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FY2004 01/21/2004 AgreementDANNY L. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: March 3, 2004 TO: Lynda Stuart, Office Manager Tourist Development Council ATTN. Maxine Pacini Administrative Assistant FROM. • Pamela G. Hanc c ; Deputy Clerk At the January 21, 2004, Board of County Commissioner's meeting the Board granted approval and authorized execution of a Grant In Aid Award Agreement between Monroe County and the Key West Art & Historical Society for the Custom House Repair project in an amount not to exceed $18,475 - DAC I, FY 2004 Capital Project Resources. Enclosed are two duplicate originals. At the February 18, 2004, meeting the Board adopted Resolution No. 086-2004 to provide additional advance registration and booth -related expenses for trade shows for the Fiscal Year 2005 be paid from Tourist Development Council Funds in Fiscal Year 2004. Enclosed is a certified copy. Should you have any questions please do not hesitate to contact this office. cc: County Administrator w/o documents OMB -Resolution No. 086 County Attorney Finance File/ Grant In Aid Award Agreement This AGREEMENT dated theZday of JAN 2004, is entered into by and between the BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY, hereinafter "County" or "GRANTOR," on behalf of the TOURIST DEVELOPMENT COUNCIL, hereinafter "TDC" and Key West Art & Historical Society, a Florida not -for -profit corporation, hereinafter "Grantee". WHEREAS, the third penny of Tourist Development Tax may be used to acquire, construct, extend, enlarge, remodel, repair or improve, convention centers, sports stadiums, sports arenas, coliseums, auditoriums, fishing piers, museums, zoological parks, nature centers and beaches which are publicly owned and operated or owned and operated by not -for -profit corporations, and WHEREAS, Grantee has applied for Grant in Aid funding for the Key West Museum of Art & History at the Custom House Repairs project to repair and improve the Custom House property, hereinafter "the Property"; and WHEREAS, the Grantor and TDC have determined that it is in the best interest of the County, for purposes of promoting tourism and preserving the heritage of the community, to repair and improve the property for use as a museum open to the public; NOW, THEREFORE, in consideration of the mutual covenants and payments contained herein, the Grantee and the Grantor have entered into this agreement on the terms and conditions as set forth below. 1. GRANT AGREEMENT PERIOD. This agreement is for the period January 21, 2004 through September 30, 2004. This agreement shall remain in effect for the stated period unless one party gives to the other written notification of termination pursuant to and in compliance with paragraphs 7,12 and 13 below. All work for which grant funds are to be expended must be completed by the stated termination date. 2. SCOPE OF AGREEMENT. The Grantee shall provide such services and materials as are required to repair, sand, prime and paint the front porch floors and wood steps; Install exterior security porch lighting; Design and install new hand railings on the front steps: Install a new weather resistant wheelchair accessible lift in place on the existing elevator pad. This project shall be completed and invoices submitted to the County Finance Department no later than September 30, 2004. The Grant in Aid funds must be expensed in the fiscal year ending September 30, 2004. No funds will be available for use for this project agreement after September 30, 2004. 9 Key West Museum of Art & History at the Custom House The Grantee shall designate a project manager if no licensed architect, engineer or general contractor is involved in the project. If the project is performed by County or City personnel, the project manager shall be the Engineer, Building Official or Construction Manager of that local government agency. This designation must be made and notice pursuant to paragraph 20 provided to TDC/County prior to commencement of work' covered by this agreement. Documentation of said notice shall be submitted in the first payment application. Should any signage be erected acknowledging the development of the project, said signage shall acknowledge the Tourist Development Council of Monroe County. If the amount of award exceeds $25,000, the Grantee agrees to dedicate the project property for a period of ten years, absent any acts not in control of the Grantee such as hurricane or terrorist damage, to the public purpose for which the funds are hereunder to be paid by County. If, project does not encompass structural improvements to real property and for any reason the project property ceases such public purpose use before the expiration of the ten years, the personalty (property other than realty) acquired sunder this agreement shall be delivered to the County or a not -for -profit organization which shall use the items for purposes which are related to the promotion ofltourism in Monroe County. 3. AMOUNT OF AGREEMENT AND PAYMENT. The Grantor shall provide an amount not to exceed $18,475 for materials and services used to repair and improve the property. The Board of County Commissioners and the Tourist Development Council assume no liability to fund this agreement for an amount in excess of this award. Monroe County's performance and obligation to pay under this agreement is contingent upon an annual appropriation by the BOCC. a) Payment for expenditures permissible by law and County policies shall be made through reimbursement to Grantee upon presentation of Application for Payment Summary— AIA Document G702, invoices, canceled checks and other documentation necessary to support a claim for re mbursement. Included in said documentation shall be proof that the Grantee hs received and applied to the property matching funds equivalent to or greater than the amount invoiced to the Grantor. The application for payment document must be certified through a statement signed by an officer of the organization and notarized, declaring that representations in the invoice are true and factual. Grantee shall also provide partial releases of liens if applicable. Grantor shall retain 10% of any payment on work in progress until the Grantee has provided a Final Release of Lien for each vendor/Contractor for whom payment is requested. Final payment will not be made until the following documents are complete and submitted to the Grantor: AIA Document G-702 Application for ayment Summary AIA Document G-704 Certificate of S bstantial Completion AIA Document G-706 Contractor's Affidavit of Debts & Claims AIA Document G-706A Contractor's Affidavit of Release of Liens AIA Document G-707 Consent of Surety to Final Payment Final Release of Lien Affidavit and Partial Release of Lien All payment requests must be submitted no later than 60 days after the completion of project b) Matching funds in an amount no less than the funds provided under this agreement are required to be applied to the project. Application of matching funds requires actual payment of the matching Funds. Mere obligation through execution of a contract or approval of a budget ;item to be paid from matching funds will not suffice. In order for funds to be deemed matching, they shall have been expended for the services and materials required for the specific project described in the Scope of Services paragraph. Any funds applied to any use on the real property other than the project shall not be used as matching funds required under this agreement. In order to be considered matching funds for the project funded by grant under this agreement, the matching funds must be applied to the project during the term of this agreement. c) Documentation shall be submitted to the TDC Administrative Office to show the receipt and application of in -kind donations of goods, professional services, and materials. Said documentation should includje invoices, bills of lading, etc., and be verified as received and applied to the project through a notarized statement of the project architect, engineer, general contractor or project manager. The receipt and application to the project of volunteer labor are to be documented and verified by notarized signature of the project architect, engineer, general contractor or project manager, and said documentation submitted to the TDC Administrative Office. All submissions shall identify the items included in the schedule of values attached hereto and incorporated herein as Exhibit A which are sought to be reimbursed and shall indicate the percentage of completion of the overall project as of the submission. This document should be signed by the project architect, engineer, general contractor or project manager. Photographs showing progress on project shall' be included in any payment request. c) Funding granted under this Grant in Aid Agreement must be expended by the County no later than September 30, 2004. Any amount of the grant funds not expended by County by that date shall no longer be available to Grantee, unless prior to September 30, 2004, an amendment extending this agreement has been approved in writing and executed by both parties. 4. REPORTS. The Grantee shall provide financial reports in summary of activity on forms provided or approved by the TDC, and, quarterly narrative reports of activity under the approved work plan. The Grant a shall keep such records as are necessary to document the performance of th agreement and expenses as incurred, and give access to these records at the r quest of the TDC, the County, the State of Florida or authorized agents and representatives of said government bodies. It is the responsibility of the Grantee to maintain appropriate records to insure a proper accounting of all funds and 'expenditures. The Grantee understands that it shall be responsible for repayment of any and all audit exceptions which are identified by the Auditor General for the State of Florida, the Clerk of Court for Monroe County, the Board of County Commissioners for Monroe County, or their agents and representatives. In the event of an audit exception, the current fiscal year grant award or subsequent grant awards will be offset by the amount of the audit exception. In the event the grant is not renewed or supplemented in future years, the Grantee will be billed by the Grantor for the amount of the audit exception and shall promptly repay any audit exception. 5. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the terms of this agreement shall be only amended in writing and approved by the Board of County Commissioners for Monroe County. 6. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the Grantee is an independent contractor and not an employee of the Board of County Commissioners of Monroe County. No statement contained in this agreement shall be construed as to find the Grantee or any of its employees, contractors, servants or agents to the employees of the Board of County Commissioners of Monroe County, and they shall be entitled to none of the rights, privileges or benefits of employees of Monroe County. 