HomeMy WebLinkAbout2nd Escrow Disbursement Request ESCROW A43REEMENT-Exhibit A
ESCROW DISBURSEMENT REQUEST FORM
Old National Weskit Managemen4 acting as.escrow agent(the'E,seraW Agenr)under the.Escrow Agreement dated se of May 16,2026,by and
among the Escrow Agent,Lansing 2,Inc.(•Lessor'?and Monroe County,Florida r Lease*' "Escrow(the Agteaeetanf'),is hereby requested to
paytottmparwn orcorporalion,doalgnated below as payee thesumaelfotih below In psymentof the acquisition and installation costa.of the equipment
described below,which equipment was financed pursuant to that certain Lsese,Pur"e.Agreement dated May 15,2025, by and botween Lessor
and Lessee(III'Lease'1. The amount shown below Is due and payable render ft staged vendor invoice($)of payee with respect to the described
equipment and has not formed the basis of any prior request for payment from the escrow account established under the Escrow AgreemenL
PAYEE: South fladda EmeMgm WablQits
AMOUNTt- t
DESCRIPTION OF EQUIPMENT: �__25 tt(gPLMojjrs VSN 439PT209XSC560340 and Vtht 4S9r?T2O96SC560335
' INVOICE# iZO945 find 12090 DATED:,911212025 _
indleata Method for Psyrnent 0lsbursem,e t•
Overnight Check"` ,..__Regular Meg Check L„__Wire Funds
1 Making Address: Wire Instruciionst Fine Mark.Nartnnat.Bonk
I ARA - 067 16231.
A=5 SO67972
Acct Name,SFEV
••'Please mote that there might be a fee charged for overnight delivery,.
Thl9 fee will be'deducted from the escrow balance before disbursement Is made:
Lessee: Monroe County,Floride
By: Christine Hurley o..,soa,u:u,+,:��.�� cued after-the-fact:
Approved
PP .
Na„no;Christine Hurley
Tice- Monroe County Administrator
Kevin Madok,Monroe County Clerk
Assignee:Santander Bank,N.A.
By P6"LCL -
AuttionzsdafgW
ACCEPTANCE CERTIFICATE
Losses hereby admovMedges recafpi In good ao i0on of all the oquipment described above and included on the attached Vendor Invoioe(s),hereby
accepts such equipment;and hereby certifies that Lessor or its assignee has fully and satisfactorily performed all covenants and conditions to be
performed by It under the Lease with regard to such erpr1prn9I that such equipment Is fatify Insured in accordance with Section 8M of the Lease
and lhat equlpm c ut all or a portion of the Equipment as that term as defined In the Lease.
Lessee: Monroe County,Florida
By y or.aos,oa+,,:�;+oacvc
Nerve;Christine Hurley
rni,: Monroe County Administr
ator
Ma"Gluk Approved as to legal fonu&sufficiency:
Eve M.Lewis , ;,
i
As DgMPY C4 k Eire M Lml is•Assistant County.Attorney
9
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South Florida Emergency Vehicles, LLC
4655 CUMMINS CT. Invoice
FT, MYERS, FL, 33905
PH:239-267-5300 Date
FAX:239-590-5246 E&E20275-120946
9/16/2025
Bill To: Ship To:
MONROE COUNTY, FLORIDA
1100 SIMONTON STREET
KEY WEST, FL, 33040
S.O. No. P.O. Number Terms Rep Via HS #
76988
Net 30
City, U/M Part numbers Description List p. Price Each Amount
FOUTS CHASSIS INCH 2025 FOUT'S BROS MODEL FB-94 889,845�03 889,845.03
VIN 94S9DT2D9XSC560340
Sales Tax 0.00% 0.00
Thank you for your busj¢jess,
_JT0ta'
$88 !, 03
Payments/Credits 0.00
Balance Due 9, !L.03
-
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4
p TES IEMERG1040Y RESPCN4 "INVOICE NIt D� 9n r °ui
A CA 15,,2o2
IN00821854 ; .<
VEMCLEb it ENt'ThIF90ATIONE NO YEAR
4S9QT2D9 SC560 40 2025 SPABT,r N
BODY I TYPE. g ^m is
CAS OVER �6990
H-P,iS A E.g s 4.W.4v.Ftl. No,GYLs. SE RIES 0A MODBL.,
450 2100 0045000 , a r
t
1,the enders fined authorized representative of the company,firm or corporation named below,',b eby ceirfify
that the new vehicle described above bs the property Qfthe said company,firrn oir,corporation and Wltransf rrsd
art the above date end under the lnv tic "1�lu tber fmdicated t the fall swing, istriblitor`or ddaler”.
NAME OF CDI"a"`6AIC311TOR,4ALE R,E'I"4. Z
Et)41TS OMME IA►L VEHICLES LLC
'C
R is further certified that this was the first tr nsfer of such new vehicle to ordinary trade and com,morce,
SPAR I hM ,,LLB; N ,
7,77
SIP, dATURE OF AUTHORIZED RV PAESFNUTIVE) � fA
CffY-S TAT E
a
E n rnnc.9er nod:seltor cejjo es to het aaf tag kta aw"Ywkjra,inteur uibrx"r pd V t taro r gaa errnR a!Y aw tk at I �raN w ws r
th7�or aucy ptaa At tYve 60'rr estzNa{iw7ary^amad the vViNc1a Is oonYsuaNerj to any rLCM�Var�ym}tlptSC�
FOR VALIJE,f t C FIVk I T IN 1 7°�96��k Y�1 4E 0It
hlAhtF C1� a ��—�� � ♦r
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AWFICSS
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USE P9 b CA C TfL7 9 C5 tlO.Y dC REOWIR, IN Tir'FLLIS^IG OU MtraCtla;ul
N tte,f
NAME Of
AS
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USE NO TAfjl44"TtMSN ONLr,tF F;EQ,7f rt?`SA8 R M Ntl4 8fSOICTION
r NAME OF
PLJRCHASEA �
k�
I dattVty rab ih kr%ro5t tit my krnnvde-die Ytd�t tdwn d"�rreai�fnr raroasrjgo-at�Y ,�
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Federal 1 I.ry Yaeo r td� xiza r1<aa Murea&ng,in uuryrvcN'tion cwrflh too trdrrsjer eat mad rx rptu ,Frard prra.f a cal a wY a,�rey✓td nit ftr yf result in fwne arn(vor+ ttsonrowl
6 d &d 1hO bw,,A' t %dga that tYo a narsfayr rraru�tr9 3s¢1 ac RuasY mi4a a of the hpG(�dn& ra Wit t e Vs
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j y �P ram sakr jh�sattsrr fat--Pate 01 T Mu
aatrrd e�Olt parrchanvn�t ULM aW �Mr�dr 44 :a, y.
Printod Nrsraos(s)of 9°unrc.anar k r
k'kayrarrr h. 6taay
C arorry taut'N ra('d At pBu r(rmy 'State at
9
Pxleti rx '90(4� ..
USak',N TlARIZATICiN:C1a�Y JF t"tCC8U AMe)INTin Y ldy tJf U DC�Vt CtkD ' '�"
f et 4en in t atrnr of �
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ar"ndwtPCMr"M an 9or.of
7777
MANUFACTURERS, S
The undersigned (company, firm or corporation): hereby Certifies.that the��new,
motor vehicle described b loW,the pro ett< of tide said (eampainy�firm r corporatiarij,
has been transferred on the date and involce nurnber b6ioW to:
South Florida Emergency YEka3cl LLQ
.. ~
4655 Cur mires-Courk
Ft Myers, 'L 3606
SE0NP-5" fiNG"iEEtt7YC3SC.Fr1TiCMN
SCDy IDENTI
FICATION NO. YEAR TRADE NAIVE OF BODY 8C7C1YSTYLE SERFS OR!U►i EL.NCr�; � r
i§bo6w 2M Fouts+Cerrlmercia[VehIclesL 'Pumper''
INVOICE GATE INVOICE NO. 800Y WEIGHT r
6l1 J125 76988 1 920Ibs
FIRST STAGE VEHICLE DESCRIPTION
VEHICLE IDENTIFICATION NO. YEAR MAKE OF CHASSIS AND POWERTRAIN
4 qbtT [IkSC56040 12025 partata'
FIRST•STAGE'VEHICLEACQUIRED FROM CHASSIS WEIGHT` _
Spartan Emergency Response , 116,990 Ibs
COMPLETED VEHICLE
COMNNED CHASSIS AND BODY WEIGHT
It is further certified that this is the fir t transferfhls secands � lI in
e
ordi ry trade and"e+nm-merle ", "' �. OV
y: Title�Cierk' ", "
OA
AUTHORIZED SIGNATURE TITLE OR iF(tf
1�8 ROBER ON 1 ILL ROAb, SUITE 11,0, MILL Ea EV9, kGA
OFFICE ADDRESS OF SIGNATORY
IMPORTANT NOTICE
Birth this Statement of Origin and the first-stage rtaterrient of Origin truest accornpany,the eppli a k�����
7
Both this Statement of C?n&and the nt'pf sdgin rrrPet accompany t6 apptl ion for`Title.
> nldE FEEL t .0 ralry trwast ��a �rrp tKaq rlthe etcarehC rid n ;
and c6dif i as Chet the vehicle is now wait�� �tretarr feglstatOd'41 thls or any olher state;lndhrldi'tal elso Warrerais thOltla tra3d;
n aat�rr?iehicle in aims of delivery,submit tZro`;the fishO 4nd 4hrwumFa� s.it AhV, W Out jOW- e
Ar ount ivV t.Geia. bai ," 't"o'6�Paonn QUO
Adtks '
[7ated at
By"
Tr6nsfenar irm14i pna�turs Ps trr�:
Vwe a�srtlt+,wander errath a7t v,r at tea state set abawe true�hd � rat`t ' st �� arwl �e
informatlon and betie& .. ,
ltn
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finCa
day ,
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E ONO, T
FOR SAL UE RE EiVED,,thd,Uhdersigrled hsre4 trend 010 thICStaibin6nt ant�Oold 4ndl.tha motar'Whd e s r4*0 therein I
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ddress
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erwd cartiffes Chat-thee vsrhleiti;is ndW not Risen rs�tatr to 1hGs ar a beet�tawtndivtdu scw at pa s thlt mid
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Witness myldur Handis)entt�ealts)
w
This day of, ° 2
" + VAkE FitaVEC3,phs,unt9lpd net R6,Crerrsisra Steranent eat In end the maatarrveldie dazrtbedtlieirein to
grid csrklte Rnat than w ehlal - ,nevy and has In
to rtRl ,rrr ere to l# duel
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South Florida Emergency Vehicles,, LLC
,4655 CUMMINS CT, Invoice
FT. MYERS, FL. 33905 Date
PH:239-267-5300
2025-12 FAX:239-590-5246 EN::-:W94
9/16/2025
BiH To: Ship To:
MONROE COUNTY, FLORIDA
1100 SIMONTON STREET
KEY WEST, FL. 33040
S.0, No. P.O. Number Terms Rep Via HS #
76981 DUE UPON DE... LL
h Amount
Qty. Ulm Part numbers Description List p... Price Each
FOUTS CHASSIS[NCO 2025 FOUTS BRO.S MODEL FB-94 899,845-03 8199,845�03
VfN#4S9DT2D96SC560335
SalesTax 000
0.00% 0.00
Thank
You for your 17ush]es4, J
Total' $899,845.0�3
FPayments/Credits $0.00
B c
alance Due $899,845.03
N008 so
✓ FdV"f,� I hk�tEl tYONtI ` YEAR,: � ='MAKE
o
r „
5- 5, 20, x
aP f T ,
BODY TYF�E � r iRT
MPLS
CAB OVER 04
WA, � NO.GYLS SERIES OP MODEL
a0 0045000
Er G1;
L 14und6rsioned;authorized representatjve of thecompeny„firm or corpcfet(ori 6atned below h4f kiy errdtl ;
a thdt tMe now 41l6e described ritred above is,th property of the said company,fjfirne or corgioration and
on the above date anti under the Invoice Ntimbor indicated to Cho,toiiol4irtg;distributor or dkiler
NAME OF 0 f,.I H 1BUTOR,DEALEk,ETO,
lE
' S N �N1M�CK'R1 ;
A ,
MILLEDG "ELM F t °
„
' it is further certified that this'+ as the first transfer of skh new vehicle in 'ordinary.trade and commerce,
SEART EI RE, LLB: t
m yry
y o
a,
,.,
PSIGN.TUBE aEAUTFdoI REPAESENTATIv tAG
SF 0031 -1")147
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cuYrr �ns� ktrrkra �z.i ,�raw,"
� 1 trw� rret d Neat Cher
thlOx any, 4wa eP"ti 140'af,dolivopy ajustie ye-mom IS Aft
FOR VALPE,RECEWED it TRANS
l cddmly to tPj��besl u#� rJ !R9aa sox9s?rxaelek readl
�� rFY414M9^0r OF-A4@ F•N1�"9 47F�
w ,CY4'd+L,4;.gro,r l kcrIN15V Ml; dqy,' Betry dul as 'eari s,
u""+t5,'D9e ,k'" nd co a+T"i,'`w�"Ud' "'P Tm 9 C "._" Mj�� �✓, tl za k91Y .daam
12� craon read
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USE N T F11 ATBC3NJcmP� Yw pea'i
ZDAN t1bCN w11JF11S1)I T1C7N;
q i NAME r1
air
� tl ce�uly,te-NRr��ees4¢al my{�rorr+Ake�a dapa mkumn nr� 1Ar r sa knary Ns �? �'�
'�Wt.UFAr. aTr4a&s�" Ca�?Pt�3k.en�N :Naaalsraal dcGasdMyyed«rr"i�apiraa�hmutha ¢ e"6aarnra % tl�
m
Slate of11
� 1r,�"emat!•�at�" ro
Yae1r, "'TMk d 1 ,"
Y&k7llt
County
USENOT"tai FTNC.Y IIF'REOl11N YN [UN d��l 4TI
iF
qc, NAME OR
F+URCHA$i6
am ADDRESS
1 edtlrlY too 111 DOW O1 pry ks wvtctdga i 1hg odcamety rec�dangT is
NWdhRRt CAp C6r,hcGNd7YiPer_. if9F-a�,�.El�'W N.d('!;A96a��NplY�k?F'ii r, .,.,. r-a;�....
y, kkSn¢ duly s Gr�SF7i5 b 4J6hY�p �9ak 6dtlaenent9 daeXd
steto of l raa to rnp
....•�,.,.-.-.. ._..- USE Nr11 n«,4�sre&Nl -, dan ed.,
near e �erke� kaRas�rroya ertd
C~npPsy@ref a
_.._N5 nkNry Waikalte
.T'Fvi�tr.,Ai{ dal C)hd0.�y IF 6iEC)�MN1iF.10 IN Id 71JNG�j0.JX�tlN„,d,K,'I IC)1�9
w NAME O
Vic T"G7RCHASE*($')
Ata1aRES'5
kr[i dy to tN ra1,t spY an ti Jaxtry e ark I tlr ka nrna r raP a�utrT�� w. ..
.0 eii tNs
w NAME OF CO3U;HS)4a1 tiaFAC fi"4i`�ILda�'dr NFaN NadN7�aaY °""
'41eang dN1y etivaraM'tr uga+,tkt a4ktF eyu Yhaal thelaklrt' ra1 a .,
t aRa of and 5WdF.rkf Wktpl
Craan�ty rat
tJ
_....- F..NOTARIZATION ONLY IFanr
' r 4 c ->rdl
NEC#'Up;i IN r
TtTIJN r,JtY iG E 1CT1 43iW
FnscJ iau d anarr,reelnlros you to s it the cre'�+craeter mileage in raarotYer„aaaara witfi ahra trerial ar of aey+ry�eehigi.Fire to�7ratpWaatrp M"prelrtd#"Ch�a Fe,ll � raT a�a a as xtlt 0 lk e and r a rp�lsgningot
1 cro iNy 1e#14,bef r l ca 1h 114rr 4Nk i10e t r0admig is tiv actual Fobageolitio.aVhO3 ui one 01#16 f6i0mrq$jitwa ' W�`
" Road,
.. enrh.IJ Thedeage stetrl r Inxr�et rrae �lglyots, � br4iewr" tarf
r NaYTy koareQ d ae4rersfel y yV 'M1V,�kFk 01 TIE0 01 "
laknnled Nrarr�{st�d�IRs a l�ekadd s 9u ��.04 F efrwg tasty 46 rr n„a� r�s a11�
� I�sdnlur€@ Ne $��aa)vaP 1�wFara�aaa^ �karc�thrde. y , ��
ComparTa N"n tff Ap lraa64e, +
N11 a cot
Addrc+ss of,rliakrneer�a1..,__.
4JaE NOTARIZATION C,nN V(F R LTUIREO IN TBTON`,ptJITH80I€TtCDN
481 died in la Or of � �
Whose add
''Ind&bean in 84 W eG
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1YI�ar�N edrdrtr�"4 .
m
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MANUFACTURERSSECONIP-STAGE
; " ,
The undersigned (company, firm' or corporatl r,i) lh r+eb , ertl'fles.tha t the w oe
Motor vehicle described belovy,,th property of the said((Co firm cr Corporation), '
h ;s beep transferred on the date and invoice hufnber'beloW to-
South Florida,Emergencyr,Voiples.LLC
4655 Cumniihs Court
Ft'Myers;FL"'3 9Q
SECOND-STAGEBODY.IBESCRIP'TION.
BODY IDENTIFICATION NO, '�YEAR TWr*NAME,OFBODY � BODY STYLE SERIES ORh MODEL,NO,
BDO093 2025 ' Fout OQrniTi;rcial Vehicles t Ruamper, B.chq
INIVOICE 6uE I IN' ICE NO. BODY WEIGHT
6/ 5/Z5 . ° 8 61 1 ,92q lbs
FIRST-STAGE VEHICLE DESCRIPTION
VEHICLE IDENTIFICATION NO, YEAR MAKE OF CHASSIS AND POWERTRAIN
489DT D96SC66033 " 26 j
Sperteu7
FIRSWSTA E4 ICLEACQUIR FROM CHaASSIS,WEIGHT
per an mergencyr 'espc� se 7„,0'4Q llbs ,.,
COMPLETED VEHICLE
COMB¢NED CHASSIS AND BODY WEIGHT
9,960 lbs, T!4''�"Z; y
It is further certified that this is the first transfer of this �o s *
% '
veKII '
ordi=, UTHORIZED
trade and
limb
Tit
le C
BY: NrrU FIeE.
1,38 ROB N MILL R AD, SUITE 110,"MILLBD B"
OFFICE ACD09EBS OF'SI NATOR f°
IMPORTANT NOTICE
Both thisStatemeat of,C7ri�lrY armr fha ti cs#stage of remeri4 of Orlo6 inu r accampar�y rtlrr� pll at�vn far Tilt ,
s
, e 1
Soth this Statement f Origin and ttte f)ret•stege' taten5eht ovorigiri tnPat accornpap the app9icAtjon for f"itle.
a
IRST ASSI�hgIWIE YT a
1
FOR W'ALUE'RECEIV t u ersigne to tra,star tht� 'mot t3rf�iryAW-he motor a alilo rib,
6
1 Address
and 0ortifies,that the'vahiole is n "erndhaa hotboon u gistar irr,thfs`orany other' te;Indtvtdual a warrerots.t�be`NI##e said
motor Oshicle attime of daitverj,subJe t to the,fiens and«tncumbr cas,If hi ant out balows `
Amount of Liam Date 'To 44!hgarra Dias �
Adldr I .
Dated- go at
Tbsnefar(lrnt Werr"� ignatu -".�" sttiorr
��
vwe comf),under ncity of'd nW,that the a e arhta eat n above r 'true and rant,t th4 at
lnformatlon and belief,
WVitness m Hand(s)and Seal(s) *,
9lais . — day of,
S OND'ASSI M MEND 1
FOR VALUE RECEIVED,4 the undersigned hereby tterraF rs this,Sta emerd of Orfgtra and the motoruehwsde,dez�crrD l therein t "` „��"P
Address
„ r a
and d does that,the a vehicle'.is new an ct haas'not been registered in�tfiis or y olharatatar;lindivtdua#"ales warrant saha kYtia-rat laid
motor vehl6le at Brame of de)ivery,aubjeot to the Nine and 6&urna jahce' i(enjr,as satorat' tava.,"" w F,: �
Amount of Lien': Date ., o W9Pocam Clue
"Addross,
Dated 2u � at
y".
Transilamr(tritro Name) ptt»nr-
Iawe cartit%and r Nnafty of t.aw,that,the statemene eat forth abrr a to true arw,core the best of myPour�troowl �n
information and ballet. n
Witness my/our Hand(s)and Saaf(s)
i
7hs"" day oft1
�r�rr�ra�ASl�r�r �r��
FOR ffALfJE RECEIVED,the undorstgned hereby transfers w4r Statement of Origin and the motor Yohicle ties
pribed,therein to;
Arctdrfas -
a;#nd car wee phi the vehicle Na,new and tree not been reg)et red do th ,or and ogharst te;)nd+deiafalen war ,.ts tFre train d s�ufiti 91
otory tact ettCrrro.rrfdeltve ar�bJe�t.tp,fife,Jie anal atcq�enbrariFs ,.iJ rr " a�ae4youtbeiowr
mx
aAmouof Sian 4Yatai �u�Iha Duo
st .
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C01239-
DA10/02/2025Y1
CERTIFICATE OF LIABILITY INSURANCETE
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 holster Is an ADDITIONAL INSURED,the policy(ios)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 ri hts to the certificate holder In lieu of such endorsements.
..PRODUCER 800-233-1957 c�NT T EdiEnfield
VFIS of Florida — _ Faz
PHONE $00-233-"1957 600 729-6347
183 Leader Heights Road IAac No Ex� lAac N�
York,PA'173 `eenlglatfeels:c�m� _.... _....__.
VFI'S of Florida ss
_.....
_...__...__�_...._. _.............._. ---... _. _ INSURER A mNat l Union l=Ire Ins Ccr cif PA
-Mu tfoonroe County Board of
INStaRER p
County Commissioners INSURER C
1111 12th Street,Suite 408 —... ..._ .... --- ._......_
Key West,FL 33040 ENSURER_
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 RE',DUCED BY PAID CLAIMS._ ___.._.. ...._ ........._
INSR� BDL SUI3R POLICY EFF.. POLICY EXP LIMITS
TYPE OF INSURANCE POLICY NUMBER
COMMERCIAL GENERAL LIABILITY
EAOH_9qqURRENCE $ _.._..... .........
�.... CLAIMS-MADE ........'. �OCCUR DAMAGE,TO RENTED
,P,,,LjFItEISES fEs pc, IF611'C8a „� 1.. _...........
._ T_................_.. ...... DIED EXP(Anjone person S
._...._.._._ _,.e........... PERSONAL&ACV INJURY
GENT AGGREGATE LIMIT APPLIES PER'
_GE!jERALAGGREGATE $
....._ POLICY .._. JERCOT E] LOC PRODUCTS-COMP/OPAGG_'.._$.
_
OTHER .. _
—
X. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT .._ _. '..
clderacl
ANY AUTO VFNU-CM-0021866 10/0112025 10/0112026 -BQDILV INJURY{F�e�Delson �._
C7WNED SCHEDULED ..--..-._—
_......... AUTOS ONLY AUTOpS4�NEp
.......�. A�'E ONLM' PN,UTCIS{)NlY PROPERTY
DAMAGEaceigarn(C._�..
acclrTY
UMBRELLA LIAR OCCUR EACH OCCURRE._..._..NCE $
EXCESS LIAR CLAIMS-MADE
- .. . .......__ ......
...._. _ RE.�._� ......._..._.. AGGREGATE
DED TENrIONs
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY PER
Y P N �.EhS.U.. _ ...�........
AA�NY PROPRIETORlPARTNERIEXECUTIVE . _ —....._.,
'IMandtory ER/MEMBER EXCLUDED? '.,N 1 A E..L.EACH ACCIDENT S
If yyes,descnhe under E.L.DIS _EASE-POU .�L9O___.MITE S
DESCRIPTION OF OPERATIONS below A .... .
A Automobile VFNU-CM-0021866 10/61/2025 10/01/2026'Comp 5000 DIED
Physical Damage Collision 5000 DED
DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES IACORD 101,Additlonal Remarks Schedule,may be attached If more space is required)
Certificate Holder, Leasing 2 Inc,and/or It's Assi ns shall be listed as
Lass Payee on 2,025 Spa an Pumper 4 a9DT2D9 SCS60340 and a 2025 Spartan
Pumper 4$9dt2d96sc560335 with comp and collisiion deductibles at$5,000
each.Value of vehicles$1 789 69006
ADDITIONAL INSURED 1100 all bNTON ST, KEY WEST FLORIDA 33040
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Leasing 2 Inc and/tar ACCORDANCE WITH THE POLICY PROVISIONS.
It's Assigns
1720 West.Cass Street AUTHORIZED REPRESENTATIVE
Tampa, FL 33606-1230 .'t'e-G/
ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. Ali rights reserved.
The ACORD name and logo are registered marks of ACORD