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Certificates of Insurance . ACORQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNY) 01/14/2002 PRODUCER (305)743-0494 FAX (305)743-0582 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Keys Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 500280 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marathon, FL 33050-0280 INSURERS AFFORDING COVERAGE INSURED Gall Holley INSURER A: Western World Ins Co PO Box 501856 INSURER B: Marathon, FL 33050 INSURER C: INSURER 0: 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 MAYBE 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~~: TYPE OF INSURANCE POLICY NUMBER P.9.L!~~ EFF!,~TI~lE Pg~!flr~~:ft~N LIMITS DATE MM/DDNY ~NERAL LIABILITY NGLOOI673 11/19/2001 11/19/2002 EACH OCCURRENCE $ 100,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 50,000 I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ 5,00 A PERSONAL & ADV INJURY $ 100,00 - - GENERAL AGGREGATE $ 200,000 ~'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ i ncl uded n PRO- n POLICY JECT LaC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) - - HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) I-- I-- PROPERTY DAMAGE $ (Per accident) RRAGE LIABILITY ~I -" AUTO ONLY - EA ACCIDENT $ ANY AUTO APp~m . 1(7J! @;MlaN'f OTHER THAN EAACC $ II l AUTO ONLY: AGG $ EXCESS LIABILITY I;> v \-J b"O=J EACH OCCURRENCE $ tJ OCCUR D CLAIMS MADE DATE N/AZ AGGREGATE $ WAIVER YES $ R ,DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS I IOJ~- EMPLOYERS' LIABILITY E.l. EACH ACCIDENT $ E.l. DISEASE - EA EMPLOYEE $ E.l. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~dditional Insured: Monroe County Board of County Commissioners CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION ""'""'.,, 0' "" """" "sc.,~ CA'C"~O ""'" ru, EXPIRATION DATE THEREOF, THE ISSUING C PAN WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NO ~CE TO THE C TlFICAT HOLDER NAMED TO THE LEFT, Monroe County Board of County Commissioners BUT FAILURE TO MAIL SUCI NOTICE SH L IMPO NO OBLIGATION OR LIABILITY PO Box 1680 OF ANY KIND UPON THE CO~PANY, ITS G~ OR REPRESENTATIVES. Key West, FL 33040 AUTHORIZED REPRESENTATIVE - \. ~ ACORD 25-S (7/97) @ACORDCORPORATION 1988 .:? . , "-~,,.....C:'~ ..f F --. J.;:s, CI Co..... . ~ j $.......1:.. Co. ~ ACORDTM CERTIFICATt: OF LIABILITY INSURANCE I DATE (MMIDDIYY) 12/02/2002 PRODUCER (305) 743-0494 FAX (305) 743-0582 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Keys Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 500280 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marathon, Fl 33050-0280 INSURERS AFFORDING COVERAGE INSURED Ga 11 Holley INSURER A: Western World Ins Co PO Box 501856 INSURER B Marathon, Fl 33050 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 LTR TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL liABILITY CLAIMS MADE 0 OCCUR POLICY NUMBER NGl001673 DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY LIMITS EACH OCCURRENCE 100,oI:f) FIRE DAMAGE (Anyone fire) $ 50,otX) MED EXP (Anyone person) $ 5,0~ PERSONAL & ADV INJURY $ 100 , (()D GENERAL AGGREGATE $ 200 , OCO PRODUCTS. COMP/OP AGG i nc1 ud COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY. EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ OTH- ER EL DISEASE. EA EMPLOYE $ EL DISEASE. POLICY LIMIT $ A GEN'L AGGREGATE LIMIT APPLIES PER: j~gT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS APPR BY DATE - WAIVER M t~~ENT -();}.. N/A- ES GARAGE LIABILITY ANY AUTO EXCESS LIABILITY OCCUR D CLAIMS MADE ,OTHER DESCRIPTION