Item C17
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: February 18.2009
Division: Engineering
Bulk Item: Yes ---X- No
Department: Facilities Development
Staff Contact PersonlPhone #: Peter Horton X 5210
Ann Riger X 4439
AGENDA ITEM WORDING: Approval of an Award Agreement for Art in Public Places to Elena
Ortega DIB/ A Artsy Studio, for artwork at the Key West International Airport.
ITEM BACKGROUND: On November 17, 2008, the Art in Public Places voting committee
approved seven artists for art at the Key West terminal complex. Elena Ortega was selected and she
will be providing 4 "critters" throughout unexpected areas of the complex. Chosen is a Flying
Spoonbill, a Cat, an Egret, and an Osprey with Fish.
PREVIOUS RELEVANT BOCC ACTION: At the BOCC public hearing on 08/20/08, the
commissioners approved $180,000 for artwork at the Key West International Airport.
CONTRACVAGREEMffiNTCHANGES:WA
STAFF RECOMMENDATIONS: Approval as stated above.
TOTAL COST: $4.000.00
BUDGETED: Yes ~No
COST TO COUNTY: $4.000.00
SOURCE OF FUNDS:One Coot lnfirft3tmemre
REVENUE PRODUCING: Yes No-X AMOUNTPERMONTH_ Year
.,.U>/
APPROVED BY: County Atty Jk. OMB/Purchasing _ Risk Management _
DOCUMffiNTA TION:
Included X
Not Required_
DISPosmON:
AGENDA ITEM #
Revised 1/09
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Artsy Studio Contract #_
Effective Date: 02/18/09
Expiration Date:
Contract Purpose/Description:
To provide artwork through Art in Public Places for the Key West International Airport
Contract Manager: Ann Riger X4549 Facilities Devel/Stop # 1
(Name) (Ext.) (Department/Stop #)
for BOCC meeting on 02/18/08 Agenda Deadline: 02/03/09
CONTRACT COSTS
Total Dollar Value of Contract: $ 4,000.00
Budgeted? Yes[gJ No 0 Account Codes:
Grant: $ N/A
County Match: $ N/ A
Current Year Portion: $ 4,000.00
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ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Da~ In
Division Director Q~1
Risk Manag~ment ~ (c 01
PJLG ~~f\
O.M.BJPurcha'sing Z -4 -If)
County Attorney 1 j ctI
Comments:
Date Out
;) !:Hc>r
YesDNod
YeSONO~ ~~
YesDNoQ/ 7/~ v!2;#
OMB Form Revised 2/27/01 MCP #2
Monroe County Art in Public Places Award A2reement
This AGREEMENT dated the 28 day of January. 2009, is entered into by and
between the BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY,
hereinafter "County", and ELENA ORTEGA D/B/A ARTSY STUDIO, hereinafter
"Artist" ,
SSAN:
WHEREAS, the Art in Public Places Ordinance #022-2001, codified at MCC ~2-
322(A), provides for an appropriation of 1 % of the construction costs for new
construction exceeding $500,000 and renovations exceeding $100,000; and
WHEREAS, the Ordinance established an Arts in Public Places (AIPP)
Committee to advise the County Commission regarding art to be acquired and installed in
each public construction project subject to the AIPP allocation; and
WHEREAS, the AIPP Committee has selected and recommended to the BOCC
one or more artists for this project; and
WHEREAS, the Board of County Commissioners of Monroe County have
determined that it is in the interest of the promoting the understanding and awareness of
the visual arts to contract for the creation and installation of artwork in the Key West
International Airport.
NOW, THEREFORE, in consideration of the mutual covenants and payments
contained herein, the parties have entered into this agreement on the terms and conditions
as set forth below.
1. AGREEMENT PERIOD: This agreement is for the period January 28, 2009
through 60 days subsequent to date of issuance of Certificate of Occupancy or
Certificate of Completion for building. This agreement shall remain in effect for
the stated period unless one party gives to the other written notification of
termination pursuant to and in compliance with paragraphs 7, 12, and 13 below.
All work for which AIPP funds are to be expended must be completed by the
stated termination date.
2. SCOPE OF AGREEMENT: The Artist shall provide
4 "critters", selection and specific locations. The pieces will be painted on linen
and marouflaged to minimize the impact of the wall's texture. They will be
coated with exterior UV resistant low luster varnish to protect it from UV rays.
