4th Task Order 05/17/2023 Kevin Madok, cpA
Clerk of the Circuit Court& Comptroller- Monroe County, Florida
DATI: Nlav 18, 2023
TO: Rlionda Haag
Cluct'Resilience 01ficer
Janet Gulidersoll
(;raids Coordinator
FROM: I'aincla G. I
SUBJECT: Nlav 17' BOCUNIceling
Attaclied our electronic copies of the following Items for your liaildling:
13() 1" Nlodification to Federal Entergency Nlaiiagenient Agency (FENIA) Hazard
Mitigation (;rant Program (I INIGP) subgrwit agTccniciit 110856 %%lidi Honda Division of'
Emergency Mariagenient to dc%'clop NVaterslied Matiagenient Platis for 1;,tyloii, Key Colony Bcacli
atid Nlaradion, Increasing federal Itinding by $399,506.25 mid bringing the total graiii wiiouiit to
$693,900. 11ic 25% nialcli%%,III be provided by Resilient Honda Vulnerability Assessment grains
22PI,No'5 (Maradion) mid 23P1,N97 (1;aN1oii/KcN, Colony' Beacli). No County funds arc expended
16r this Nvork. Please be sum to remm a fufly executed copy of tbe mo&flcabon once siped by tbe
swe for the recoiii
U2 V—bask Order witli NN'SP USA 1"imi-onnient & I nFrastruct tire Solutions, Inc., III [lie
not to exceed aInotint ol'$59,183.27, to develop and submit a grant application for all electric
velilcle cliarging station corridor III die County mid municipalities, under the Categoi), C on-call
Resilience mid Imvironniental Engineering Services contract; retroactive to May 1., 2023.
Should you liave any questions please feel free to contact nic at (305)) 292-35)50.
CC: County Attorney
Finance
File
KEY WEST MARATHON PLANTATION KEY
500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway
Key West, Florida 33040 Marathon, Florida 3300 Plantation Key, Florida 33070
TASK ORDER #4 FOR CATEGORY C
RESILIENCE AND ENVIRONMENTAL ENGINEERING SERVICES
FOR GRANT APPLICATION DEVELOPMENT SERVICES
BETWEEN MONROE COUNTY AND
WSP USA ENVIRONMENT & INFRASTRUCTURE INC.
FOR
THE FEDERAL HIGHWAY ADMINISTRATION
CHARGING AND FUELING INFRASTRUCTURE PROGRAM
IN MONROE COUNTY, FLORIDA
This Task Order #4 is entered into on this 17 day of May 2023, in accordance with the
Continuing Contract for On-Call Professional Environmental Engineering Services made
and entered on the 18th day of May 2022, as amended by Amendment No.1 dated
November 15th, 2022, between Monroe County, hereinafter referred to as the "County"
and WSP USA Environment & Infrastructure, Inc. hereinafter referred to as "Consultant"
where design services are allowed if construction costs do not exceed $4,000,000.
All terms and conditions of the referenced Contract for On-Call Professional Engineering
Services apply to the Task Order unless the Task Order modifies an Article of the
Agreement of which will be specifically referenced in this Task Order and the modification
shall be precisely described.
WITNESSETH
WHEREAS, the Federal Highway Administration (FHWA) Charging And Fueling
Infrastructure (CFI) program opportunity solicits applications for grants that will accelerate
an electrified and alternative fuel transportation system that is convenient, affordable,
reliable, equitable, accessible and safety; and
WHEREAS, the CFI FY 2022-2023 Notice of Funding Opportunity authorizes $700 million
in funding under the Bipartisan Infrastructure Law (BIL); and
WHEREAS, the grant application deadline is May 30, 2023; and
WHEREAS, this task will be comprised of a team of WSP staff with expertise in grant
narrative development and DOT funding applications who will work alongside WSP's
planning staff and electrification experts; and
WHEREAS, WSP will prepare a complete final grant application and submit it before the
grant deadline.