OF OPERA TIONSILOCA TIONSNEHICLESJEXC~USIONS ADDED BY ENDO~SEMENTISPECIAL PROVISIONS ertificateho1der is additional lnsured as the1r interest may appear CERTIFICATE HOLDER A DESCRIBED POLICIES BE CANCELLED BEFORE THE CANCELLATION Monroe County Board of County Commissioners PO Box 1680 Key West, Fl 33040 ACORD 25-5 97) . C.C : @ACORD CORPORATION 1 FR(]1 FAX i'D. Nov. 04 2002 08:51AM Pi ")9(, Etlili(.1 MONROE COUNTY, FLORIDA Request For Waiver of In~lUrance Requirements It is requested that the insurance requirements, as specified in tbe County's Schedule oflnsuranc:e RequiremfDts. LJ be waived or modified on the fo~owing ~ntract- j / II l_ . \ ~61C.i2 d.S 0 r Cod_." _GAJ_-liJ2LL~f-:n .~ ..fL ?At1ll-d ~.$~ C.."aetfu" _~ ", .Ill i2 ?ad~ AddrcssofContraCtor: ? Q .~.n..f_.5_{2J.E.~- ff}-AWh OA.),_E~~'.dLt-33.o5. () bd:.-f-~---J!L3 - Lf q 9-f2- ~B11V1~ J1l1bJ~ --11, .tJ ;.., ... -------- Phone: Sc:o~ of Work: Reasgn for Waiver::':;:; _\)SC /'t1-v /"J/ ~(/'..(..nAJ,,4! (i /'J,()::r: jJ..ti.JlL.t.~~~rJ I p!:IJillJ Net... -:;: 'pc fAX) f- I 1lA"',..ooR f /1-' 'I e: '1"""';<;". ~~ v,;' ..." ..01!- -/" -r11 e. P. ,"',? pe,lf.::I:r-.L.t v t:. ~ t! ,prJ..< I .i.l:u.-S.."'..Lfi (8 ~v ~ . d (!" A.,1 1l;J4LJ-,\'to W c,zK. ' ' p()1icjes Waiver will applYto:--'----.-. -.-'- ,._,-' Slgnat...ofConua- (--4",'"':::;.'--. - -~~ Approv.d X _ _ () ~'" A pro '" - - - ~~u.W---.u.;/_ .-- County Administrator appeal: ~ ~ tP-~ .uL rN- 1 Pv- N.. Ap,/oved: ~,4 ""6 p...;. ,u. --'- ---- ~ ~ r ~ w/WJ~'.I Not ApplO>td: ~ ~. ~ ff-'tI:O't ..,C~ ~.~*' Risk Management Date Approved: Date: Board of County Commissioners a.ppeal: Approved: ___ Meeting Date: Administratiua Instruc:tion 4/4'709.3 _..----~----- ACOBQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) 03/16/2004 PRODUCER (305) 743-0494 FAX (05) 743-0582 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Keys Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 500280 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marathon, FL 33050-0280 INSURERS AFFORDING COVERAGE NAIC# INSURED Gail Holley INSURER A: Penn America Ins. Co. PO Box 501856 INSURER B: Marathon, FL 33050 INSURER C: INSURER D: INSURER E: VE A E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI 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 EXPIRATION LIMITS 11/19/2004 EACH OCCURRENCE $ 100,00 DAMAGE TO RENTED $ 50,000 MED EXP (Anyone person) $ 5,00 PERSONAL & ADV INJURY $ 100,000 GENERAL AGGREGATE $ 200,00 PRODUCTS - COMP/OP AGG $ 100,000 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ $ E.L DISEASE - EA EMPLOYE S E.L DISEASE - POLICY LIMIT $ INSR DO' POLICY NUMBER POLICY EFFECTIVE TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 0 OCCUR PAC6338968 11/19/2003 A LOC ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR 0 CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ertificateholder is additional insured as their interest may appear. SHOULD AJoIY OF THE ABOVE DESCRIBED POLICIES BE CAJoICELLED 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 SUC OTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY RER, ITS AGENTS OR REPRESENTATIVES, Monroe County Board of County Commissioners 1100 Simonton St. Rm 268 Key West, FL 33040 ACORD 25 (2001/08) tfAX: 295-4342 C~ ..