Artist shall confer with and coordinate activities with the construction contractor
on the job in order to insure that there is as much cooperation and cohesiveness in
the incorporation of the art into the building under construction, and so that there
shall be the least amount of interference between the Artist and the Contractor.
3. AMOUNT OF AGREEMENT AND PAYMENT: The County shall provide an
amount not to exceed $4,000.00 for materials and services used to create and
install the project. The Board of County Commissioners assumes no liability to
fund this agreement for an amount in excess of this award. Monroe County's
perfonnance and obligation to pay under this agreement is contingent upon an
annual appropriation by the BOCC. Pursuant to Florida's Prompt Payment Act,
upon receipt by County of an Invoice for each of three (3) phases, and
documentation to satisfy the Clerk that the appropriate phase has been
completed, payment shall be made for the following phases at the referenced
rates:
1) Design Phase:
2) Materials:
33.3% oftotal payment;
33.3% of total when artist submits receipts for materials and
eligible costs equal to or greater than 33.3% ofthe contract total;
and
33.3% final payment due when installation is deemed complete
and contractual agreement specifications are verified by the
Monroe County Purchasing Department or designee.
3) Completion:
Eligible costs and exoonditures for the proiect and the total award include. but are not
limited to:
A. Artist's design fee
B. Labor, materials, contracted services required for production and installation
C. Artist's operating expenses related to the project
D. Travel related to this project, pursuant to statutory limitations
E. Transportation of the work to the site
F. Installation to the site
G. Permits and fees necessary for the installation (applicable for exterior projects
which also require HARC review)
H. Legal costs directly related to the project
I. Liability costs of artist
Payment shall be made upon presentation of an original invoice and documentation
necessary to support the completion of the work. Artist shall also provide a release of
lien if applicable.
Final payment request must be submitted no later than 60 days after the completion of the
project.
4. OWNERSHIP and RIGHTS: Upon the installation of the artwork, County shall
own the artwork and all rights related thereto fully and completely.
5. RECORDS: The Artist shall keep such records as are necessary to document the
perfonnance of the agreement and give access to these records at the request of
the County, the State of Florida, or authorized agent and representative of said
government bodies. The Artist understands that it shall be responsible for
repayment of any and all audit exceptions which are identified by the Auditor
General for the State of Florida, the Clerk of Court for Monroe County, the Board
of County Commissioners for Monroe County, or their agents and representatives.
6. MODIFICATIONS AND AMENDMENTS: Any and all modifications of the
tenns of this agreement shall be only amended in writing and approved the Board
of County Commissioners for Monroe County.
7. INDEPENDENT CONTRACTOR: At all times and for all purposes hereunder,
the Artist is an independent contractor and not an employee of the Board of
County Commissioners of Monroe County. No statement contained in this
agreement shall be construed as to find the Artist or any of its employees,
contractors, servants or agents to the employees of the Board of County
Commissioners of Monroe County, and they shall be entitled to none of the rights,
privileges or benefits of employees of Monroe County.
8. COMPLIANCE WITH LAW: In carrying out its obligations under this
agreement, the Artist shall abide by all statutes, ordinances, rules and regulations
pertaining to or regulating the provisions of this agreement, including those now
in effect and hereafter adopted. Any violation of said statutes, ordinances, rules
or regulations shall constitute a material breach of this agreement and shall entitle
the County to temrinate this agreement immediately upon delivery of written
notice of tennination to the Artist.
9. HOLD HARMLESS/INDEMNIFICATION: The Artist hereby agrees to
indemnify and hold harmless the BOCC Florida Keys Council of the Arts, AIPP
Committee and Monroe County and any of their officers and employees from and
against any and all claims, liabilities, litigation. causes of action, damages, costs,
expenses (including but not limited to fees and expenses arising from any factual
investigation, discovery or preparation for litigation), and the payment of any and
all of the foregoing or any demands, settlements or judgments arising directly or
indirectly under this agreement. The Artist shall immediately give notice to the
County of any suit, claim or action made against the County that is related to the
activity under this agreement, and will cooperate with the County in the
investigation arising as a result of any suit, action or claim related to this
agreement.
10. ANTI-DISCRIMINATION: The Artist agrees that they will not discriminate
against any of their employees or applicants for employment or against persons
for any benefit or service because of their race, color, religion, sex, national
origin, or physical or mental handicap where the handicap does not affect the
ability of an individual to perform in a position of employment, and to abide by
all federal and state laws regarding non-discrimination.
11. ANTI-KICKBACK: The Artist warrants that no person has been employed or
retained to solicit or secure this agreement upon an agreement or understanding
for a commission, percentage, brokerage or contingent fee, and that no employee
or officer of the County has any interest, financially or otherwise, in the said
funded project, except for general membership. For breach or violation of this
warranty, the County shall have the right to annul this agreement without liability
or, in its discretion, to deduct from the agreement price or consideration, the full
amount of such commission, percentage, brokerage or contingent fee.
12. TERMINATION: This agreement shall terminate pursuant to Paragraph #1.
Termination prior thereto shall occur whenever funds cannot be obtained or
cannot be continued at a level sufficient to allow for the continuation of this
agreement pursuant to the terms herein. In the event that funds cannot be
continued at a level sufficient to allow the continuation of this agreement pursuant
to the terms specified herein, this agreement may then be terminated immediately
by written notice of termination delivered in person or by mail to Artist. The
County may terminate this agreement without cause upon giving 90 days written
notice of termination to Artist. The County shall not be obligated to pay for any
services or goods provided by Artist after Artist has received written notice of
termination.
13. TERMINATION FOR BREACH: The County may immediately terminate this
agreement for any breach of the terms contained herein. Such termination shall
take place immediately upon receipt of written notice of said termination. Any
waiver of any breach of covenants herein contained to be kept and performed by
Artist shall not be deemed or considered as a continuing waiver and shall not
operate to bar or prevent the County from declaring a forfeiture for any
succeeding breach either of the same conditions or of any other conditions.
14. ENTIRE AGREEMENT: This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all
prior agreements with respect to such subject matter between the County and the
Artist.
15. CONSENT TO JURISDICTION: This agreement, its performance, and all
disputes arising hereunder, shall be governed by the laws of the State of Florida,
and both parties agree that the proper venue for any actions shall be in Monroe
County.
16. ETHICS CLAUSE: Artist warrants that he has not employed, retained or
othenvise had act on his behalf any former County officer or employee in
violation of Section 2 of Ordinance No. 10-1990 or any County officer or
employee in violation of Section 3 of Ordinance No. 10-1990. For breach or
violation of the provision the County may, at its discretion tenninate this
agreement without liability and may also, at its discretion, deduct from the
agreement or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former or present
County officer or employee.
17. PUBLIC ENTITY CRIME STATEMENT: A person or affiliate who has been
placed on the convicted vendor list following a conviction for public entity crime
may not submit a bid on an agreement to provide any goods or services to a public
entity, may not submit a bid on an agreement with a public entity for the
construction or repair of a public building or public work, may not submit bids on
leases of real property to public entity, may not be awarded or perform work as a
contractor, supplier, sub-contractor, or consultant under an agreement with any
public entity, and may not transact business with any public entity in excess of the
threshold amount provided in Section 287.017, for CATEGORY TWO for a
period of 36 months from the date of being placed on the convicted vendor list.
Artist represents that Artist is not on the Convicted Vendor list.
18. AUTHORITY: Artist warrants that it is authorized by law to engage in the
performance of the activities encompassed by the project herein described. Each
of the signatories for the Artist below are authorized to contract Artist's services.
19. LICENSING AND PERMITS: Artist warrants that he or she shall have, prior to
commencement of work under this agreement and at all times during said work,
all required licenses and permits whether federal, state, County or City.
20. INSURANCE: Artist agrees that it maintains in force at its own expense a
liability insurance policy which will insure and indemnify the Artist and the
County from any suits, claims or actions brought by any person or persons and
from all costs and expenses occurring during the agreement or thereafter that
results from performance by Artist of the obligations set forth in this agreement.
At all times during the term of the agreement and for one year after acceptance of
the project, unless the requirement is waived by the Monroe County Risk
Manager, Artist shall maintain on file with the County a certificate of the
insurance of the carriers showing that the aforesaid insurance policy is in renewal,
material change or reduction in coverage unless a minimum of thirty (30) days
prior notification is given to the County by the insurer.
