Certificates of Insurance
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ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AlTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
COMPANIES AFFORDING COVERAGE
Pl.aatridqe Aqenay, Inc.
Bll S. ~. Ocean Bl.vd.
Stuart rL 34994-2427
Jean R. Parka
PhoneNo. 561":287-5!;32 FaNo. 561-287-5572
INSURED
CXlMPAN\'
A
American Rati.oD&l. I'.i%e Ins.
CXlMPNl'f
B
American Undazwa 1:er Contrac1:or
G Scuba SCJ:'Ubbera, Inc.
102 SUnfJ.lIh Lan.
JUpi~ F.L 33477-7212
CXlMPNl'f
C
CXlMPNl'f
D
:,.:' .,
nus IS TO CERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOI/E FOR THE POI.JC'( PERIOD
INDICATED. NOTWmiSTANDING NfY REQUIREMENT. TERM OR CONDmON OF AHYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POI.ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXa.USIONS AND CONDITIONS OF SUCH POLICIES. LMTS SHOWN MAY HAVE BEEN REDUCED BY PAID aANS.
co
llR
1'tPE OF INSURANCE
PCUC'I NUMBER
POUCYEFFECTlVE PCUC'I EXPIRAllON
DAlE...,ooM'l DAlE (IoUOOM')
LMTS
~ LIAIILIIY
A X COI81ERCW. GENERAL LIAIILIIY
...." I CLMoeMADE 0 OCCUR
_ OWNER'S & CXlNTRACTCR'S PROT
X ShipJ:eI)a:LJ:e%'a Lia
OYB250095901
08/30/00
08/30/01
GENERAL AGGREGAlE
PRODlJCfS. CCItoFIOP AGG
PERSClNAL & AlN INJU('(
EAai OCCURRENCE
FIRE DAMAGE (AIrf-tnt
ME) EXP (AIrf - ...-)
I 2000000
11000000
11000000
11000000
I 50000
I 2500
~LIAIILIIY
_Nl'fAUTO
_ AlL OWNED AUTOS
'"- SCHEDULED AUTOS
f-- HIU:D AUTOS
'"- NON-OWNeD AUTOS
'_~r'~: !~~.'~'
., '~., \ 'f.~jiLiJ~ ~
"'':'1: __ IDl'~ I rY:.
&~((),Jl
_ Cc".l v;mmw
COM8INED SINGLE LMT I
BOOlLY INJURY I
,.., ...-1
IlODlLY INJURY I
,.., -*IenIl
PROPERlY DAMAGE I
~LIAIILIIY
f--Nl'fAUTO
I ...~~:
..~ ..
. c.. Yf.S
AUTO ONLY .I:A ACCICENI' I
cmlER THAN AUTO ONLY:
EAai ACCICENI' I
AGGREGAlE I
EAai OCCURRENCE I
AGGREGAlE I
I
~I m }i;:..{/::::::"::,,""
a EAai ACCIDENT I
a ClSEASE. POLICY' LMT I
a ClSEASE.1:A BFlDYEE I
, :,';:-'::,':'
EXCESS LIA8UTY
r-UMBRB.I.AFORM
I cmER tHAN UMIIRS.LA FORM
WORKERS COIPENSATION AND
EMPLOYERS'LIAIILIIY
~ R::.
0TlER
0ESCRPT1aII OF OPERATlONSILClCA'T1ONSNEHICLSSI1TEMS
CertJ.~J.ca'te holdar J.. 1.J..'ted _ additional. inaured wi.t:h %eCJarda to t:he
General. Liabi.1. 1:y
CERTlfl<:A1l;.:~~E.~!'::J::::i,::::i:t.>,;
YolU'o. Coun1:y Board
COIIIIDi.aaionera
Kim McGee
5100 College Road
Key W.st F.L 33040
of Coun1:y
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..:mRO- 5 IHClULD Nl'f OFlHE ABOVE CEl!ICRIIED POLICES BE CANCELLED BEFClRElHE
EXPIRATION DAlE1lEREDF. lHE ISSUNG CDIIfINl'fWLL ENCEAVCR TO MAl.
~ DAYS WRIT11:N NOnCETOlHECERlFlCAlE HOLCER NAMEDTOlHE LEFT,
an- FAlWRE TO MAIL SUCH NOnCE SHALL IMPOSE NO OIIUGAllON OR LIAIIlUTY
OF Nl'f ICINO UPON lHE CDIIfINl'f, ITS AGENTS OR ~l1VES.
