Certificates of Insurance
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FILE COpy
- ANIMAL SHELTER RE-ROOF PROJECT
Marathon, Florida
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MONROE COUNTY, FL;ORlDA
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Requeat For Waiver
of: '
Insurance Requirements
It is requested that the insurance requirements. 81 ~ in, tho County's Schedulo ,of
Insurance Requirements, be waived or modified on the fofIowing COIltIlIct
Contractor: A I Htf r rM..f\[1'~' r')~\e(l~~ "~/h)a. OOe.la~,~ ':>
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COlI'lty Administrator appeal:
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. Approved
Contract for:
Address of Contractor:
Phone:
Scope of Work:
Reason for Waiver:
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Not ApprOYtNi
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Soard of County Commissioners appeal:
Approved
Meeting Date:
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ET METAL & AIR CONDITIONING CONTRACTORS ASSOCIATION INC,
SELF INSURERS FUND
P.O. BOX 4907. WINTER PARK, FL 32793. (407) 671-FRSA
1-800-767-3772. FAX (407) 671-2520
CERTIFICATE OF INSURANCE
ISSUED TO:
COpy PROVIDED TO:
Monroe County BOCC
Attn: Purchasing Dept.
1100 simonton st., 216
Key West FL 33040
A. Herrmann Associates, Inc.
d/b/a Associates Roofing
2351 Thomas St.
Hollywood FL 33020-2038
ATTN:To whom it may concern
Date: 12/09/2003
A. Herrmann Associates, Inc. d/b/a Associates Roofing
This is to certify that 2351 Thomas st.
Hollywood FL 33020-2038
being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of
compensation by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING
CONTRACTORS ASSOCIATION SELF INSURERS FUND.
870-001266
EFFECTIVE DATE:
01/01/2003
LIMITS
Workers' Compensation Statutory - State of Florida
COVERAGE NUMBER:
$100,000 - Each Accident
$100,000 - Disease, Each Employee
$500,000 - Disease, Policy Limit
REMARKS: Non-cancelable without 30 days prior written notice, except for non-payment of premium which will
be a 10 day written notice.
01/01/2004
Employers' Liability
EXPIRATION DATE:
Job ref: Monroe County Animal Shelter
This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate
shall be constructed as extending coverage not afforded by the policy(ies) shown above or as affording
insurance to any insured not named above. This provides coverage for Florida policyholders and Florida
domicile employees only.
13c~~
Brett Stiegel, Administra
FRSA-SIF
By:
BY'~:'~
Debbie Kemmere - Underwriting Manager
FRSA-SIF
~UCtibN MAtiAGEMENT
~~~L~::F1NG' SHEET METAL & AIR CONOrnONING CONTRACTORS ASSOCIATION. INC.
SELF INSURERS FUND
P.O. BOX 4907. WINTER PARK, FL 32793. (407) 671-FRSA
1-800-767-3772. FAX (407) 671-2520
CERTIFICATE OF INSURANCE
ISSUED TO:
COpy PROVIDED TO:
Monroe County BOCC
Attn: Purchasing Dept.
1100 simonton st., 216
Key West FL 33040
A. Herrmann Associates, Inc.
d/b/a Associates Roofing
2351 Thomas St.
Hollywood FL 33020-2038
ATTN:To whom it may concern
Date: 12/09/2003
A. Herrmann Associates, Inc. d/b/a Associates Roofing
This is to certify that 2351 Thomas St.
Hollywood FL 33020-2038
being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of
compensation by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING
CONTRACTORS ASSOCIATION SELF INSURERS FUND.
COVERAGE NUMBER:
870-001266
EFFECTIVE DATE:
01/01/2004
LIMITS
Workers' Compensation Statutory - State of Florida
$100,000 - Each Accident
$100,000 - Disease, Each Employee
$500,000 - Disease, Policy Limit
REMARKS: Non-cancelable without 30 days prior written notice, except for non-payment of premium which will
be a 10 day written notice.
01/01/2005
Employers' Liability
EXPIRATION DATE:
Job ref: Monroe County Animal Shelter
APP~~SENl
BY - '~ =.
DATE ~'
YES-'
WAIVER N/A '
This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate
shall be constructed as extending coverage not afforded by the poficy(ies) shown above or as affording
insurance to any insured not named above. This provides coverage for Florida policyholders and Florida
domicile employees only.
.&14~
Brett Stiegel, Administra
FRSA-SIF
By:
BY:~:'~
Debbie Kemmere - Underwntlng Manager
FRSA-SIF
dddddddddddd THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAnON
ONLY AND CONFERS NO RIGHTS UPON THE CERnFlCATE
HOLDER. THIS CERnFlCATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
FRANK H. FURMAN, INC.
FRANK H. FURMAN #A091425
P. O. BOX 1927
POMPANO BEACH,
FL 33061
INSURED
ASSOCIATES ROOFING
A HERRMANN ASSOC INC DBA:
2351 THOMAS STREET
HOLLYWOOD FL 33020
COMPANY
A
NATIONAL FIRE INS OF HARTFORD
COMPANY
B
AMERICAN CAS CO OF READING PA
COMPANY
C
TRANSPORTATION INS CO
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 CONDmON 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.
CO
LTlt
TYPE OF INSURANCE
POUCY NUMBER
GENERAL UABILITY
X COMMERCIAL GENERAl liABilITY
CLAIMS MADE [][] OCCUR
OWNER'S & CONTRACTOR'S PROT
1036382092
AUTOMOBILE UABIUTY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
1036379130
GARAGE UABIUTY
ANY AUTO
EXCESS UABIUTY 1036382108
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSAnON AND
EMPLOYERS' UABIUTY
"THE PROPRIETOR!
PARTNERs/EXECUTIVE
OFFICERS ARE:
OTHER
INCl
EXCL
POUCY EFFECTIVE POUCY EXPlRAT10N
DATE (MMIDDIYY) DATE (MMlDDIYY)
LIMITS
5/01/03
5/01/04
GENERAl AGGREGATE $2 , 000 , 000
PRODUCTS. COMPIOP AGG $1, 0 0 0 , 0 0 0
PERSONAL & ADV INJURY $1, 000, 000
EACH OCCURRENCE $1, 000, 000
FIRE DAMAGE (Any one fire) $ 5 0 , 0 0 0
MED EXP (Any one person) $ 5 , 0 0 0
1,000,000
COMBINED SINGLE llMrT $
5/01/04
BODilY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
$
AUTO ONLY - EA ACCIDENT $
O"THER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
5/01/03 5/01/04 EACH OCCURRENCE $2,000,000
AGGREGATE $2 , 000, 000
$
$
EL DISEASE-POLICY UMrT $
EL DISEASE-EA EMPLOYEE $
DESCRIPT10N OF OPERATIONSILOCAnONSNEHlCLESlSPECIAL ITEMS
RE: MONROE COUNTY ANIMAL SHELTER/ MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
ARE ADDITIONAL INSUREDS FOR GEN LIAB & AUTO LIAB AS PER ATTCH'D ENDORSEMENTS
G-140331A & CA00011001. UMBRELLA IS EXCESS OVER GENERAL & AUTO LIABILITY.
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MONROE COUNTY
COMMISSIONERS
1100 SIMONTON
KEY WEST
BOARD OF COUNTY
-PURCHASING DEPT
ST 216
FL 33040
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11tE
EXPIRAnON DATE THEREOF, THE ISSUING COMPANY WLL ENDEAVOR TO MAL
!.J.Q DAYS WRITTEN NOnCE TO THE CERnFlCATE HOLDER NAMED TO THE LEFT,
BUT FAlWRE TO MAIL SUCH NonCE SHALL IMPOSE NO OBUGAT1ON OR UABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED ~ATlVE
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