NOW, THEREFORE, in consideration of the mutual promises, covenants, and
agreements stated herein, and for other good and valuable consideration, the sufficiency
of which is hereby acknowledged, County and Consultant agree as follows:
ARTICLE 1.1 TERMS OF AGREEMENT:
This Task Order is effective on May 4, 2023 and shall expire June 30, 2023.
1
ARTICLE II SCOPE OF BASIC SERVICES IS AMENDED AS FOLLOWS:
Task 1 — Project Management & Coordination
Task 1A - WSP will develop a proposed timeline with internal milestones for all
tasks.
Task 1 B - WSP will meet once weekly with Monroe County and the municipal
representatives as the grant application is being developed to provide updates,
collaborate and ensure the best available information is incorporated into the grant
application.
Task 2 —Project Planning & Development
Task 2A - Scoping Meeting: WSP will conduct one 2-hour scoping meeting with
Monroe County stakeholders to determine charging project scope, desired
outcomes, number of locations by charging speed, and budget.
Task 2B - Site Feasibility: WSP will investigate candidate up to ten (10) sites
identified by Monroe County and the municipalities for proximity to power and
determine what charging speed can be accommodated by the existing power
supply as well as number of charge points and layout appropriate for each location.
Additionally, WSP Grants team will contribute to charging site location matrix (i.e.
alignment with NOFO guidance/criteria, Justice 40, parking ratio analysis). WSP
will work with the utility providers to help determine the sites to be proposed.
Task 2C— Conceptual Site Plans: WSP will develop concept level site plans for
two (2) locations and support graphics to highlight key project features (charging
speed, number of charge points, power supply detail, community demographics,
points of interest). At least one of the locations will be in unincorporated Monroe
County.
Deliverables/Tasks:
• Completion of one scoping meeting to clarify project goals, guardrails and
previous work available to the project (i.e. Site locations, preliminary Site
Feasibility, number of locations desired, by charging speed).
• Submission of prioritized candidate charging site matrix(with a maximum of 10
locations evaluated), that will help Monroe County select locations that best
align with local goals and budgets. It shall also contain a description of the
alignment with the various NOFO guidance/criteria, Justice 40, parking ratio
analysis, etc.
• Two (2) Conceptual Site Plans (example components include: planning level
cost estimate, site CADD drawing, electrical components needed for desired
charging spaces and power), one of which will be in unincorporated Monroe
County
• Program-level graphics to support public engagement and supplemental
documentation needs for the CFI grant.
2
Task 3 —Charging and Fueling Infrastructure (CFI) Grant Development
Task 3A - WSP will provide required grant forms to the County by May 10 for
County internal completion: SF-424, Grants.gov lobbying form, SF-424A/B (Non-
Construction Programs) OR SF-424C/D (Construction Programs), Key Contacts
Task 31B- WSP will prepare and deliver one combination draft grant application to
Monroe County for review and comment.
Task 3C - WSP will incorporate feedback from Monroe County into the final
application package, which will be submitted to Monroe County 3 days ahead of
the DOT deadline.
Task 3D - WSP shall submit the grant application into the portal prior to the DOT
deadline. County shall provide login information for Sam-E.
Deliverables:
• One Data Request for Monroe County.
• One draft grant application package.
• One final combination application package for the Community Program and
Corridor program grants.
• Notice of grant application receipt.
Assumptions:
a) The grant program of interest that Monroe County is interested in pursuing under
the CFI Grant Program is the Corridor Program to strategically deploy publicly
accessible EV charging infrastructure along designated alternative fuel corridors
(AFCs). However, the NOFO states that while applicants can choose to apply for
only one grant program, this combined solicitation allows applicants to
simultaneously apply for funding under both programs (Community Program and
Corridor Program) by submitting only one application. As such, the application will
be prepared to answer the narrative requirements for both programs in order to be
considered for both.
