AUTO ONLY - EA ACCIDENT , Not Included ==l ANY AUTO Y- OTHER THAN EAACC , Not Included . . AUTO ONLY AGG $ Not Included ~ESS I UMBRELLA LIABILITY 6' A'. {QfI,(L EACH OCCURRENCE , Not Included OCCUR D CLAIMS MADE 9 ( \ J~(); AGGREGATE i$ Not Included , Not Included ==l DEDUCTIBLE $ Not Included I RETENTION $ '-'. <r " Not Included WORKERS COMPENSATION AND IYVCSTATIJ. I I OTHER TORY LIMITS EMPLOYERS' LIABILITY EL EACH ACCIDENT , Not Included AtJY PROPRIETORIPARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? E.l. DISEASE-EA EMPLOYEE $ Not Included It yes,cIescrlbe under E.L DISEASE-POLICY LIMIT , Not Included SPECIAL PROVISIONS belo'll' OTHER: PROFESSIONAL LIABILITY NGAOOO0318 09/15/06 09/15/07 $1,000,000 EACH CLAIM A $3,000,000 AGGREGATE DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS CERTIFICATE HOLDER TO BE NAMED AS ADDITIONAL INSURED UNDER THE ABOVE POLICY BUT ONLY AS THEIR INTERESTS MAY APPEAR AND ONLY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. C-C.' ;:f;; /111 t" e...... CERTIFICATE HOLDER CANCELLATION MONROE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BOARD OF COUNTY COMMISSIONERS EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE 1100 SIMONTON ST TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, KEY WEST FL 33040 Irs AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE b;;:JC.~ Attention: Sa . Clipsham ACORD 25 (2001108) Certificate # 46098 @ACORDCORPORATION1988 CE:RTIFICATE OF LIABILITY INSURANCE FL~~C~ DAT;~M/M;;7o';1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Greg Roe Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9851 State Road 54 ,'-'~-',-,--"",_,,_ -AJ..tl;B, Ti:j~.COVERAGE AFFORDED BY THE POLICIES BELOW. New Port Richey FL 34655 i P !="('Cf\ 'C'T) ~' I Phone-'-'7.27~376-0030 Fax: 727-37~_:f~~'__'\ .~',~mtki!IiE~1'F RDING COVERAGE I NAIC# INSURED I - I ~SURE~i~~ed National Group Florida K~~ys Children I S j M/'; c: 1:1 I :~:~:::: . ProgrBS.SiV,: Am~rica_~~~~~,. ~~e~r~E:po;~~~ . Road I ~~SURER 0-'----------- __ Tavernier FL 33070-2005 l !' .'~___ ""1 'INSURER E ACORD. PRODUCER 09412 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 ISSUEO OR MAY PERTAIN, THE INSURANCE }\FFORDED BY THE POLICIes DESCRIBED HEReIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ] , -. L TR NSR A x TYPE OF INSURANCE ~NERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X I CLAIMS MADE 0 OCCUR ~ I , I h~N'L AGGRaE=GA.: TorE LIMIT APPLIES PER: j PRO- n POLICY JECT LOC AUTOMOBILE LIABILITY - ANY AUTO - _ ALL OWNED AUTOS ~ SCHEDULED AUTOS - NON-OWNED AUTOS - f-- POLICY NUMBER DATE fMMfDD~t DATE {MMIDDt0rr' I I I EACH OCCURRENCE 09/15/06 I 09/15/07 I PREM:SES'(E;~~~OO'] liMED EXP (Anyone person) I II PERSONAL & ADV INJURY GENERAL AGGREGATE I LPRODUCTS - COMP/OP AGG LIMITS NGA0000318 .1,000,000 .100,000 .5,000 '1,000,000 .3,000,000 .3,000,000 COMBINED SINGLE LIMIT (Eaaccident) '1,000,000 HIRED AUTOS I 03685779-0 09/15/06 09/15/07 BODILY INJURY (Per person) I. A BODILY INJURY (Per accident) . ~RAGE LIABILITY I ANY AUTO EXCESs/UMBRELLA LIABILITY =:=J OCCUR 0 CLAIMS MADE ~ DEDUCTIBLE I RETENTION $ WORKERS COMPENSATION ANI) EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFJCERlMEMBER EXCLUDED? I ~P~C:I~ts~~~VISrciNS below OTHER I I PROPERTY DAMAGE (Per accident) .