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~
ACORD2S;;S:(tl95)
CERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERYw
TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NonCE TO THE CERTIACATE HOLDER NAMED BELOW. BUT IN
EVENT SHAli THIS CER11ACATE BE VAUD MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CER1lACATE OF INSURAt
DOES NOr CHANGE THE COVERAGE PROVIDED BY ANY POUCY DESCRIBED BELOW. '
This certifies that rBI STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, IIlnois, or
o STATE FARM FIRE AND CASUAL TV COMPANY of Bloomington, Ulnois
has coverage in force for the following Named Insured as shown below:
Named Insured AMERICAN'UNDERWATER CONTRACTOR DBA SCUBA SCRUBBERS
Address of Named Insured 4196 RUSSELL ST
TEQUESTA, FL 33469-2632
POUCY NUMBER ~229-D21-59
EFFECTIVE DATE OF 1l).21~ . 04-21-01
PoUCY
1995 GIIC SUBURBAN
DESCRIPTION OF
VEHICLE
UABIUTY COVERAGE ~YES NO
UMITS OF LlABIUTY
L BodIy lf1ury $100,000.00
Each Penson
.. Badly Inpy $300,000.00
Each AccIdent
b. Property Darnage $50.000.00
c. BodIly 1f1ury &
Property Damage
SIngle Uml Each
Accldent
PHYSICAL DAMAGE
COVERAGES
a.Com ensIve
b. CoIlJsIon
DYES ~NO
NO
NO
DYES
DNO
NO
DYES
DNO
DYES
ONO
NO
Signature of Authorized Representative
AGENT
TiUe
2741
Agent's Code Number
11/13100
Date
Name and Address of Certil'Icate Holder
-,
I
Name and Address of Agent
BILL BOWMAN INS. AGENCY INC.
STATE FARM INSURANCE
720 W. INDIANTOWN RD.
JUPITER. Fl 33458
L
--1
L
Check if a permanent Certificate of Insurance for liability coverage is needed: 0
Check if the Certificate Holder should be added as an Additional Insured: 0
Ct~J
CERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE
TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN NO
EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE
DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW.
This certifies that: ~ STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, or
o STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
has coverage in force for the following Named Insured as shown below:
Named Insured AMERICAN UNDERWATER CONTRACTOR DBA SCUBA SCRUBBERS
Address of Named Insured 4196 RUSSELL ST
TEQUEST A, FL. 33469-2632
POLlCY NUMBER \ 885-5229-021-59
EFFECTIVE DATE OF 10-21-00 - 04-21-01
POLlCY
DESCRIPTION OF
VEHICLE
LIABILITY COVERAGE
LIMITS OF LIABILITY
a, Bodily Injury
Each Person
a, Bodily Injury
Each Accident
b, Property Damage
c, Bodily Injury &
Property Damage
Single limit Each
Accident
PHYSICAL DAMAGE
COVERAGES
a, Com rehensive
b, Collision
EMPLOYER'S
NON-OWNERSHIP
COVERAGE
H ED CAR COVERAGE
1995 GMC SUBURBAN
~YES DNO
DYES
DNO
DYES
DNO
DYES
DNO
$100,000.00
$300,000.00
$50,000.00
~YES DNO
$500,00 Deductible
[gIYES DNO
$500,00 Deductible
DYES DNO DYES DNo DYES DNo
Deductible Deductible Deductible
DYES DNo DYES DNo DYES DNO
Deductible Deductible Deductible
DYES DNO DYES DNO DYES DNO
DYES DNO DYES DNO DYES DNO
AGENT 2741 11/13/00
Title Agent's Code Number Date
DYES
Signature of Authorized Representative
I
MONROE COUNTY, AS ADDITIONAL
INSURED
BOARD OF COUNTY COMMISSIONER
ATTENTION: KIM MCGEE
C/O RISK MANAGEMENT
5100 COLLEGE ROAD - RM. 410
KEY WEST, FL. 33040
Name and Address of Certificate Holder
Name and Address of Agent
I
I
I
BILL BOWMAN INS. AGENCY INC.
STATE FARM INSURANCE
720 W. INDIANTOWN RD,
JUPITER, FL 33458
..,Y
L D."E~IO-~ffi_-
~ L (561)746-505~.\:'.Tq: I~';" / '!FS_____ ~
Check .~-;;enn~_;;_ent C-;;rt;.cate 01 In~'o' I",~",ge ~~~
Check If the Certificate Holder should be added as an Additional Insured: D CC'