b) Required application components for the Community Program include:
• Project Narrative
• Budget Information
• Project Merit Criteria
• Project Readiness and Environmental Risk
c) Required application components for the Corridor Program include:
• Project Narrative
• Budget Narrative
• Project Merit Criteria
• Project Readiness and Environmental Risk
3
d) Required forms for the combined Community and Corridor application:
• S F-424
• Grants.gov lobbying form
• Project Abstract Summary
• SF-424A/13 (Non-Construction Programs) OR SF-424C/D (Construction
Programs)
• Key Contacts (Optional)
e) Monroe County will provide the WSP team with requested data, material, and
project information necessary to complete the grant application package.
f) Monroe County will participate in meetings and conference calls as needed by
WSP to address and clarify comments and revisions.
g) Monroe County will be responsible for coordinating internal review of the draft
application package.
h) WSP will be responsible for submitting the final application for funding to DOT via
grants.gov.
i) The scope of the grant support services ends with the WSP submittal of an
application to DOT, or on May 30, 2023.
Article VII, Paragraph 7.1.1 is amended to include the following:
The costs of providing the professional services shall be included on a time and material
not to exceed (T&M NTE) basis. The T&M NTE amount to complete the assignment is
$59,483.27, which is outlined in the cost proposal attached as Exhibit A
Task 1: Project Management and Coordination $ 11,439.06
Task 2: Project Planning and Development $ 19,395.00
Task 3: CFI Grant Development $ 28,649.21
Total Fee $ 59,483.27
THE REMAINDER OF THIS PAGE PURPOSELY LEFT BLANK
4
IN WITNESS WHEREOF, each party caused the Task Order#4 to be executed by its duly
authorized representative.
CONSULTANT: WITNESS:
WSP USA ENVIRONMENT
& INFRASTRUCTUREINC.
5/5/23 5/5/23
Signature Date Signature Date
Assistant Vice President, Civil Engineer
Title
0 BOARD OF COUNTY COMMISSIONERS
EVIN MADOK, CLERK OF MONROE LINTY, FLORIDA
Mayor/dhairman
As Deputy Clerk
Date: May 17,2023 -T1
F
M
-T1
y. CD
r-1
Approved as to form and legal sufficiency:
Monroe County Attorney's Office 5-6-2023
010j'�'t. fw
5
EXHIBIT A
FEE SCHEDULE
6
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DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 5/1/2023
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 have ADDITIONAL INSURED provisions or 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
NAME: AJG Service Team
Arthur J. Gallagher Risk Management Services, LLC PHONE FAx
300 Madison Avenue A/c No Ext: 212-994-7100 A/c,Noy 212-994-7047
28th Floor ADMDRESS: GGB.WSPUS.CERTREQUESTS@AJG.COM
New York NY 10017 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Liberty Insurance Corporation 42404
INSURED WSPGLOB-01 INSURERB:Zurich American Insurance Company 16535
WSP USA Environment& Infrastructure Inc. INSURERC:American Guarantee and Liability Ins Co 26247
1075 Big Shanty Rd. Suite 100
Kennesaw, GA 30144 INSURERD:AXIS Surplus Insurance Company 26620
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1264096623 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 INSD WVD POLICY NUMBER MMIDD/YYY MMIDD/YYY
B X COMMERCIAL GENERAL LIABILITY Y GLO 9835819-10 5/1/2023 5/1/2024 EACH OCCURRENCE $3,500,000
CLAIMS-MADE OCCUR PREMISES DAMAGE TO
PREMISES Ea occurrence)
ccurrence $3,500,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $3,500,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $7,000,000
POLICY❑ PRO ❑
JECT LOC PRODUCTS-COMP/OP AGG $4,000,000
X
OTHER: $
A AUTOMOBILE LIABILITY Y AS7-621-094060-033 5/1/2023 5/1/2024 COMBINED SINGLE LIMIT $5,000,000
D P-001-001008908-02 5/1/2023 5/1/2024 Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
XS COMB.SINGLE LIMIT $5,000,000
C X UMBRELLA LAB X OCCUR AUC 00144386-07 5/1/2023 5/1/2024 EACH OCCURRENCE $5,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION$ $
A WORKERS COMPENSATION WA7-62D-094060-013 5/1/2023 5/1/2024 X PER OTH-
A AND EMPLOYERS'LIABILITY Y/N WA7-62D-095609-073 5/1/2023 5/1/2024 STATUTE ER
A ANYPROPRIETOR/PARTNER/EXECUTIVE WC7-621-094060-913 5/1/2023 5/1/2024 E.L.EACH ACCIDENT $2,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
THIRTY(30)DAYS NOTICE OF CANCELLATION.