- . {[kuh.. Cru AUTO ONLY - EA ACCIDENT $ EA ACC $ AGG $ . . . . . ~~9RY~~'IMITS il_---L~ ~ I EL EACH ACCIDENT $ :_~..~:ELS~_~~E-=~~ .E~~L~~~ ...! _____ __ _.________ i EL DISEASE - POLICY LIMIT $ I OTHER THAN AUTO ONLY' -- DESCRIPTION OF OPERATIONS { LOCATIONS I VEHICLES { EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY AS PER CONTRACT REQUIREMENTS. FAXED TO HOLDER 305-292-4487. r nl, \11 .Q ~ -- (3--0 7 'f. 16v6. . I '\ I I EACH OCCURRENCE AGGREGATE -. CERTIFICATE HOLDER MONROE COUN~~Y BOARD OF COUNTY COMMISSIONERS MONROE RISK MGT 1100 SIMONTON ST KEY WEST FL 33040 CANCELLATION 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. AU IZ D REPRESENTATlV . ACORD 25 (2001/~) . Ce..' ~-<.Z" @ ACORD CORPORATION 1988 A CORD_ CERTIFICATE OF LIABILITY INSURANCE CSR AD I DATE (MM/DDfYYYY) FLKEYSC 10/02/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Greg Roe Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENO OR 9851 State Road 54 , . . - Ab-l'ER VERAGE AFFORDED 8Y THE POLICIES 8ELOW. New Port Richey FL 34655 i i i ~.' (', L 'i\ i. . 1 ! , , -,;..,\.t'_ ; ~' '1IlSIiRE~S AFF RDING COVERAGE Phone: 727-376-0030 Fax:727-3761226~._.~ . ~"'-"'-' NAIC# INS~RE~' j--=~. ~~d sta'te--i-~~~~~~~~~ -~_~~__~_ -.--.- -..- ------ INSURED I ' --- I ! OCT 9 lNS~R~ Pr ressive American Ins. Co. 09412 Florida Keys Children's i l INSURER c:i Shelter, Inc. ------- .- 73 Highpoint Road Iti~.URER oJ Tavernier FL 33070-2005 .--.-"'---- ,-_..._---, ~_.,,- 1--.- .- J r.',' ,:_',E CQ H~~RER E , ,'ir:,'",.!\,.; .[1':1 ~.______. . .-.- .-" -"~'- 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. ~ri~fJ.f~E P8k~E MM/DDNY --. LTR NSR TYPE OF INSURANCE POLICY NUMBER LIMITS ~NERAL LIABILITY EACH OCCURRENCE '2,000,000 A X X COMMERCIAL GENERAL LIABILITY PGAOOO0381 09/19/07 09/19/08 I ~~~.A~" $100,000 PREMISES (Ea oc.curence) - U CLAIMS MADE ~ OCCUR MED EXP (Any ona parson) 'EXCLUDED e- PERSONAL & ADV INJURY '2,000,000 - -...._- I .. e- , GENERAL AGGREGATE ~.4, 000,000 -- , h'L AGG~EnE LIMIT APPlS PER PRODUCTS - COMP/OP AGG , 4,000,000 ! POLICY rf8-f LOC I aOMOBILE LIABILITY I i COMBINED SINGLE LIMIT '1,000,000 ANY AUTO i (EaaCCidant)___ ! I -- ALL OWNED AUTOS ! BODILY INJURY A ~ SCHEDULED AUTOS 03685779-1 09/15/07 09/15/08 ' (Par parson) , I - ~' HIRED AUTOS BODILY INJURY I NON-OWNED AUTOS (Paraccidenl) $ e--- - PROPERTY DAMAGE $ {Per accident) ~RAGE LIABILITY ffi, ~nll .~ AUTO ONLY - EA ACCIDENT , , ~ I ANY AUTO .-- OTHER THAN EA ACC $ AUTO ONLY -. AGG $ EXCESS/UMBRELLA LIABILITY , lD;Z /121 EACH OCCURRENCE , ~J OCCUR D CLAIMS MADE . . -- AGGREGATE , 1. -- R DEDUCTIBLE , ---- i . ! ( .n ) .--. , I RETENTION 1--. .- $ ~ , $ T WORKERS COMPENSATION AND IU~ ITb'~ySJ~Ws I IU~~ EMPLOYERS' LIABILITY ~ ..- I ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT , OFFICER/MEMBER EXCLUDED? (( /:1 -..- E,L, DISEASE - EA EMPLOYEE $ If yes, descnbeundar ... --- SPECIAL PROVISIONS below LL. DISEASE - POLICY LIMIT $ OTHER I i i DESCRIPTION OF OPERATIONS I LOCATIONS {VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT {SPECIAL PROVISIONS HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY AS PER CONTRACT REQUIREMENTS. FAXED TO HOLDER 305-292-4487. c.C hi-J(Ul~<!.