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Certificates of Insurance GE'CO GEICO GENERAL INSURANCE COMPANY Washington DC VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE) MAILING ADDRESS Policy Number: 0403890809 ANTHONY D AND ANGELA D CULVER Effective Date: 12-04-23 PO BOX 500333 Expiration Date: 06-04-24 MARATHON FL 33050-0333 Registered State: FLORIDA To whom it may concern: This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend, extend or alter the coverage afforded by this policy. Vehicle Year: 2021 Make: NISSAN Model: TITAN VIN: 1 N6AA1 EF9MN513967 COVERAGES LIMITS DEDUCTIBLES Bodily Injury Liability Each Person/Each Occurrence $100,000/$300,000 Property Damage Liability $50,000 Personal Injury Protection Non-Ded/Insd&Rel Uninsured Motorist/Stacked Each Person/Each Occurrence Insured Rejects Comprehensive(Excluding Collision) $1,000 Ded Collision $1,000 Ded Emergency Road Service ERS FULL Rental Reimbursement $30 Per Day/$900 Max Mechanical Breakdown $250 Ded Lienholder Additional Insured X Interested Party Monroe County BOCC As Certificate Holder 1100 Simonton St y I'S' T KEY WEST, FL 33040 y ° 214.24DAT --„ Additional Information: WAMM l Issue Date: 02-14-24 If you have any additional questions, please call 1-800-841-3000. CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION'OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR EMAIL. U33 12-17 2018 Edition MONROE COUNTY,FLORIDA QUEST FOR WAIVER OF INSURANCE REQUIREMENTS It is requested that the insurance requirements,as specified in the County's Schedule of Insurance Requirements,be waived or modified on the following contract. Contractor)Vendor: Anthony Culver DBA Culver's Cleaning Company Project or Service: janitorial Cleaning Services at the Florida Keys Marathon International Airport Contractort'Vendor PO Box 500333,Marathon,FL 33050 Address&Phone li 305-393-0684 General Scope of Work: janitorial Cleaning Services at theFlorida Keys Marathon International Airport Reason for Waiver or Exempt from Workers Compensation ........... . Modification: Policies Waiver or Workers Compensation and Employer's Liability Modification will apply to: Signature of ContractoriVendor. w Date: ,/ Y Approved X .. ....... Not Approved .......... ..... Risk Management Signature Dates 2.12.24 County Administrator appeal: Approved: ._-..,. ,_.. Not Approved: Date- Board ofCounty Commissioners appeal: Approved. ._..__....,__..__...__w Not Approved: Meeting Date- Administrative Instruction 7500.7 t{;14 �PF WO 0"I""PTUT e.,mmr'"/MM°;:, '(,mounmuAhu,mmlUmmuIDveoN l 7n, 2AE.ii k "� GEICO GEICO GENERAL INSURANCE COMPANY Washington DC VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE) MAILING ADDRESS Policy Number; 0403890809 ANTHONY D AND ANGELA D CULVER Effective Date: 12-04-23 PO BOX 500333 Expiration Date: 06-04-24 MARATHON FL 33050-0333 Registered State: FLORIDA To whom it may concern: This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed.This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend,extend or alter the coverage afforded by this policy. Vehicle Year: 2021 Make: NISSAN Model: TITAN VIN: 1 N6AA1 EF9MN513967 COVERAGES LIMITS DEDUCTIBLES Bodily Injury Liability Each Person/Each Occurrence $100,0001$300,000 Property Damage Liability $50,000 Personal Injury Protection Non-Ded/Insd&Rel Uninsured Motorist/Stacked Each Person/Each Occurrence Insured Rejects Comprehensive(Excluding Collision) $1,000 Ded Collision $1,000 Ded Emergency Road Service ERS FULL Rental Reimbursement $30 Per Day f$900 Max Mechanical Breakdown $250 Ded Lienholder Additional Insured X Interested Party Monroe County BOCC 1100 Simonton St KEY WEST,FL 33040 .......... Additional Information: Issue Date:01-24-24 .................. ...................... ........................................................... -------------- --------------- If you have any additional questions, please call 1-800-841-3000. CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION"OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR EMAIL. U33 12-17 0, J,,-Q MI ANTHCUL-01 LEBLANCN CERTIFICATE OF LIABILITY INSURANCE DATE DD(YYYY) IIIv(MMI(MM4 024 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 endorsemen s. CONTACT PRODUCER N ME: Insurance Office of America IONHE Ext).(407 788-3000 FAx 1855 West State Road 434 ) (Aec,N2):(407)788-7933 E-MAIL Longwood,FL 32760 ADss INSURER(SI AFFORDING COVERAGE .__._.__.. ._NAIC# INSURERA:Ohio Securit y Insurance Corn an 24082 INSURED INSURERB:Westem Sure Com an CNA. 13188 Anthony Culver dba Culvees Cleaning Company INsuRERc: PO Box 500333 INSURERD: __....__....._- -- Marathon,FL 33050-0761 INSURER E INSURER F: COVERAGES CERTIFICATE_NUMBER: 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 — -- --ADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER I M LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR X BLS66080772 8/23/2023 8/23/2024 DDAAMMAGETO RoNcED $ 300,000 MEDEXP(Any oneperson) $ 15,0— PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE—__,$__,,_ 21000,000 X POLICY❑P�1- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ --- COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea a id nt ANY AUTO BODILY INJURY(Per person)_ $ OWNED SCHEDULED AUTOS ONLY AUTOS EE BODILY INJURY Per accident A�TOS ONLY A�IO50NLY 1r4 PROPERTY DAMAGE ^ Per accident $ $ UMBRELLA LIAB OCCUR 2.12.24 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WAOM X $ WORKERS COMPENSATION PTAT TE OfH AND EMPLOYERS'LIABILITY YIN --'--" ANY PROPRIETOR/PARTNER/EXECUTIVE —] NIA E.L.EACH ACCIDENT.,.__ $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Fidelity Bond 68634853 7/3012023 7/30/2024 Limit 10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is Additional Insured with respect to General Liability when required by written contract perform#CG88100413 __._..............._.._.......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. AUTHORIZED REPRESENTATIVE Monroe County Board of Commissioners 1111-12th Street Suite 408 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i= � m mmmmmo ��� � Tmmmmmrr, TmTT mmmEmmmmmTETz,