~~~ Lt ':}"'D @ [}CORPORATION 1988 '~M CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYVY) 11/18/2004 PRODUCER (305)743-0494 FAX (305)743-0582 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Keys Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 500280 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marathon, FL 33050-0280 INSURERS AFFORDING COVERAGE NAIC# INSURED Gail Holley INSURER A: Penn America Ins. Co. PO Box 501856 INSURER B: Old Republic Surety Co. Marathon, FL 33050 INSURER C: INSURER D: INSURER E: C VERA 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. POLICY EFFECTIVE POLICY EXPIRATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOT E TO THE C TlFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUC NOTICE S L IMPOSE NO OBLIGATION OR LIABILITY POLICY NUMBER BINDER ATTGN-S 11/19/2004 TYPE OF INSURANCE GENERAL LIABILITY 11/19/2005 $ $ $ $ $ PRODUCTS - COMP/OP AGG $ EACH OCCURRENCE DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [K] OCCUR MED EXP (Anyone person) PERSONAL & ADV INJURY GENERAL AGGREGATE A LOC COMBINED SINGLE LIMIT (Ea accident) ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS DIL Y INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ $ $ $ $ $ $ $ OTHER THAN AUTO ONLY: EXCESS/UMBRELLA LIABILITY OCCUR 0 CLAIMS MADE EACH OCCURRENCE AGGREGATE B DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ~Ta~~ i ty Bond BINDER 041118 11/19/2004 11/19/2005 EL. DISEASE - EA EMPLOYEE $ EL. DISEASE - POLICY LIMIT $ $10,000 E,L. EACH ACCIDENT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ertifcateholder is additional insured with respect to liability as their interest may appear Monroe County Board of County Commissioners 1100 Simonton St. Rm 268 Key West, FL 33040 ACORD 25 (2001/08) FAX: 295 -4342 . ~ . G c:.. ~ ~~...... <<J- LIMITS $ $ $ $ EA ACC AGG $ @ACORD CORPORATION 1988 '~M CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 03/03/2006 PRODtiCER (305)743-0494 FAX (305)743-0582 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Keys Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 500280 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marathon, FL 33050-0280 INSURERS AFFORDING COVERAGE NAIC# INSURED Gail Holley INSURER A Penn America Ins. Co. PO Box 501856 INSURER B Old Republic General Group Marathon, FL 33050 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, I~~: ~~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY PAC6540146 11/19/2005 11/19/2006 EACH OCCURRENCE $ 100,000 - X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00C I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000 A PERSONAL & ADV INJURY $ 100,000 - 200,00(J GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS. COMP/OP AGG $ 100,000 I n PRO. nLOC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS (Per person) - HIRED AUTOS BODILY INJURY - $ NON.OWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ~ ANY AUTO ,.,...'.0L " ~;(~( ,,': (1 OTHER THAN EA ACC $ , i _,..1 AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY 3: '7rOtp EACH OCCURRENCE $ ~ OCCUR D CLAIMS MADE AGGREGATE $ ~/I;'\ i ; I ' ~ y. $ ~ DEDUCTIBLE ( bt{) lIDAt:.. $ RETENTION $ . \:ff:(J, $ WORKERS COMPENSATION AND ( C., 'II De~ I WC STATU. I 10J~' EMPLOYERS' LIABILITY ~;'~nl' l ANY PROPRIETOR/PARTNER/EXECUTIVE --- '0 E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L DISEASE. EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L, DISEASE. POLICY LIMIT $ B~~~ OBS548232 11/19/2005 11/19/2006 $10,000 B DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ertificate Holder is Additional Insured with respect to Liability as their interest may appear. CERTIFICATE H LDE Monroe County BOCC P.O. Box 1026 Key West , FL 33041-1026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL _ 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 AG AUTHORIZED REPRESENTATIVE Derek Martin-Ve ue ACORD 25 (2001108) Cc,: , *