--- COVERAGES CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS MONROE RISK MGT 1100 SIMONTON ST 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 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AU IZ D REPRESENTATIV . ACORD 25 (2001/08) @ ACORD CORPORATION 1988 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder other than those provided by this policy. This certificate does not amend, extend, or alter the coverage afforded by the policies described herein. r "~I ' I i l i~D i--~O~ _v lM~RSH --~Ur,!iiUE CC1UIHY ;V~I\ j ,:,:; Ei\,\t~! "___.___----, I'" :Jc,,; Named Insured(s): Gevity HR, Inc; Gevity HR, LP; Gevity HR II, LP; Gevity HR I LP; Gevity HR IV, LP; Gevity HR V, LP; Gevity HR VI, LP; Gevity HR VII, LP; Gevity HR VIII, LP; Gevity HR IX, LP; Gevity HR X, LP; Gevity HR XI, LLC; Gevity HR XII Corp.; Gevity XIV, LLC. 9000 Town Center Parkway 1< ,.-'- n Insurer Affordinl! Covera2e Bradenton, Florida 34202 (A) Commerce & Industry Insurance Company Coverages: (B) New Hampshire Insurance Company This is to certify that the policy(ies) ofinsurance described herein have been issued to the insured nwned herein for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which the Certificate may be issued or may pertain, the insurance afforded by the policy(ies)described herein is subject to all the terms, conditions and exclusions of such policy(ies). (Aggregate) Limits shown may have been reduced by paid claims. TVDe of Insurance Certificate Exp. Date Policy Number* Limits Emolovers Liability Workers' 1-1-2010 (A) RMWC7095050 Bodily Injury By Accident Compensation $ 2,000,000 Each Accident (B) RMWC7095051 Bodily Injury By Disease $ 2,000,000 Policy Limit Bodily Injury By Disease $ 2,000,000 Each Person Other: Employees Leased To: Effective Date: 01101109 44538 Florida Keys Childrens Shelter, Inc. The above referenced workers' compensation policy(ies) provide(s) statutory benefits only to the employees of the Named Insured(s) on such policy{ies). not to the employees of any other employer. Notice of Cancellation: Should any of the policies described herein be cancelled before the expiration date thereof, the insurer affording coverage will endeavor to mail 30 days written notice to the certificate holder narned herein, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer affording coverage, its agents or rff"fsenpfives. '''''''' 0="""""",, -"" OOj";~~.. , 'V' . ~. ~ Certificate Holder: ;:'". .- - "U-:fJ[J--- -..---- /lr(~e.Mti.~ , .'i i,.-. ~._ Monroe County Board of County Commissioners 1100 Simonton St Key West, FL 33040-3110 I"II",I~II""I"III"",II'I"II",IIII"III",II",,1,1,1 c.Co :~ Michael C. Weiss Authorized Representative of Marsh USA Inc. (866) 443-8489 Phone 01/01/2009 Date Issued CSR AD DATE (MM/DDIYYYY) FLKEYSC 03 02 09 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 AL T~.B l]:il;, ,OVERAGE AFFORDED BY THE POLICIES BELOW. ACORD... CERTIFICATE OF LIABILITY INSURANCE PRODUCER Greg Roe Insurance, Inc. 9851 State Road 54 ~~~n~~;~7~i3~~:~0~~ 3~:~5: 727-376 r;;'~';~"-"t~.' . INSURED ;- 1 \ .r~~iJ~ERS AFFORDING COVERAGE INSURER A: Arch Insurance Com an Florida Keys Children's Shelter, Inc. 73 Highpoint Road Tavernier FL 33070-2005 MAR 1 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IssuEbro TRETNsUREffNAMEO' 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 NUMBER TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ~ OCCUR 03/01/09 A X NCPKG0108700 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG LOC A ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) NCAUT0108700 03/01/09 BODILY INJURY 03/01/10 (Per person) BODILY INJURY (Per accident) GARAGE LIABILITY ANY AUTO PROPERTY DAMAGE (Per accident) ~: DEDUCTIBLE RETENTION $ AUTO ONLY - EA ACCIDENT $ $ $ $ $ $ $ $ OTHER THAN AUTO ONLY: EXCESS/UMBRELLA LIABILITY OCCUR D CLAIMS MADE EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? If Yell. de5Cl'ibe under SPECIAL PROVISIONS below I OTHER I i L- DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY PER CONTRACT REQUIREMENTS. FAXED TO HOLDER 305-292-4487. E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ AS CERTIFICA TE HOLDER NAIC# LIMITS $1,000,000 $ 100,000 $10,000 $1,000,000 $ 3,000,000 $ 3,000,000 $1,000,000 $ $ $ EA Ace AGG $ MONROE COUNTY BOARD OF COUNTY COMMISSIONERS MONROE COUNTY RISK MGT 1100 SIMONTON ST KEY WEST FL 33040 CANCELLA TION MONRCOU 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. AU D REPRESENTATI\l , ACORD 25 (2001~) c,c.: ~ @)ACORDCORPORATION 1988 Certificate of Insurance 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 described herein. Named Insured(s): 9000 Town Center Parkway Bradenton, FL 34202 SeD ....i TriNet HR Corporation Gevity HR, Inc and all its affiliates & subsidiaries. Florida Keys Childrens Shelter, Inc. (Endorsed as alternate e ploye r',< , " ; e The policies of insurance listed below have been issued to the i me a ove or e policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which the 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 Insurer Policy Number State Effective Insurance Date Expiration Date Limits [B] we Statutory Limits Workrs' Compensation (A) 023259191 FL 07-01-2009 07-01-2010 Employers Liability Bodily Injury By Accident $ 2,000,000 Each Accident Bodily Injury By Disease $ 2,000,000 Policy Limit Bodily Injury By Disease $ 2,000,000 Each Person ~, Dj ,~ " ,~ Other: Client Number 44538 The above referenced workers' compensation policies provide statutory benefits only to the employees of the Named Insured(s) on such policies, not to the employees of any oth.:!r employer. * Gevity HR, Ine; Gevity HR, LP; Gevity HR II, LP; Gevity HR III, LP; Gevity HR IV, LP; Gevity HR V, LP; Gevity HR VI, LP; Gevity HR VII, LP; Gevity HR VIII, LP; Gevity HR IX, LP; Gevity HR X, LP; Gevity HR XI, LLC; Gevity HR XII Corp.; Gevity XIV, LLC Cancellation: Should any of the above described policies be cancelled before the expiration date thereof. the insurer affording coverage will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer affording coverage, its agents or representatives. Certificate Holder Monroe COlmty Board of County Commissioners 1100 Simonton St Key West, FL 33040-3110 1IIIIIIIIIj I,II,! 1,1I11111111,11111,1111111111111111111111111 c.e...~~ :A.ON'Risk Services Northeast, Inc. AON Risk Services Northeast, Inc. Authorized Representative of AON Risk Services (866) 443-8489 Phone 09/16/2009 Date Issued 03 1692 ACORD. CERTIFICATE OF LIABILITY INSURANCE OP IDAD I DATE (MMIDOIYYYY) FLKEYSC 04/19/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION . ONLY J'-HD CONfEr S NO RIGHTS UPON THE CERTIFICATE Greg Roe Insurance, Inc. . t .- 'g. THIS CER J"IFICATE DOES NOT AMEND, EXTEND OR 9851 state Road 54 i ~ THE COVER ~GE AFFORDED BY THE POLICIES BELOW. - '." 1 New Port Richey FL 34655 Phone: 727-376-0030 Fax: 727-376-2262 INSURERS AFtORDI~ G COVERAGE NAIC # INSURED i INr1JRER lUlU Atch In surance Company INSURER B: ! Florida Keys Children's . . INSURER e~ .-. -.. .....---~ .J Shelter, Inc. 73 Highpoint Road ! . ~lN~Y~~ ~. ~ y~ Tavernier FL 33070-2005 ' ' -~...._" INSUR!:~" - ," - ~.,...... ,_. ...-.- 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 ~DD'L POLICY EFFECTIVE POLICY EXPtRATlON LIMITS LTR lNSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDIYY) DATE (MMlDD/YY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - DAMAGE TO RENTED A X X COMMERCIAL GENERAL LIABILITY NCPKG0108701 03/01/10 03/01/11 PREMISES (Ea occurence) $ 100,000 - o CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $ 10,000 - PERSONAL & ADV INJURY $ 1,000,000 - ~ INCL SEXUAL ABUSE GENERAL AGGREGATE $ 3,000,000 GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 3,000,000 I POliCY n PRO- nLOC Emp Ben. 1,000,000 JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ 1,000,000 X ANY AUTO (Ea accident) ---I ALL OWNED AUTOS BODILY INJURY f--- $ A ~ SCHEDULED AUTOS NCAUT0108701 03/01/10 03/01/11 (Per person) HIRED AUTOS BODILY INJURY - $ NON-OWNED AUTOS (Per accident) - A ~ PIP $10,000 PROPERTY DAMAGE $ A X Ned Pay $5,000 (Per accident) GARAGE LIABILITY g AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO (n OTHER THAN EA ACC $ ~^ AUTO ONLY: AGG $ EXCESSlUMBRELLA LIABILITY .\) ~4~ ~ EACH OCCURRENCE $ :=J OCCUR D CLAIMS MADE V -- \0 .,-,... AGGREGATE $ $ =1 OEDUCTiBLE 'f $ RETENTION ' '.~ /""'\ s s WORKERS COMPENSATION AND ~ '~(1 ~ I WC STATU- I 10TH. TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? [' (' JeQe E.L. DISEASE - EA EMPLOYEE S If yes, describe under SPECIAL PROVISIONS below .- E.L. DISEASE - POLICY LIMIT $ OTHER A Crime NCPKG0108701 03/01/10 03/01/11 Employee 50,000 Dishonsty DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY AND COMMERCIAL AUTO AS PER CONTRACT REQUIREMENTS. FAXED TO HOLDER 305-292-4487. *30 DAYS NOTICE OF CANCELLATION EXCEPT 10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM. ,t:::; r1 a.. r1 (" c..C e..... CERTIFICATE HOLDER CANCELLATION MONRCOU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS MONROE COUNTY RISK MGT 1100 SIMONTON ST KEY WEST FL 33040 DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAileD TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. @ ACORD CORPORATION 1988 ACORD 25 (2001/08) Certificate of Insurance 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 described herein. I I Named Insured(s): f<ECEIVEf j ~- ~.-'! I i TriNet HR Corporation : Insurer Affording Coverage and all its affiliates and subsidiaries* , JUL 20 2010 Commerce & Industry Ins Company (A) Florida Keys Childrens Shelter, Inc. i (Endorsed as alternate employer) I I Illinois National Insurance Company (8) i i..........~.._.~__._ ...._ .,J Ins Co of the State of Pennsylvania (C) 9000 Town Center Parkway i MmmJE COUf Bradenton, FL 3420:2 ! RiSh !<MJ":-E~' ~ Nat Union Fire Ins Co of Pittsburgh PA (D) 1_.. -~_..._-,- New Hampshire Insurance Company (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 the 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 Insurer Policy Number Effective Date Expiration Date Limits 00 we Statutory Limits Workers' Compensation A 057057094 (FL) 07/01/2010 07/01/2011 Employers Liability Bodily Injury By Accident $ 2,000,000 Each Accident Bodily Injury By Disease $ 2,000,000 Each Person Bodily Injury By Disease $ 2,000,000 Policy Limit UJs ' Jtk u/i-a ~ Other: Client Number: 9MF,93VT The above referenced workers' compensation policies provide statutory benefits only to the employees of the Named Insured(s) on such policies, not to the employees of any other employer. . TriNet HR V, Inc.; TriNet HR Corporation Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the insurer affording coverage will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer affording coverage, its agents or representatives. Certificate Holder: Monroe County Board of County Commissioners 1100 Simonton Street Key Wes)/, FL 33040 {!,C'~~ ;?tON'RisR Services Northeast, Inc. AON Risk Services Northeast, Inc. (866) 443-8489 Phone 7/13/2010 Date Issued ( OPID:MH A , °RR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/24/12 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 CO 727- 376 -0030 NAME: Greg Roe Insurance, Inc. 727.376_2262 PHONE FAX 9851 State Road 54 ( A/C. No. EMI: (A/C, No): New Port Richey, FL 34655 EMAIL ADDRESS: Gregory G. Roe A224149 PRODUCER CUSTOMER ID #: FLKEYSC INSURER(S) AFFORDING COVERAGE NAIC # INSURED Florida Keys Children's INSURER A: Arch Insurance Company 11150 Shelter, Inc. INSURER B : 73 Highpoint Road INSURER C Tavernier, FL 33070 -2005 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSR s�u/sDa POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DDIYYYY) (MM /DDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X NCPKG0108702 03/01/12 03/01/13 DAMAGE TO REN PREMISES (Ea occurrence 100,000 $ ,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 X INCL SEXUAL ABUSE GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 7 POLICY JECT LOC Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1 ,000,000 (Ea accident) A X ANY AUTO NCAUT0108702 03/01/12 03/01/13 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS • PROPERTY DAMAGE X HIRED AUTOS 8 h Pl2 V ' RISK (Per accident) X NON -OWNED AUTOS DA O- N $ UMBRELLA LIAB OCCUR ( C/(i EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE CC I f AGGREGATE $ DEDUCTIBLE RETENTION $ $ i WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N 1 A $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Crime NCPKG0108702 03/01/12 03/01/13 DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mores ' ace Is required) HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY AND COMMERCIAL AUTO AS PER CONTRACT REQUIREMENTS. FAXED TO HOLDER 305- 2924487. *30 DAYS NOTICE OF CANCELLATION EXCEPT 10 DAYS NOTICE OF CANCELLATION FOR NON - PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION MONRCOU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MONROE COUNTY BOARD OF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COUNTY COMMISSIONERS ACCORDANCE WITH THE POLICY PROVISIONS. MONROE COUNTY RISK MGT 1100 SIMONTON ST AUTHORIZED REPRESENTATIVE KEY WEST, FL 33040 P rte, „ g 4114 7 6 / 4- " 4 - © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD A o D CERTIFICATE OF LIABILITY INSURANCE D 05/10/2012 rv) 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 AMFMIn FYTFAIIl no Al R THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE D NOT NTRACT ETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER FICATE IMPORTANT: If the certificate holder is an ADDITI NAL INSURED, the policy(ies) must endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A st ement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). M Ay ? 'D 7012 PRODUCER CONTACT NAME: Doug Jones c/o Artex Risk Solutions, Inc. P HONE FAX Aic x o : (480) 951 -4177 Arcc, No): (480) 951 -4266 8800 E. Chaparral Rd, Suite 230 MONROE C �1�dYiJ Scottsdale, AZ 85250 RISK MAN IN URER(S) AFFORDING COVERAGE NAIC # INSURERA: American Zurich Insurance Company 40142 INSURED INSURER B : Oasis Acquisition, Inc Alt. Emp: FLORIDA KEYS CHILDREN'S SHELTER, INSURER C: INC 2054 Vista Parkway Suite 300 INSURER D : West Palm Beach, FL 33411 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12FL075822652 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I SUBR EFF POLICY EXP TYPE OF INSURANCE N W SR VD POLICY NUMBER (MM /DD R /YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR AP••1t A i' • - ` - GEMENT MED EXP (Any one person) $ BY DA • PERSONAL & ADV INJURY $ W 4 � • • GENERAL AGGREGATE $ oriV GE 'L AGGREGATE LIMIT APPLIES PER: a.v r .Pr? PRODUCTS - COMP /OP AGG $ POLICY J C LOC $ AUTOMOBILE COMBINED SINGLE LIMIT UTOMOBILE LIABILITY {Ea accident) _$ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TOR LIMITS ER Y / N A ANY PROOR/PARTNER/EXECU TIVE N / A WC 29- 38- 687 -10 06./01 /2012 06/01/2013 E.L. EACH ACCIDENT $ 1,000,000 OFCER/t EXC (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 06/01/2012 06/01/2013 Client# 8954 - MAIN DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) FLORIDA KEYS CHILDREN'S SHELTER, INC Coverage is provided for 73 HIGH POINT RD only those employees TAVERNIER, FL 33070 leased to but not subcontractors of: C: 1 r K __ f_2____. CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: MONIQUE DIAZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 SIMONTON ST ACCORDANCE WITH THE POLICY PROVISIONS. KEY WEST, FL 33040 AUTHORIZ / E � DREPRE�SENTATIVE © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD '^ � ' . . 1 Ac o D0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAjTnJv LY AMFNrt FYTCWf AO hi R THE COVERAGE AFFORDED BY THE POLICIES REPRESE OR ER, A D CER FICATE NTRACT ETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITI NAL INSURED, the policy(ies) must endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A st ement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). IA AY 2 ? 2012 PRODUCER CONTACT NAME: Doug Jones c/o Artex Risk Solutions, Inc. PHONE Xtr. (480) 951-4177 FAX 951 -4266 8800 E. Chaparral Rd, Suite 230 MONROE l lac, Not: ( 480 ) Scottsdale, AZ 85250 RISK MAN AMT URER(S) AFFORDING COVERAGE NAIC # INSURER A : American Zurich Insurance Company 40142 INSURED INSURER B : Oasis Acquisition, Inc Alt. Emp: FLORIDA KEYS CHILDREN'S SHELTER, INSURER C : INC 2054 Vista Parkway Suite 300 INSURER D : West Palm Beach, FL 33411 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12FL075822652 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) • CLAIMS -MADE OCCUR "',� - • G MED EXP (Any one person) $ BY DA 11112Vtfl PERSONAL & ADV INJURY $ W . -. GENERAL AGGREGATE $ of GEN'L AGGREGATE LIMIT APPLIES PER: Lk. L IV PRODUCTS - COMP /OP AGG $ — 1 POLICY JF . LOC $ AUTOMOBILE COMBINED SINGLE LIMIT UTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS — NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION x WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOPARTN CUTIVE N / A WC 29-38-687-10 06/01/2012 06/01 /2013 A (Mandatory in ER R/ EXC (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 06/01/2012 06/01/2013 Client# 8954 -MAIN DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) FLORIDA KEYS CHILDREN'S SHELTER, INC Coverage is provided for 73 HIGH POINT RD only those employees TAVERNIER, FL 33070 leased to but not subcontractors of: G C .' n ate/ cl__ CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: MONIQUE DIAZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 SIMONTON ST ACCORDANCE WITH THE POLICY PROVISIONS. KEY WEST, FL 33040 AUTHORIZED REPRESENTATIVE l.; ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Ac R° ® CERTIFICATE OF LIABILITY INSURANCE DATE �") 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 Josephine Mansur Roe Insurance Inc. PLIIAWNEr Est1: (727) 376 -0030 l Futil No. (727)376 -2262 9851 State Road 54 ADDRESS: jo @roeins . com INSUSER(S) AFFORDING COVERAGE 1 NAIC 6 New Port Richey FL 34655 INSURER Arch Insurance Company INSURED INSURER B Florida Keys Children's Shelter, Inc. INSURER C : 73 Highpoint Road INSURER 0: INSURER E : Tavernier FL 33070 -2005 INSURER F: COVERAGES CERTIFICATE NUMBER:15 -16 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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. AD + =1Z POLICY NUMBER ( POLICY H AUD� 1 LIMITS �� TYPE OF INSURANCE BEM YYVD GENERAL EDIBILITY EACH OCCURRENCE $ 1,000,000 — DAMAGE it) RtN ILL) 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES IEa occurrence) $ A 1 CLAIMS-MADE © OCCUR X $CPKG010B706 3/1/2015 3/1/2016 MEDEXP (Any one person) $ 10,000 PERSONAL & ADV IN,JRY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENII_ AGGREGATE LIMIT APPLIES PER: _PRODUCTS - COMP /OP AGE $ 3,000,000 il POLICY n F A [] LOC , $ OC $ AUTOMOBILE LIABILITY ( C E O acci LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED — SCHEDULED X RCAOT0108706 3/1/2015 3/1/2016 BODILY INJURY (Per acdde ) $ _ AUTOS AUTOS O VNVED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per incident) Uninsured motorist B I spilt RV $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE , $ EXCESS UAB CLAIMS -MADE AGGREGATE $ OED 1 I RETENTION $ $ WORKERS COMPENSATION ! ANUS I I AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y Et. EACH ACCIDENT $ N OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOY $ (Mandatory M NH) If yeS. describe Under E.L. DISEASE - POLICY LIM T $ DESCRIPTION OF OPERATIONS below 1 DESCRIPTION OF OPERATIONS! LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if - space i required) HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECT TO GENERAL LI r a COMMERCIAL AUTO PER CONTRACT REQUIREMENTS. TARE TO HOLDER AP' =' 1 11 G0 C . C 1-� CERTIFICATE HOLDER CANCELLATION (305) 292-4487 SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILD BE DELrvERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIOLdROE COUNTY BOARD of 1� `�1N t i1 ' QJ 10)01140t4 COUNTY CO MyIISSIONERS �•�.� AUTHORIZED REPRESENTATIVE MONROE COUNTY RISK 143T ' 1 'a U{3 1100 SINiONTONN ST KEY WEST, FL 33040 u :�.�- ..F"t���- - �.:_�� s m- Josephine Mansur /JM ACORD 25 (201006) s I t b CZ nn _ ] ®1988 -2010 ACORD CO All rights reserved. 1E8025 (701 nos ) o 1 TN. 080338 11O �notirr rpnicfororrmarlrc Li