Acceptance and/or approval of Artist's insurance shall not be construed as
relieving Artist from any liability or obligation assumed under this contract or
imposed by law.
The Monroe County Board of County Commissioners, its employees and officials
will be included as "Additional Inured" on all policies except worker's
compensation.
Any deviations from these General Insurance Requirements must be requested in
writing on the County form titled "Request for Waiver of Insurance
Requirements" and must be approved by Monroe County Risk Management. The
following coverages shall be provided prior to commencement of work governed
by this contract:
1. Workers Compensation if, and as required by Florida Statutes
2. General Liability Insurance. Coverage shall be maintained through out the
life of the contract and include, as a minimum:
. Premises Operations
. Products and Completed Operations
. Blanket Contractual Liability
. Personal Injury Liability
. Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a
Claims Made policy, its provisions should include coverage for claims
filed on or after the effective date of this contract. In addition, the period
for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County.
21. NOTICE: Any written notice to be given to either party under his
agreement or related hereto shall be addressed and delivered as follows:
For Artist
For County:
Artsy Studio
Elena Ortega
1604 Monmouth Lane
Key Largo, FL 33037
Florida Keys Council of the Arts
1100 Simonton Street
Key West, FL 33040
and
County Attorney
P.O. Box 1026
Key West, FL 33041-1026
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed the
day and year first above written.
(SEAL)
ATIEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By:
By:
Deputy Clerk
Mayor/Chairman
WITNESSES:
ARTIST:
EL~ft:;y STUDIO
t~t~~
MONROE COUNTY ATTORNEY
AP~ROVED d) RM:
~,jATILEENE w. CASSEL
ASSISTANT <J;UtHY ATTORNEY
Date ...2/) (Yj
Back up documentation
We are contracting for 4 critters at $1,000.00
each.
~
(
Artsy Studio ~~
Elena Ortega ~
1604 Monmouth Lane, Key Largo, FL 33037 (786) 564-6214
RFP for McCoy Terminal Complex
at the Key West International Airport,
Monroe County, Florida
Artwork Narrative Summarv. "Kev West Fauna"
This artwork would be on the wall spaces available for art inside the building. The artistic style
will be photorealistic-trompe l'oeil. It will be visible from most points of the building, giving a feeling
of wonder, as people would also experience throughout the city where these animals are so well loved.
The imagery is of subtle surprise, little animals sneaking in the building, sharing the spaces
with the community as they do in this picturesque city.
The public will be greeted by these critters: cats, iguana, egret, roosters' chickens, peacock,
spoonbill, seagull, pelican, osprey, parrot, cockatoo, throughout unexpected areas behind benches,
above windows, seating on a light fIxture, fooling the eye of the viewer.
This artwork illustrates the lifestyle and images from Key West, full of native fauna.
I'm including a layout of 21 critters, receptive to adjustment of location and amount. The
pieces will be painted on linen and marouflaged to minimize the impact of the wall's texture. It will be
coated with exterior UV resistant low luster varnish to protect it from UV rays, no maintenance
required.
Prepared by: Elena Ortega
Signedf1~~
Date:
W-d-'5-o<6
'; ,~,-,>L:;~:t'y
,~.);,. :3ICpIT:81-'-:
JAN ~..
RFP FOR McCoy Terminal Complex at the Key West International Airport, MONROE COUNTY FlC
ITEMiZeD BUDGET
Artwork -Key W... Fauna-
,AREA : , 1 i !
ESTIMATED COMPlETION TIME .60 daYS I I
. MATERIALS PAINT i S3OO.00 ! $300.00
I . MEDIUM $100.00 $100.00
I ! I
i I I
i
i iMISCEUANEOUS $500.00
i I NOTE: MISCElLANEOUS INClUDES
I ,PAPERS. FOAM BRUSHES. CHIP BRUSHES.
I I
! IPAlNT PANS. PAINT BUCKETS. I
I PHOTOGRAPHIC REFEReNCE AND THE
SUCH
EClUIPMENT SCISSOR UFT 10FT IX 1 WEEK $400.00
I
LABOR Installation of artwork $2 000.00 1 week $2.000.00
iARTfST PRELIMINARY SKETCH DESIGN, FINAl ARTWORK AND
! COMPl.ETION $18,000.00
I : I I
Note: each piece averages aprox. $1,000,00 TOTAL $21,300.00
CGunty
:)f:veiopmeni
JAN ~}
~
Date: f [-.;J '5 - 0<6
Monroe County Art In Public Plac:u
REQUEST FOR PROPOSALS
Application Cover Sheet
Applicant Contact Information: .