The Monroe County Board Of County Commissioners are included as Additional Insured with respect to the General Liability and Automobile Liability policies as
required by written agreement,pursuant to and subject to the policy's terms,definitions,conditions and exclusions.
M
5 . 23
T
i .
CERTIFICATE HOLDER CANCELLATION 5 . „
.�
SHOULD ANY OF 1--_-_ _____ __- RE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County Board of County Commissioners
1100 Simonton Street, Suite 205 AUTHORIZED REPRESENTATIVE
Key West FL 33040 --
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
710/26/2022
E(MM/DD/YYYY)
ACCORD® CERTIFICATE OF LIABILITY INSURANCE
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 have ADDITIONAL INSURED provisions or 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
NAME: AJG Service Team
Arthur J. Gallagher Risk Management Services, Inc PHONE FAx
300 Madison Avenue A/c No Ext: 212-981-2485 A/c,Noy 212-994-7074
28th Floor ADMDRESS: GGB.WSPUS.CertRequests@ajg.com
New York NY 10017 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: QBE Specialty Insurance Company 11515
INSURED WSPGLOB-01 INSURER B:
WSP USA Environment and Infrastructure Inc.
f/k/a Wood Environment& Infrastructure Solutions INSURERC:
1075 Big Shanty Rd. Suite 100 INSURER D7
Kennesaw GA 30144 INSURER E7
INSURER F:
COVERAGES CERTIFICATE NUMBER:1283195556 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 INSD WVD POLICY NUMBER MMIDD/YYY MMIDD/YYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR PREMISES DAMAGE TO
PREMISES Ea occurrence)
ccurrence $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY❑ PRO-
❑
JECT LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A ProfessionalLiability QPL0022630 11/1/2022 10/31/2023 Per Claim $1,000,000
CLAIMS-MADE Aggregate $3,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
THIRTY(30)DAYS NOTICE OF CANCELLATION
RE: Project Description: Category C Resilience and Environmental Engineering Services, Project Number:600837.
APPROVED BY RISK MANAGEMENT
By,W
DATE 10/27/202.2....�
WAIVER N/A YES
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County BOCC
PO Box 100085-FX AUTHORIZED REPRESENTATIVE
Duluth GA 30096 --
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
710/28/2022
E(MM/DD/YYYY)
ACCORD® CERTIFICATE OF LIABILITY INSURANCE
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 have ADDITIONAL INSURED provisions or 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
NAME: AJG Service Team
Arthur J. Gallagher Risk Management Services, Inc PHONE FAx
300 Madison Avenue A/c No Ext: 212-981-2485 A/c,No:212-994-7047
28th Floor ADMDRESS: GGB.WSPUS.CertRequests@ajg.com
New York NY 10017 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Steadfast Insurance Company 26387
INSURED WSPGLOB-01 INSURER B:
WSP USA Environment and Infrastructure Inc.
f/k/a Wood Environment& Infrastructure Solutions INSURERC:
1075 Big Shanty Rd. Suite 100 INSURER D7
Kennesaw GA 30144 INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1530174162 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 INSD WVD POLICY NUMBER MMIDD/YYY MMIDD/YYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR PREMISES DAMAGE TO
PREMISES Ea occurrence)
ccurrence $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY❑ PRO-
❑
JECT LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Pollution Liability CPL4846279-01 11/1/2022 11/1/2023 Per Claim/Aggregate $5,000,000
CLAIMS MADE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more o—i—n
THIRTY(30)DAYS NOTICE OF CANCELLATION Ir y"
By
5 . 23 �
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County Board of County Commissioners
1100 Simonton Street, Suite 205 AUTHORIZED REPRESENTATIVE
Key West FL 33040 --
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD