Certificates of Insurance
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MARINE CERTIFICATE OF INSURANCE
PRODUCER:
THIS CERTIFICATE IS ISSUED AS A MAITER OF
Charter Lakes Insurance Agency INFORMATION ONLY AND CONFERS NO RIGHT
P.O. Box 8797 UPON THE CERTIFICATE HOLDER. THIS
Kentwood, MI 4518-8797 CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
INSURED:
COMPANIES AFFORDING COVERAGE
Dennis Leith
dba Captain Dennis Fantasy Company
Charters Letter A - St. Paul Insurance Company - Guide
112 Parker Drive Company
Islamorada, FL 33036 Letter B
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.
Type of Insurance Policy Number Policy Effective Policy Expiration Limits
PROTEcrION AND 99567051FL 01/17/01 01117102 500000
INDEMNITY UABlUTY
EXCESS PROTEcrION AND
INDEMNITY UABIUTY
MEDICAL PAYMENTS 99567051FL 01117/01 01117102 10000
DESCRIPTION: 1984 - . See Schedule
CERTIFICATE HOLDER & ADDITIONAL CANCELLATION:
INSURED: : SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
Monroe County Board of CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
County Commisioners THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10
c/o Risk Management DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
5100 College Road, RM 410 NAMED TO THE LEFI', BUT FAILURE TO MAIL SUCH
Attn: Kim McGee, Key West, FL 33040 NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
/ ANY KIN~N THE COMPANY, ITS AGENTS OR
REPRESE IVES.
/l
AUTHORIZED REPRESENTATIVE:L ~,/{ J~ DATE:
01111/01 ' "'/'-7'/ /' / ,rI
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9-29-19967:11PM
FROM MARINE PROJECTS 295 4317
P.2
MARINE CERTIFICATE OF INSURANCE
PRODUCER:
THIS CERTIFICATE IS ISSUED AS A MAITER OF
Charter Lakes Insurance Agency INFORMATION ONLY AND CONFERS NO RIGHT
P.O. Box 8797 UPON TIlE CERTIFICATE HOLDER. THIS
Kentwood, MI 49517-8797 CERTIFICATE DOES NOT AMEND, EXTEND OR
t1f\\ U-lutN J NPt-e.tV~ ALTER TIIE COVERAGE AFFORDED BY TIm
POUCIES BELOW.
INSURED:
COMPANIES AFFORDING COVERAGE
Dennis Leith
dba Captain Dennis Fantasy Company
Charters Lctlcr A.. St. Paul Insurance Company - G-\lide
112 Parker Drive Company . - t)'OJA~"':" "~'
"'m" ,'- ~ .....~.-,~
Islamorada, FL 33036 Letter B ~":>
. . '.I'lI'V
DESCRIPTION: 1984 - 18' Diversified, Ser# DU18129M84G :-~ .--l-=L q ~-
1984 - 18' Diversified, Ser# DLIl8127M84G ' ',;:: r':.;~.. /":S
COVERAGES:
This is to certify that the policies of insurance listed below bave 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.
Type of Insurance Policy Number Policy Effective Policy Expiration Limits
PROTECTION AND 99567051FL 01117101 01/17/02 500000
INO.6MNIlY UABIUTY
EXCESS PR0TECI10N AND
INDEMNITY UABIUlY
MEDICI\L PAYMENTS 99567051FL 01117/01 ' 01/17102 10000
The following is considered an additional insured, but only as their interest may appear in the vessel described herein
and for the liability arising out of the negligence of the insured; as defl1led in the poliCy. By issuance of tbis certificate,
the company does not waive its right of subrogation. The coverage afforded by this endorsement shaU arise out of
liability that rest solely with the msul"ed.
ADDmONAl, INSURED &: CERTIFICATE HOLDER: CANCELlATION:
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE
Monroe County Board of CANCR! Lp.n BEFORE nIE EXPIRATION DATE THEREOF,
County Coounisioners THE ISSUING COMPANY WILL ENDEAVOR TO MAlL 10 "
c/o Risk Management DAYS WRITrEN NOTICE TO THE CERTIFICATE HOLDER
5100 College Road, RM 203 NAMED TO THE !.EFf, BUT FAll...URE TO MAll. SUCH
Attn: Maria DelRio NOTICE SHALL IMPOSE NO OBUGATION OR llABILITY OF
Key West, FL 33040 ANY KIND OPoN THE COMPANY, ITS AGENfS OR
REPRESENTATIVES.
AunIORIZED REPRESENTATIVE: Wan-en Peterson DAre lmJOO
.
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A CORD_ CERTIFICATE OF LIABILITY INSURANC~~n~ C21 DATE (MMIDDIYY)
09/19/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Plastridge Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
811 S. E. Ocean Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
stuart FL 34994-2427 INSURERS AFFORDING COVERAGE
Phone: 561-287-5532 Fax: 561-287-5572
INSUREO INSURER A: American National Fire Ins.
INSURER B:
American Underwater Contractor INSURER C:
& Scuba Scrubbers, Inc.
102 Sunfish Lane INSURER D:
Jupiter FL 33477-7212 INSURER E:
I
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 TYPE OF INSURANCE POLICY NUMBER b2~1f7M~bBW~YE I P~l-,t~~ri~rd~~WN liMITS
lTR
GENERAL liABiliTY EACH OCCURRENCE $ 1000000
- 08/30/01 08/30/02
A X COMMERCIAL GENERAL LIABILITY OMH250095901 FIRE DAMAGE (Anyone fire) $ 50000
I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 2500
~ Shiprepairers Lia PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
-
GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PlOP AGG $ 1000000
I n PRO- nlOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
AI'NAUTO ~ "'AOIM ~N'f (Ea accident)
- A~~~\~.. ?i
All OWNED AUTOS 7JhW BODilY INJURY
- BY f .A (Per person) $
SCHEDULED AUTOS
- "I L...
HIRED AUTOS DATE' Q BODilY INJURY
- (Per accident) $
NON.OWNED AUTOS LYES
-
- WAIVER N/A PROPERTY DAMAGE $
(Per accident)
GARAGE liABiliTY ~:G ~A/h) AUTO ONLY. EA ACCIDENT $
~ ANY AUTO EA ACC $
.....- OTHER THAN
.n /'\ AUTO ONLY: AGG $
EXCESS liABiliTY {t'- 't: Vp EACH OCCURRENCE $
~ OCCUR o CLAIMS MADE . r ~
f{(6e AGGREGATE $
KJn ""
~ $
l DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY lIMris 1 IOJ~-
EMPLOYERS' liABiliTY
E,l. EACH ACCIDENT $
E.l. DISEASE - EA EMPLOYEE $
E.l. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/lOCATIONSNEHIClES/EXClUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder is listed as additional insured with regards to the
General Liability
CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER lETTER: CANCELLATION
MONRO-5 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 Board of County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, BUT FAilURE TO DO SO SHAll
Commissioners
ATTN: Kim McGee-305-295-4317 IMPOSE'Nq OBLIGATION OR liABiliTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
\ ~
5100 College Road RM 410 R,EPRESEN1ATIVES, ~
Key West FL 33040 A~~-V-B~T~ /;;~
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ACORD 25-8 (7/97)
c............-
@ACORDCORPORATION 1988
ACORD~ CERTIFICATE OF LIABILITY INSURANC~~n~ C21 DATE (MM/DDIYYI
01/09/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Plastridge Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
811 S. E. Ocean Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
stuart FL 34994-2427
Phone: 561-287-5532 Fax: 561-287-5572 INSURERS AFFORDING COVERAGE
INSURED INSURER A: American National Fire Ins.
INSURER B:
American Underwater Contractor INSURER C:
& Scuba Scrubbers, Inc.
102 Sunfish Lane INSURER D:
Jupiter FL 33477-7212
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 TYPE OF INSURANCE POLICY NUMBER b2flf~~bBW~YE P~Al,}~1r.i~rJW'~?N LIMITS
lTR
GENERAL LIABiliTY EACH OCCURRENCE $ 1000000
-
A X COMMERCIAL GENERAL LIABILITY OMH250095901 08/30/00 08/30/01 FIRE DAMAGE (Anyone fire) $ 50000
~ CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 2500
f--
X Shiprepairers Lia PERSONAL & ADV INJURY $ 1000000
1---
f-- GENERAL AGGREGATE $ 2000000
GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1000000
n n PRO- III LOC
POliCY JECT
AUTOMOBilE LIABILITY COMBINED SINGLE LIMIT
f-- $
ANY AUTO (Ea accident)
f--
All OWNED AUTOS BODilY INJURY
f-- $
SCHEDULED AUTOS (Per person)
f--
HIRED AUTOS "';fY t];~( ~: ,;- '~f"4>'
.-.. .' '- ,- -'.'"' BODilY INJURY
f-- " .' '< $
NON-OWNED AUTOS vY V . 'j /I i;) (Per accident)
r--
r-- :J-II.... ~'"'!I;t PROPERTY DAMAGE
./'11 (Per accident) $
.......,....
GARAGE liABILITY m" - AUTO ONLY - EA ACCIDENT $
R ANY AUTO )\I",'~JFR: " -...L::. Yr:~___"_,,,~ EA ACC $
(.!, ':- ~'..... OTHER THAN
AUTO ONLY: AGG $
EXCESS liABiliTY EACH OCCURRENCE $
~ OCCUR o CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I fo~~l~;;;Ws I IU~~'
EMPLOYERS' liABiliTY
E.l. EACH ACCIDENT $
E,l, DISEASE. EA EMPLOYEE $
E.l. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/lOCATIONSNEHIClES/EXClUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder is listed as additional insured with regards to the
General Liability
CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER lETTER: CANCELLATION
MONRO-5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER Will ENDEAVOR TO MAil .10..-. DAYS WRITTEN
Monroe County Board of County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, BUT FAilURE TO DO SO SHAll
Commissioners IMPO~ OBLIGATION OR liABILITY OF A/jPON THE INSURER, ITS AGENTS OR
ATTN: Kim McGee-305-295-4317
5100 College Road RM 410 REPRESEN A TIVES, ,..---. ,1
Key West FL 33040 AUTHOl;l1 'l.d7~AT~ hit 114
I J~j~
ACORD 25-8 (7/97) L/"-=- , @ACORD CORPORATION 1988
STATE FARM
A
INSURANCE
SEPTEMBER 20, 2001
AUTO POLICY STATUS
1995 GMC
SPORT WG
VIN: 1GDFK16KXSJ719557
SUBURBAN
(561) 697-0330
IRG:
TERR:
CLASS:
ACC FREE:
BIRTH:
15
022
1D3H400
APR-21-94
SEP-07-58
AMERICAN UNDERWATER
CONTRACTORDBA SCUBA SCRUBBERS
4196 RUSSELL ST
TEQUESTA FL 33469-2632
H PHONE:
MUTL 885 5229-D21-59H
STATUS:RENBL DUE DATE:OCT-21-01 TERM DATE: TOT PREM:
AMT DUE: 358.80 OXD:APR-21-94 COY DATE:JUN-28-00 PREY PREM:
358.80
353.80
A 100 /300 /50
P10
D500
G500
C20000
165.60
51.60
21. 70
75.50
44.40
AMT PAID: 353.80 DATE PAID: MAY-07-01
MCD 61.52, AFD 15% $47.00, VSD 30% 38.20, ABS 5%,
ANTI-THEFT 10% 2.00, APP DATE 11-30-01.
NAME: AMERI CAN UNDERWATER
H PHONE: (561) 697-0330
POLICY FORM: 98107
REPLACED POLICY: 8855229-59G
EXCEP. & END: ADD'L INSURED - COUNTY OF MONROE 5100 COLLEGE RD KEY WEST FL
33040, SEE FILE, INS. CERT TERM NOTICE - SOUTH FLORIDA WATER MANAGEMENT PO
BOX 24680 WEST PALM BCH FL 33416, SEE FILE.
COY. S NAMES
S AMT
Nt A -...=:::::YES
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LL', ~ ~
K Vm fYle(, tJC
REC CHG:
STATE FARM
A
BILL BOWMAN INS. AGENCY, INC.
P.O. Box 878, 720 W. Indiantown Road
Jupiter, Florida 33468-0878
Off. (561) 746-5050
Res. (561) 746-6288
INSURANCE
@
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: t81 STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANV of Bloomington, Illinois, or
o STATE FARM FIRE AND CASUALTV COMPANV 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
POLlCV NUMBER I 885-5229-021-59 I
EFFECTIVE DATE OF 10121/00.04121101
POllCV
1995 GMC SUBURBAN
DESCRIPTION OF SPORT WG
VEHICLE
L1ABILlTV COVERAGE ~VES DNO DVES DNO elVES DNO DVES DNO
LIMITS OF LIABILITY
a, Bodily Injury $100,000.00
Each Person
a. Bodily Iniury $300,000.00
Each Accident
b, Property Damage $50,000.00
c, Bodily Injury &
Property Damage
Single limit Each
Accident
PHVSICAL DAMAGE ~VES DNO DVES DNO DVES ONO DVES DNO
COVERAGES $500.00 Deductible $0,00 Deductible $0,00 Deductible $0,00 Deductible
a, Comorehensive
t8}YES DNO DVES DNO DVES DNO DVES DNO
b, Conision $500,00 Deductible $0.00 Deductible $0.00 Deductible $0.00 Deductible
EMPLOYER'S
NON-OWNERSHIP DVES ~NO DVES ~NO DVES ONO DVES DNO
COVERAGE
HJ~~D CAR COVERAGE DVES ~NO DVES DNO DVES DNO DVES DNO
A
7JJ.U .f ~ ~ AM) V rl}" 1 -!, 0----- AGENT 2741 01/09/01
Signature of Authorized Representative
Title
Date
Agent's Code Number
Name and Address of Certificate Holder
Name and Address of Agent
I
I"
I
I"
BILL BOWMAN INS. AGENCY INC.
STATE FARM INSURANCE
720 W. INDIANTOWN RD.
JUPITER, FL 33458
L (561)746-50~yllrt~'
_________ ___ n,HE &- t~-oL-
Check jf a permanent c;rtjfi~~te of Insuran~~f~;Jj~bi,ity ;;~~~-~;-;;-;~~O---------~VFq~,"?- . ~-.L~FS ------
Check if the Certificate Holder should be added as an Additional Insured: D
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
L
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Remarks: