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HomeMy WebLinkAbout01/27/2026 Agreement Digitally signed by Jaclyn Flatt Jaclyn Flatt Date: 2026.01.08 15:20:36 -05'00' Digitally signed by Lisa Abreu Lisa Abreu Date: 2026.01.21 13:45:23 -05'00' Digitally signed by Angelica Malcosky Angelica Malcosky Date: 2026.01.21 15:06:04 -05'00' Ejhjubmmz!tjhofe!cz! Disjtujof Disjtujof!Ivsmfz! Ebuf;!3137/12/38! Ivsmfz 19;61;55!.16(11( DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/05/2026 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBY THE POLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed. IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementon this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: PHONEFAX CENNAIRUS LLC (A/C, No, Ext):(866) 890-9965(A/C, No):(888) 733-5112 P O BOX 25897 E-MAIL travelersselectpayrollservices@travelers.com ADDRESS: SARASOTA, FL 342772897 INSURER(S) AFFORDING COVERAGENAIC # (866)890-9965 INSURER A :THE TRAVELERS INDEMNITY COMPANY OF AMERICA INSURED INSURER B : MEDIXSAFE US INC INSURER C : 12220 ITEC HAUL DR BLDG 200 INSURER D : UNIT 201-202 FORT MYERS, FL 33913 INSURER E : INSURER F : REVISION NUMBER: COVERAGES 015286401201563 CERTIFICATE NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBE ISSUED ORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDLSUBRPOLICY EFF POLICY EXP POLICY NUMBER TYPE OF INSURANCELIMITS LTRINSDWVD(MM/DD/YYYY)(MM/DD/YYYY) $ EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES (Ea occurrence) CLAIMS-MADEOCCUR $ MED EXP (Any one person) $ PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: $ GENERAL AGGREGATE PRO- POLICYLOC $ PRODUCTS - COMP/OP AGG JECT OTHER: $ COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY(Ea accident) BODILY INJURY (Per person) $ ANY AUTO SCHEDULED OWNED BODILY INJURY (Per accident) $ AUTOS AUTOS ONLY HIREDNON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY $ (Per accident) $ UMBRELLA LIAB OCCUREACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDRETENTION $ $ PEROTH- WORKERS COMPENSATION N/A UB-A9067311-26 01/24/202601/24/2027 X STATUTEER A AND EMPLOYERS' LIABILITYY/N $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? $ E.L. DISEASE - EA EMPLOYEE (Mandatory in NH)1,000,000 If yes, describe under $ 1,000,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE MONROE COUNTY BOARD THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN OF COUNTY COMMISSIONERS ACCORDANCEWITH THE POLICY PROVISIONS. 1100 SIMONTON ST KEY WEST, FL 33040 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD REQUESTFOR WAIVER OFINSURANCEREQUIREMENTS Itis requested that the insurance requirements, asspecifiedintheScheduleof Insurance Requirements, be waived ormodified on the following contract Contractor/Vendor: Project orService: Contractor/Vendor Address & Phone #: General Scope ofWork: Reason for Waiver or Modification: Policies Waiver or Modification will apply to: : Signatureof Date:ApprovedNotApproved RiskManagementSignature:_ Date: CountyAdministratorappeal: Approved:NotApproved: Date: BoardofCountyCommissionersappeal: Approved:NotApproved: MeetingDate: