Certificates of InsuranceCERTIFICATE OF COVERAGE
Certificate Holder
Administrator Issue Date 10/1/03
MONROE COUNTY BOARD OF COUNTY
Florida League of Cities, Inc.
COMMISSIONERS
Public Risk Services
1100 SIMONTON STREET
P.O. Box 530065 iCE��d
Orlando, Florida 32853-0065
KEY WEST, FL 33040
2003
COVERAGES
THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO THE DESIGNATED MEMBER FOR THE COVERAGE 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 COVERAGE AFFORDED BY THE
AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT.
COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST
AGREEMENT NUMBER: FMIT 0386
COVERAGE PERIOD: FROM 10/1/03
1 COVERAGE PERIOD: TO 10/1/04 12:01 AM Standard Time
TYPE OF COVERAGE - LIABILITY
TYPE OF COVERAGE - PROPERTY
General Liability
❑ Buildings ❑ Miscellaneous
❑ Basic Form ❑Inland Marine
® Comprehensive General Liability, Bodily Injury, Property Damage and
❑ Special Form ❑ Electronic Data Processing
Personal Injury
® Errors and Omissions Liability
❑ Personal Property ❑ Bond
® Supplemental Employment Practice
❑ Basic Form ❑
® Employee Benefits Program Administration Liability
❑ Special Form
® Medical Attendants'/Medical Directors' Malpractice Liability
❑ Agreed Amount
® Broad Form Property Damage
❑ Deductible N/A
❑ Law Enforcement Liability
❑ Coinsurance N/A
® Underground, Explosion & Collapse Hazard
❑ Blanket
❑ Specific
Limits of Liability
❑ Replacement Cost
* Combined Single Limit
❑ Actual Cash Value
Deductible N/A
Limits of Liability on File with Administrator
Automobile Liability
TYPE OF COVERAGE -WORKERS' COMPENSATION
® All owned Autos (Private Passenger)
® All owned Autos (Other than Private Passenger)
® Autos
❑ Statutory Workers' Compensation
Hired
® Non -Owned Autos
❑ Employers Liability $1,000,000 Each Accident
$1,000,000 By Disease
$1,000,000 Aggregate By Disease
Limits of Liability
❑ Deductible N/A
* Combined Single Limit
Deductible N/A
❑
Automobile/Equipment - Deductible
® Physical Damage Per Schedule - Comprehensive - Auto Per Schedule - Collision - Auto N/A - Miscellaneous Equipment
Other
The limit of liability is $5,000,000 (combined single limit) bodily injury and/or property damage each occurrence in excess of a self -insured retention of $
100,000. This limit is solely for any liability resulting from entry of a claims bill pursuant to Section 768.28 (5) Florida Statutes or liability imposed pursuant to
Federal Law or actions outside the State of Florida.
Description of Operations/Locations/Vehicles/Special Items
RE: Verification of Coverage
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE AGREEMENT ABOVE.
DESIGNATED MEMBER
CANCELLATIONS
SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 45 DAYS
MONROE COUNTY BOARD OF COUNTY
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO MAIL
SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
COMMISSIONERS
PROGRAM, ITS AGENTS OR REPRESENTATIVES.
1100 SIMONTON STREET
(�
KEY WEST, FL 33040
AUTHORIZED REPRESENTATIVE
FMIT-CERT (10196)