Nomo. ~ o~
.......... J~4 ~; ._'t.- ~ Utn~ Q?o?l
Phone(s): G;.:; 0 c;" t
.-MoII. ~~ a ~ J-:' 0 ' OJ r>1
Webeite: . .tSV[ ~ l) , L t.f"}-n
Monroe County NSkIent: v_ ~ No_
(If year pl... attach proof of ....Id.nc:v.)
Total Buelget/Cost:
:IJ d- ( J 3t> 0
Total Number of Art Pleas InducIed In propoul: ~ I
(If applying for multiple spICa, furnish total budgat and number of art pieces for each spBc..)
PIu.. briefly deecribe the following If applicable; If not applicable Indlcat. with N/ A-
Spedalllghtlng required: f.J 'l)
other ~I requlrementa: NO
Tvpe/amount of project acceu desired: Pvu." Ace ~ s.S -tV It-JSn;:>E. LoBell
Inm-llatlon tlm. required: / (,\) e e -=:..
Mal~nce requl........b: IJ 0 tV e.
ArtIR ....Intalna a $300,000 liability IMuranc:e poIlcy:@ No If no, plea.. .xplaln.
PIeaH check the following Item. to Indicate they are attached:
~. Written proposal.
~ Itemized budget.
rsI Concept drawings; 5 pages maximum (8.5" x U") Including color sketch AI: digital rendition.
Digital Images POF or JPG not exceeding 75dpi - 5 images maximum.
a If 3-dlmenslonal art proposal, one small model.
Note: Support materials will om be returned to the applicant without prior pre-paid shipping.
Signature confirming that all Information provided for this application is true and correct.
~~.~ 6(~ Cvt~rl'~ IO-d-5..oi
Artist or head of org!M,lzation Type or print name U Date
JANrJ)
A CORa"
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (305)852-3234
Regan Insurance Agency,
90144 Overseas Hwy.
Tavernier, FL 33070
FAX (305)852-3703
Inc.
DATE (MM/DDIYYYV)
01/12/2009
THIS CERTIFICATE IS ISSUED AS A MA TIER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EX ND OR
ALTER THE COVERAGE AFFORDED BY THE POll BIib6lW.
INSURED Artsy Studio LLC
c/o Elena Ortega
1604 Monmouth Lane
Key Largo, FL 33037
INSURERS AFFORDING COVERAGE
INSURER A Fi rst COllll1erci a 1 Underwri ters
INSURER B
INSURER C
INSURER D
INSURER E
..:.,
cnVERAGEJ:: 2~
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
II,N.$': ~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P~~'9~Y EXPIRATION LIMITS
GENERAL LIABILITY GLl9946-1 05/17/2008 05/17/2009 EACH OCCURRENCE $ 1,000,OO(]
-
X COMMERCIAL GENERAL LIABILITY DAMAGE T9"RENTED $ 100,00(]
l CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,00(]
A X PERSONAL & ADV INJURY $ 1,000,OO(]
- - 1,000,00(]
GENERAL AGGREGATE $
- 1,000,00(]
GEN'l AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $
I .nPRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
I--
ALL OWNED AUTOS BODilY INJURY
I-- $
SCHEDULED AUTOS (Per person)
~ 011.,~
HIRED AUTOS ~ ,,', :;( BODll Y INJURY
I-- $
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
_".\ . "7 ~;:: (Per accident)
GARAGE liABILITY \.AU' k~J AUTO ONLY - EA ACCIDENT $
=j ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
3ESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
=j DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I we STATU-.I IOJt'-
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
If yes, describe under EL DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I lOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
certificate holder is shown as an additional insured per policy forms, conditions, 1 imitations
ilnd exclusions
R
Monroe County BOCC
1100 Simonton Street
Key West, FL 33040
SHOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
.-!L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,.
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~.L~ /VI ~
John Crowell BMONRO ~-~- / (
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
~CORD 25 (2001/08)