7. COMPLIANCE WITH LAW. In carrying out its obligations under this agreement, the Grantee shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provisions of this agreement, including those now in effect and hereafter adopted. Any violation of said statutes, ordinances, rules or regulations shall constitute a material breach of this agreement and shall entitle the Grantor to terminate this agreement immediately upon delivery of written notice of termination to the Grantee. 8. RESTRICTIONS ON AGREEMENTS ENTERED PURSUANT TO THIS AGREEMENT. The Grantee shall include in all agreements funded under this agreement the following terms: a) Anti -discrimination. Contractor agrees that they will not discriminate against any employees or applicants for employment or against persons for any other benefit or service under this agreement because of their race, color, religion, sex, national origin, or physical or mental handicap where the handicap does not affect the ability of an individual to perform in a position of employment, and to abide by all federal and state laws regarding non-discrimination. b) Anti -kickback. Contractor warrants that no person has been employed or retained to solicit or secure this agreement upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, and that no employee or officer of the Contractor has any interest, financially or otherwise, in contractor. For breach or violation of this warranty, the Contractor shall have the right to annul this agreement without liability or, in its discretion, to deduct from the agreement price or consideration, the full amount of such commission, percentage, brokerage or contingent fee. Contractor acknowledges that it is 4 aware that funding for this agreement is available at least in part through the County and that violation of this paragraph may result in the County withdrawing funding for the Project. c) Hold harmless/indemnification. Contractor acknowledges that this agreement is funded at least in part by the County and agrees to indemnify and hold harmless the County and any of its officers and employees from and against any and all claims, liabilities, litigation, causes of action, damages, costs, expenses (including but not limited to fees and expenses arising from any factual investigation, discovery or preparation for litigation), and the payment of any and all of the foregoing or any demands, settlements or judgments (collectively claims) arising directly or indirectly from any negligence or criminal conduct on the part of Contractor in the performance of thel terms of this agreement. The Contractor shall immediately give notice to the County of any suit, claim or action made against the Contractor that is related to the activity under this agreement, and will cooperate with the County in the investigation arising as a result of any suit, action or claim related this agreement. d) Insurance. Contractor agrees that it maintains in force at its own expense a liability insurance policy which will insure and indemnify the Contractor and the County from any suits, claims or actions brought by any person or persons and from all costs and expenses of litigation brought against the Contractor for such injuries to persons or damage to property occurring during the agreement or thereafter that results from performance by Contractor of the obligations set forth in this agreement. At all times during the term of this agreement and for one year after acceptance of the project, Contractor shall Maintain on file with the County a certificate of the insurance of the carriers showing that the aforesaid insurance policy is in effect. The following coverage's shall be provided: 1. Workers Compensation insurance as required by Florida Statutes. 2. Commercial General Liability Insurance with minimum limits of $500,000 per occurrence for bodily injury, personal injury and property damage. 3. Comprehensive Auto Liability Insurance with minimum limits of $300,000 combined single limit per occurrence. The Contractor, the County and the TDC shall be named as additional insured, exempt workers compensation. The policies shall provide no less than 30 days notice of cancellation, non -renewal or reduction of coverage. At all times during the term of this agreement and lfor one year after acceptance of the project, Contractor shall maintain on file ith the County a certificate of insurance showing that the aforesaid insurance coterage's are in effect. All insurance certificates should be mailed directly to: Monroe County Board of County Commissioners C/O Risk Management 1100 Simonton Street Room 2-277 Key West, FL 33040 Re-imbursement shall not move forward until the above insurance certificates have been received and approved by the County Risk Management Department. e) Licensing and Permits. Contractor warrants that it shall have, prior to commencement of work under this agreement and at all times during said work, all required licenses and permits whether federal, state, County or City. 9. HOLD HARMLESS/INDEMNIFICATION. The Grantee hereby agrees to indemnify and hold harmless the BOCC/TDC I and any of its officers and employees from and against any and all claims, liabilities, litigation, causes of action, damages, costs, expenses (including but not limited to fees and expenses arising from any factual investigation, discovery or preparation for litigation), and the payment of any and all of the foregoing or; any demands, settlements or judgments arising directly or indirectly under this agreement. The Grantee shall immediately give notice to the Grantor of any suit, claim or action made against the Grantor that is related to the activity under this agreement, and will cooperate with the Grantor in the investigation arising as a result of any suit, action or claim related to this agreement. 10. ANTI -DISCRIMINATION. The Grantee agrees that they will not discriminate against any of their employees or applicants for employment or against persons for any benefit or service because of their race, color, religion, sex, national origin, or physical or mental handicap where the handicap does not affect the ability of an individual to perform in a position of e�ployment, and to abide by all federal and state laws regarding non-discriminatio 11. ANTI -KICKBACK. The Grantee warrants that Ino person has been employed or retained to solicit or secure this agreement upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, and that no employee or officer of the County or TDC'has any interest, financially or otherwise, in the said funded project, except for general membership. For breach or violation of this warranty, the Grantor shall have the right to annul this agreement without liability or, in its discretion, to deduct from the agreement price or consideration, the full amount of such commission, percentage, brokerage or contingent fee. 12. TERMINATION. This agreement shall terminate on September 30, 2004. Termination prior thereto shall occur whenever funds cannot be obtained or cannot be continued at a level sufficient to allow for the continuation of this agreement pursuant to the terms herein. In the event that funds cannot be continued at a level sufficient to allow the continuation of this agreement pursuant to the terms specified herein, this agreement may then be terminated immediately by written notice of termination delivered in person or by mail to Grantee. The Grantor may terminate this agreement without cause upon giving written notice of termination to Applicant. The Grantor shall not be obligated to pay for any services or goods provided by Grantee after Grantee has received written notice of termination. If the Agreement idoes not receive an approved extension beyond the grant agreement period, as defined in -paragraph 1, the grant in aid funds will expire on the fiscal year ending date of September 30, 2004. 13. TERMINATION FOR BREACH. The Grantor'may immediately terminate this agreement for any breach of the terms contained herein. Such termination shall take place immediately upon receipt of written notice of said termination. Any waiver of any breach of covenants herein contained to be kept and performed by Grantee shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Grantor from declaring a forfeiture for any succeeding breach either of the same conditions or of any other conditions. Failure to provide Grantor with certification of use of matching funds or matching in -kind services at or above the rate of request for reimbursement or payment by is a breach of agreement, for which the Grantor may terminate this agreement upon giving written notification of termination. 14. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the Grantee and the Grantor. 15. CONSENT TO JURISDICTION. This agreement, its performance, and all disputes arising hereunder, shall be governed by the laws of the State of Florida, and both parties agree that the proper venue for any actions shall be in Monroe County. 16. ETHICS CLAUSE: Grantee warrants that he has not employed, retained or otherwise had act on his behalf any former County officer or employee in violation of Section 2 or Ordinance No. 10-1990 or any County officer or employee in violation of Section 3 of Ordinance; No. 10-1990. For breach or violation of the provision the Grantor may, at its discretion terminate this agreement without liability and may also, at its discretion, deduct from the agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former or present County officer or employee. 17. PUBLIC ENTITY CRIME STATEMENT: A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on an agreement to provide any goods or services to a public entity, may not submit a bid on a agreement with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, sub -contractor, or consultant under a agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. 18. AUTHORITY: Grantee warrants that it is authorized by law to engage in the performance of the activities encompassed by the project herein described. Each of the signatories for the Grantee below certifies and warrants that the Grantee's name in this agreement is the full name as designated in its corporate charter (if a corporation); they are empowered to act and contract for the Grantee, and this agreement has been approved by the Board of Directors of Grantee or other appropriate authority. 19. LICENSING AND PERMITS: Grantee warr nts that it shall have, prior to commencement of work under this agreement and at all times during said work, all required licenses and permits whether federal, state, County or City. 20. INSURANCE: Grantee agrees that it maintains in force at its own expense a liability insurance policy which will insure and indemnify the Grantee and the Grantor from any suits, claims or actions brought by any person or persons and from all costs and expenses of litigation brought against the Grantee for such injuries to persons or damage to property occurring during the agreement or thereafter that results from performance by Grantee of the obligations set forth in this agreement. At all times during the term of this agreement and for one year after acceptance of the project, Grantee shall maintain on file with the Grantor a certificate of the insurance of the carriers showing that the aforesaid insurance policy is in effect. The following coverage's shall be provided: 1. Workers Compensation insurance as required by Florida Statutes. 2. Commercial General Liability Insurance with minimum limits of $500,000 per occurrence for bodily injury, personal injury and property damage. 3. Comprehensive Auto Liability Insurance with minimum limits of $300,000 combined single limit per occurrence. The Grantee, the Grantor and the TDC shall be named as additional insured, except workers compensation. The policies shall provide no less than 30 days notice of cancellation, non -renewal or reduction of coverage. At all times during the term of this agreement and for one year after acceptance of the project, Grantee shall maintain on file with the Grantor a certificate of insurance showing that the aforesaid insurance coverage's are in effect. 21. NOTICE. Any written notice to be given to either party under this agreement or related hereto shall be addressed and delivered as follows: For Grantee: Diane Rippe Director of Operations Key West Art & Historical Society 281 Front Street Key West, FL 33040 For Grantor: Lynda Stuart Monroe County Tourist Development Council 1201 White Street, Suite 102 Key West, FL 33040 and Suzanne Hutton, Asst. County Attorney P.O. Box 1026 Key West, FL 33041-1026 IN WITNESS WHEREOF. the parties hereto have caused this agreement above written. BOARD OF COUNTY OF MONROE COUNTY, FLORIDA By: Mayor/Chairman - m rn%-< I `n (SEAL) Key West Art & Historical Society < r., By: President MONROE COUNTY ATTORNEY APPROVED A$ T9,FOPX: Qom__-uZANNE A. HUTTON ASSISTANT COW'Ty AVORNEY Date- 9 EXHIBIT A Key West Art & Historical Society spends approximately $45 000 per year on maintenance and supplies for the Custom House Our funds come from -grants ticket and retail sales, donations weddings corporate group functions and membership support. PART V: PROJECT BUDGET AND TIMETABLE - ALL PROJECTS 1. Cost Estimates: List all major work items and the estimated costs of each. If the project is phased, segregate clearly those costs for the phase to be assisted by the TDC funds requested. All phases and total estimated cost of the entire project must be listed here. Porch repairs and painting $6 000 Installing exterior liahtlna $2 500 Installina new handrails on front steps $6,450 Installation new wheelchair lift $22 000 Total cost of phase/project for which funds are requested: (not to exceed 50% of the total project cost: a) Phase b) Project $18,475.00 Percentage of TDC funds requested of Total Budget: (not to exceed 50% of the total project cost) a) Phased b) Project 50 Percent 2. Confirmation that signed, sealed bid process was utilized for acquiring architectural services, or that project does not regylire architectural services. structure requirements are maintained 3. Matching Funds. List the sources and amounts of confirmed matching funds. (For items involving personnel, include the number of hours to be spent on the project activities and their per -hour value). These funds must not be expended before execution of a Capital Projeci Agreement. Prior donated services or expenditures are not acceptable as match for grant funds. No more than fifty (50%) percent of matching funds or tw my -five (25%) percent of the total project shall be in -kind services. a Hard -dollar Key West Art & Historical Socie $18,475.00 bl In -Kind (50%) limit: 10 Page 1 of 2 Total confirmed matching Hard -dollar funds: $18,475.00 Total confirmed matching In -kind funds: This amount should equal or exceed TDC Funds requested. Proiected in -kind services and goods shall be allocated the following values subject to negotiation with TDC/County. List here all such anticipated values: 4. Outline of expansion opportunity for acquiring further match grants. vim.. IAR__A A-1 A .b_i_ proiecLs. Potential funding sources include: Winston Salem Foundation Department of State Division of Historic Resources Florida State Historic Preservation Dogwood Foundation Haffenreffer Family Fund Key West Insurance Rodel Foundation 3. Tentative timetable. Indicate all mayor project activities and the anticipated time required to complete each stage of the project on the graph below. Project Timetable (in months) rroiect Activity 1 2 3 4 5 6 7 8 9 10 11 12 a) Porch repair and painting 3 months b) Installation of lights 1 month c) Installation of lift 6 months d) Installation of hand rails 6 months Please indicate any critical dates and explain why they are critical. N/A 4. What is the total project cost: $ _ 36,950.00 5. Length of time for project completion (months and year(s): 6 months 11 Page 2 of 2 AC�RD - CERTIFICATE OF LIABILITY INSURANCE CSR LK DATE(MM/DD/YYYY) PRODUCER The Johnsons Insurance Agency 13361 Overseas Highway Marathon FL 33050 Phone:305-289-021DECEIVED MAR2 2004 INSURED Key West Art 6 Historical Society 281 Front Street Key West FL 33040 COVERAGES KEYWE-1 O1 22 04 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE I NAIC # INSURER A: The St. Paul Companies INSURER B: INSURER C: INSURER D: INSURER E: 5 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRE TYPE OF INSURANCE POLICY NUMBER OL Y FFE TIV DATE MM/DD/YY PO IC EXPIRA ION DATE MM/DD/YY LIMITS A X GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE Ic OCCUR BLO1556798 11/19/03. 11/19/04 EACH OCCURRENCE $ 1,000,000 X PREMISES (Ea occurence) $ 300r000 MED EXP (Any one person) $ 10000 0 r PERSONAL & ADV INJURY $ 1 000 000 - GENERAL AGGREGATE $ 2 r 000 r 000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 RO- POLICY PJECLOC T AUTOMOBILE LIABILITY $ A ANY AUTO BLO1556798 11/19/03 11/19/04 COMBINED SINGLE LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY $ ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY $ A OCCUR ❑CLAIMS MADE BL01556796 EACH OCCURRENCE $ 1 r 000 r 000 11/19/03 11/19/04 AGGREGATE $ 1,000,000, DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND �� MA EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? BY If yes, describe under SPECIAL PROVISIONS below _ _ TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OTHER E.L. DISEASE -POLICY LIMIT $ WAIVER PIA ES — DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Gift Shops Premises Operations CERTIFICATE HOLDER CANCELLATION MONRO-6 Monroe County BOCC C/o Risk Management Room 2-277 1100 Simonton Street Key West FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE 0 OBLIdAT10/y�pR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRES[NiATIVES. / 1 11 Col THE POLICIES OF INSURANCE LISTED BEL OW HAVE BEcry IJJUCLJ I U I Nt INSUHED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDlYY DATE MM/DD/YIYO LIMITS A X GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR EL01255421 11/19/02 11/19/03 EACH OCCURRENCE $ 1 , 000 , 000 X PREMISES (Ea occurence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 . 000 . 000 GEN'L AGGREGATE LIMIT APPLIES PER: 71 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2 Q 00 000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS AP P BY SATE ._.._.._ WAIVER hire$ V,4i' M NT COMBINED SINGLE LIMIT (Ea accident) $ P/�� f.. BODILY INJURY (Per person) $ _YES BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYE $ SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PRO ISIONS Gift Shops Premises Operations CERTIFICATE HOLDER CANCELLATION MONRO- 6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 610 Monroe County Risk Management DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Monroe County BOCC NOTICE TO THE CERTIFICATE H DE NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Maria Slavik 1100 Simonton Street IMPOSE NO OBLIIdATION OR ABILI OF ANY IND UPON THE INSURER, ITS AGENTS OR Key West FL 33040 REPRESENTATIYESt A ACORD CERTIFICATE OF LIABILITY INSURANCE CSR LK DATE(MM/DD/YYYY) KEYWE-1 01 22 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Johnsons Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 13361 Overseas Highway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Marathon FL 33050 Phone:305-289-0213 INSURED Key West Art & Historical Society 281 Front Street Key West FL 33040 rnvconn_cc INSURERS AFFORDING COVERAGE I NAIC # INSURER A: Florida Retail Federation INSURER B: INSURER C: INSURER D: INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRE TYPE OF INSURANCE POLICY NUMBER PO Y EF ECT DATE MM/DD/YY PO ICY I ION DATE MM/DD/YY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE $ PREMISES (Ea occurenc.) $ MED EXP (Any one person) $ PERSONAL R ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS APYR­D SK AGEM NTF COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT $ $ GARAGE LIABILITY ANY AUTO 'M 1PI,P('�(�G, _F,t!A `- �+ �YEJ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ — $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER 052007748000 01/01/04 01/01/05 I ER =LIMIT$ $ 100000 MPLOYE $ 100000 LLIMIT $ 500000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOI nFR ,......�.. __.__. MONRO-6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Monroe County BOCC NOTICE TO THE CERTIFIC HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1100 Simonton Street IMPOSE N OBLIGATION R IABILITY ANY KIND UPON THE INSURER, ITS AGENTS OR Key West FL 33040 REPRgS7JT%TIVES. // 25 (2001/08) FEB-26-2004 THU 03:59 PM KWAHS 0000000000 P, 02 MONRO.E COUNTY, FLORIDA Request For Waiver of Insurance Requirements It is requested that the insurance requirements, as spocified in the County's Sehed,!,1,: Requirements, be waived or modified on the following contract, Contractor: ICey West Art & Historical Society, Inc, Contract for: improvements to the Custom House Address of Contractor: 291 Front Street, !Key Wes, Florida 33040 Phone: 305-295-6616 Scope of Work: to repair, sand, prune and palut the front porch Ao,,.i•s Jill instal! exterior security porch lighting; design and install new hand railings of 161! a new weather resistant wheelchair accessible lift in place on the existing elev4i 1; m I4 Reason for Waiver: We don't own any automobiles. There will not be ii ky on this project. policies Waiver will apply to: Vehicle Liability Signature of Contractor: —Ph 1A11Z Approved N Approved Risk Management: Date: -- � 7/0 5/ County Admtinistrator Appeal: Approved Date: Board of County Commissioners Appeal: Approved Meeting Date: Administration Instruction #4709.2 Not Approved Not Approved t"e Vdruon tr. s,krance Wood steps; int stops; lusts" omobiles used