01/21/2004 Agreement
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
March 5, 2004
TO:
Lynda Stuart, Office Manager
Tourist Development Council
FROM:
Maxine Pacini
Administrative Assistant
Pamela G. Hanco~k
Deputy Clerk U
ATTN:
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 Marathon Community Theatre for the Renovation of the Rehearsal Room project in an
amount not to exceed $800 - DAC III, FY 2004 Capital Project funding.
Enclosed are two duplicate originals of the above-mentioned for your handling. Should
you have any questions please do not hesitate to contact this office.
cc: County Administrator wlo document
County Attorney
Finance
Filet!
Grant In Aid Award Aareement
This AGREEMENT dated the~y of JltN 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 Marathon
Community Theatre, 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
Renovation of the Community Theatre Rehearsal Room project to remodel and
improve the Marathon Community Theatre Rehearsal Room, 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 remodel and repair the property for use as an
auditorium 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 Jhrough 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 materials
and services as are required to replace the existing floor with a new floor, re-
hang and replace the existing drop ceiling with new tiles.
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.
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 under 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 of tourism in Monroe County.
3. AMOUNT OF AGREEMENT AND PAYMENT. The Grantor shall provide
an amount not to exceed $800.00 for materials and services used to acquire,
improve, rehabilitate, repair and renovate 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- AlA Document G702, invoices, canceled checks and other
documentation necessary to support a claim for reimbursement. Included in said
documentation shall be proof that the Grantee has 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:
AlA Document
AlA Document
AlA Document
AlA Document
AlA Document
G-702 Application for Payment Summary
G-704 Certificate of Substantial Completion
G-706 Contractor's Affidavit of Debts & Claims
G-706A Contractor's Affidavit of Release of Liens
G-707 Consent of Surety to Final Payment
2
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 include 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.
d) 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 Grantee shall keep such records as
are necessary to document the performance of the agreement and expenses as
incurred, and give access to these records at the request 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
3
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 the 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 TOC 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 for one year after acceptance
of the project, Contractor shall maintain on file with the County a certificate of
insurance showing that the aforesaid insurance coverage's are in effect.
5
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 BOCCfTDC 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 employment, and to abide by all
federal and state laws regarding non-discrimination.
11. ANTI-KICKBACK. The Grantee 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 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
6
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 does 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
7
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 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.
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.
8
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.
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
Suzanne Craig
Marathon Community Theatre
P.O. Box 500124
Marathon, FL 33050
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
.>-c::~ -:Ce;;_. Key West, FL 33041-1026
I.~~~NESS WHEREOF,. the parties ~erelo have caused this agreement
/(~~f'''';'LY :.~the day and year first above wrrtten.
\?~ ~~'i1 :11 BOARD OF CO' t.1'T'V' COMMISSIONE!::I~
YJ4. -,?> ttl::J, ..if \"A'll J I ~
.~. . ;'-'_.: ~Y L. KOLHAGE, CLERK OF MONROE COUNTY, FLORlGA 0 g:;
~~~ By:~(?'~~t~
/beputy Clerk Mayor/Charman ~?52
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For Grantor:
."
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(SEAL)
MONROE COUNTY ATTORNEY
A8flROVED AS F RM'
MARfT~N C~OMMUNIJY THEA~
By: YA~~~
Preside
9
EXHIBIT A
PART V:
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 TOC funds requested. All phases and total estimated cost of the
entire project must be listed here.
New Floor for Rehearsal Room:
Ceilina Tiles:
Keyboard and Sound System:
S1000
600
2975
Total cost of phase/project for which funds are requested: (not to exceed
50% of the total project cost:
a)Phase ~4500
b ) Project
Percentage of TOC funds requested of Total Budget: (not to exceed 50%
of the total project cost)
a)Phase
b ) Project
2. Confirmation that signed, sealed bid process was utilized for acquiring
architectural services, or that project does not require architectural services.
The project does not require architectural services.
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 Project Agreement. Prior donated
services or expenditures are not acceptable as match for grant funds. No more
than fifty (50%) percent of matching funds or twenty-five (25%) percent of the
total project shall be in-kind services.
a) Hard-dollar MCT will sUDDly matchina funds throuah our oDeratina budaet
and aeneral fundraisina activities
"
b) In-Kind (50%) limit:
Total confirmed matching Hard-dollar funds:
Total confirmed matching In-kind funds:
This amount should equal or exceed TOC Funds requested.
'.
23
Page 1 of 2
Proiected in-kind services and aoods shall be allocated the followina values,
subject to neaotiation with TOC/County. List here all such anticioated values:
N/A
4. Outline of expansion opportunity for acquiring further match grants.
MeT routinelv solicits donations from individuals, coroorations, foundations and
aovernment aaencies. We will continue these activities.
...
Page 2 of 2
'.
24
1996 Edition
MONROE COUNTY, FLORIDA
Request For Waiver
of
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Requirements, be waived or modified on the following contIact.
Contractor: Marathon Community Theatre. Ine.
Contract for: Renovation of Rehearsal RoomlKevboard & Sound System Purchase
Address of Contractor: P.O. Box 500124. 5101 Overseas Hi2hwav. Marathon. FL 33050
Phone: (305) 743-0408
Scope of Work: To renovate the current soace known as the Rehearsal Room at Marathon
Community Theatre bv reolacine: the floor and ceiline: tiles.
Reason for Waiver: MCT does not own any vehicles and has no automobile insurance.
Policies Waiver will apply to: Autom
Signature of Contractor:
'r
Risk Management:
Date:
County Administrator Appeal:
Approved
Not Approved
Date:
Board of County Commissioners Appeal:
Approved
Not Approved
Meeting Date:
Administration Instruction
#4709.2
Certificate of Insurance
Page 1 of 1
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Certificate of Insurance
RE: 0520-19475
ISSUED TO: Monroe County Board of Commissioners
5100 College Road
Key West, FL 33040
Attn:
This is to certify that Marathon Community Theatre. Inc. dbaMarathon Community Cinema P.O. Box
500124 Marathon. FL 33050, being subject to the provisions of the Florida Workers' Compensation Law, has
secured the payment of any workers' compensation benefits due by insuring their risk with the Florida Retail
Federation Self Insurers Fund.
POLICY NUMBER:
0520-19475
Statutory LimitsnState of Florida
Employers Liability
$100,000 (Each Accident)
$100,000 (DiseasenEach Employee)
$500,000 (Disease--Policy Limit)
EFFECITVE DATE:
January 01. 2004
EXPIRATION DATE:
January 01. 2005
This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this
certificate shall be construed as extending coverage not afforded by the policy shown above or affording
insurance to any insured not named above.
The policy of insurance listed above has been issued to the named insured for the policy period indicated.
Notwithstanding any requirement, term or condition of any contract or other document to which this certificate
may pertain, the insurance made available by the described policy in this certificate is subject to only the
terms, exclusions and conditions of such policy. Paid claims may have reduced the shown limits.
If the policy described above is cancelled before the expiration date indicated, the issuing company will
attempt to mail 30 days' written notice to the certificate holder named above. However, the issuing company,
its agents or representatives accept no obligation or liability of any kind for failure to mail such notice.
Date 02/05/2004
- ~#,-,--
7
~3u~"t..'it t:Or.l~tlltinq.. "I.n.c.., ;\mninJs:r.~.atQ:r
Fh~l'l,d,<l Retail 1l'eoer.-atioJn ~i~U'. :rni3;.!re~G :(i"lUlO
m-
,
.<
AC-C8DN' CERTIFICATE OF LIABILITY INSURANCE CSR WD I DATE (MMIDDIYYYY)
MARAT-4 02/05/04
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 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Burlington Insurance Compan'l.
INSURER B:
Marathon Community Theatre INSURER C:
PO Box 500124 INSURER D:
Marathon FL 33050
INSURER E:
COVERAGES
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.
NSRI POLICY NUMBER r;,~y~rME~r6If~!XE OLICY.~!l-!,IRAJ~~N LIMITS
LTR TYPE OF INSURANCE DATE'(MMIDDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
r---
A X COMMERCIAL GENERAL LIABILITY 289BOO0765 10/20/03 10/20/04 PREMISES (Ea occurence) $ 50,000
I--- tJ CLAIMS MADE ~ OCCUR
MED EXP (Anyone person) $ excluded
'--
PERSONAL & ADV INJURY $1,000,000
-
GENERAL AGGREGATE $ 1,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ included
"I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
- :!l~~~1i;~
ALL OWNED AUTOS ~1t;;/ai1P11-1 BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS ~. BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- {_,_ YES PROPERTY DAMAGE $
WAIV'0.P \Ii P. _ (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY L1Mmi I IU~~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
THEATRE - OTHER THAN NOT PROFIT
CERTIFICATE HOLDER
CANCELLATION
MONR020
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, T FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION
Monroe County Board of County
Commissioners
5100 College Road
Key West FL 33040
@ ACORD CORPORATION
ACORD 25 (2001/08)
r
.
IFG Companies
POLICY NUMBER: 289B000765
EFFECTIVE DATE: 10/20/2003
SCHEDULE OF ADDITIONAL INSUREDS
The fOllowing are Additional Insureds under this policy:
Form No. Additional Insured(s) name and address
JAMES CURRY & SHERRY MILLER
C/OGEMINI PTG,5101 OVERSEASHWY
BG-G-370 0101 MARATHON . FL 33050
MARATHON LIQUORS INC.
P. O. BOX 501191
BG-G-370 0101 MARATHON . FL 33050
MONROE COUNTY BOARD OF COMMISSIONERS
5100 COLLEGE ROAD
BG-G-370 0101 KEY WEST . FL 33040
T.O.C.
P. O. BOX 866
BG-G-370 0101 KEY WEST . FL 33041
.
.
.
Issue Date: 11/19/03
IFG-I-0141 1100
Page 1 of 1
-".
" ....
. ~MMON POLlCY!.DECLARATIONS
c \. ~ co ~ Renewal of: NEW .
. IFGComponies ™ Ct.\\l'C,Q 'Uc.. .1} !f) i: {) 'T' _ i I c'
Rt. THE BURLINGTON INSURANCE COMPANY (:G" _ c~:~ _I . ,
Home Office: Burlington, North Carolina _,-
Administrative Office:238 InternationaL Road, Burlington, NC 2n15 Claims Office: 238 International Road, Burlington, NC 27215
Policy Number 289B000765
Item 1. Named Insured and Mailing Address
MARATHON COMMUNITY THEATRE
P. O. BOX 124
MARATHON
FL 33050
/
JOHNSONS INS. AGENCY (MARATHON)
Code:
Item 2. Policy Period Effective Date: 10/20/2003 Expiration Date: 10/20/2004
at 12:01 A.M., Standard Time at your mailing address shown above.
Item 3. In retLlrn for the payment of the premium, and subject to all the terms of this policy, we agree with you to
provide the insurance as stated in this policy. This policy consists of the following coverage parts for which a
premium is indicated. Where no premium is shown, there is no coverage.
Coverage Partes) Premium
Commercial General
$
$
$
$
$
$
Total Policy Premium or Deposit Premium $
6,020.00
Other Charges (If applicable)
POLICY FEE
INSPECTION FEE~
5% SURPLUS LINES TAX
FSLSO FEE
6,020.00
35.00
100.00
307.75
18.47
Total Other Charges $
I Total Amount Due* $
461. 22
6,481.22
"Premium is: D Flat [jJ Adjustable Policy Minimum Premium $
In the event you cancel this policy, we will retain 25% MINIMUM EARNED
Item 4. Forms and Endorsements applicable to this policy: See "Listing of Forms and Endorsements" (IFG-I-0150)
Item 5. Form of Business. D Individual D Partnership 0 Joint Venture
o Limited Liability Company []I Other Organization, inclUding a Corporation
D Trust CORPORATION
Business Description:' MOVIE THEATER & LIVE THEATER
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE FORM(S) AND
ANY ENDORSEMENT(S), COMPLETE THE ABOVE NUMBERED POLICY.
Countersigned:
Date: 17/01/01 ~P/fg~
Issue Date: 11/19/03
By:
SURPLUS LINES AGENT: JAMES BENNETT, IDIA019235, 2400 E. COMMERCIAL BLVD., STE #728,
FT. LAUDERDALE FL. 33308.
PRODUCING AGENT: WILLIAM DANAHER 13361 OVERSEAS HGWY MARATHON FL. 33050
IFG-I-0101 0303
PRODUCER
Page 1 of 1
~.
.
IF6 Companies
POLICY NUMBER: 289B000765
POLICY PERIOD:
10/20/2003
Effective Date
10/20/2004
Expiration Date
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LISTING OF FORMS AND ENDORSEMENTS
This listing forms a part of the following:
Commercial General Liability Policy
NUMBER
INTERLINE
IFG-I-0002 (11-00)
IFG-I - 0101 (03-03)
IL0003 (04-98)
IL0017 (11-98)
INTERLINE-PL
BG-I-015 (08-00)
IFG-I - 0141 (11- 00)
IFG-I-0300 (10-01)
IFG-I-0402 (11-00)
IL002l (04-98)
GENERAL LIABILITY-FL
IFG-G-0002-DL (03-03)
IFG-G-0060 (01-03)
BG-C-3-CW (03-0l)
BG-G-004 (09-99)
BG-G-007 (09-99)
BG-G-066 (04-92)
BG-G-084 (06-02)
BG-G-173 (02-95)
BG-G-370 (01-01)
CGOOOl (07 - 98)
CG0062 (12-02)
CG0300 (01-96)
IFG-I-0150 0303
TITLE
COVER PAGE
COMM DEC
CALCULATION OF PREMIUM
COMMON POLICY CONDITIONS
MIN EARNED PREM
SCHEDULE OF ADDITIONAL INSURED
CHANGES-CANCEL & NONRENEW
SERVICE OF SUIT
NUCLEAR ENERGY
GL DECLARATIONS
AMEND-AIRCRAFT, AUTO OR WATEERCRAFT
COMB ENDT - (FORM 3)
EXCL-LEAD BEARING
EXCL-ASBESTOS, SILICA DUST
AMEND LIQUOR EXCL
EXCL-LAND SUBSIDENCE
EXCL-PROD/COMP OPS
AI-OWNERS, LESSEES
GL COV FORM
EXCL-WAR LIABILITY
DEDUCT LIAB INS
Issue Date: 11/19/03
Page 1 of 2
POLICY NUMBER:289B000765
Forms Ust (Continued)
NUMBER
CG2116 (07- 98)
CG2135 (10-93)
CG2160 (09-98)
CG2175 (12-02)
NUMBER
IFG-'-0150 0303
! ~
TITLE
EXCL-DESIGNATED PROF SVS
EXCL-COV C MEDICAL PAY
EXCL-Y2K COMPUTER RELATED
EXCL-CERTIFIED ACTS OF TERRORISM
Additional Forms
TITLE
Issue Date: 11/19/03
Page 2 of 2
i'
'-
.....
.
IFG eon.cmies
POLICY NUMBER: 2898000765
EFFECTIVE DATE: 10/20/2003
SCHEDULE OF ADDITIONAL INSUREDS
The following are Additional Insureds under this policy:
-.....~-'
Form No. Additionallnsured(s) OIIme and address
JAMES CURRY (r SHERRY MILLER
C/OGDIINI PTG, 5101 OVERSEASHWY'
BG-G-370 0101 ON . FL 33050
I. MARATHON LIQUORS INC.
P. O. BOX 501191
BG-G-370 0101 MARATHON . FL 33050
MONROE COUNTY BOARD OF COMlIISSIONERS
5100 COLLEGE ROAD
BG-G-370 0101 ~ WEST FL 33040
T.D.C.
P. O. BOX 866
BG-G-370 0101 KEY WF..sT . 1i'T, ":1"1041
,
, ~
.
Issue Date: 11/19/03
.~
IFG-I-0141 1100
Page 1 of 1
Y.
'. Policy Number: 289BOO0765
COMMERCIAL GENERAL LIABILITY
IFG Companies DECLARATIONS
Named Insured: Effective Date:
MARATHON COMMUNITY THEATRE 10/20/2003
Item 1. UMITS OF INSURANCE
$1,000,000 General Aggregate limit IOther Than Products - Completed Operations)
$See Form BG-G-173 Products - Completed Operations Aggregate Limit
$1,000,000 Personal and Advertising Injury Limit
$1 , 0 0 0, 0 0 0 Each Occurrence Limit
$50,000 Damage To Premises Rented To You Limit (Any One Premises)
$Excluded Medical Expense Limit (Any One Person)
Refer to individual policy forms and/or endorsements for various coverage sublimits,if applicable.
Item 2. AU DIT PERIOD (If Applicable):
00 Annually o Semi-Annually o Quarterly o Monthly
Item 3. FORMIS) AND ENDORSEMENT(S) made a part of this policyattime of issue:
See Listing of Forms and Endorsements (IFG -1-0150)
Item 4. COMPOSITE RATE
0 If box is checked, see Composite Rate Endorsement (IFG-I-0152) for applicable classification, rates
and premiums, If box is not checked, see page 2 of these Declarations for applicable classifications,
rates and premiums.
Item 5. RETROACTIVE DATE (CG 0002 only) :
Coverage A of this Insurance does not apply to "bodily injury" or "property damage"which occurs
before the Retroactive Date, if any, shown here: NONE (Enter Date or "None" If no Retroactive
Date aoolies,)
Item 6. PREMIUMS
$ 6,020.00 Total Coverage Part Advance Premium
$ Coverage Part Minimum Premium lifapplicable)
These Declarations are pan of the Policy Declarations containing the name of the insured and the policy period.
IFG-G-0002-DL 0303
Page 1 of 2
Policy Number: 289BOO0765
COMMERCIAL GENERAL LIABILITY
SCHEDULE OF CLASSIFICA liONS AND RATES
Named Insured: Effective Date: 10/20/2003
MARATHON COMMUNITY THEATRE
Loc. No. Location Address (Premises you own, rent or occupyl: County,
1 5101 OVERSEAS HIGHWAY Borough or Rating Terr.
Bldg. No. Parish
MARATHON FL 33050
1 MONROE 006
Code No. Classification
44276 Halls - Other Than Not-Far-Profit - including Products and-or completed Operations. These
Products-Completed Operations are subject to the General Aggregate Limit.
Premium is: j::::.::: ,...:- .. "'. .::::::.:::.
1Rl Adjustable (See Premium Base ('..','..; :-::.:'>.. ::::::.' All Other Prod.-C.Ops
.:' ....;...,:;:.,;".;" ....
Premium AuditConditionsl .:' .;'.......;,;..
0 Flat (Not Adjustable) Rate Per 1,000 $ 350.550 $
10"".. "" "'" . , noD
0 Fully Earned When Written Advance Premium: $ 701.00 $
Loc. No. location Address (Premises you own,rentor occupyl: County,
1 5101 OVERSEAS HIGHWAY Borough or Rating T err.
Bldg. No. MARATHON FL 33050 Parish
1 MONROE 006
Code No. Classification
49184 Theaters - NOC - Other than Not-For-Profit - including Products and-or Completed Operations.
These Products-Completed Operations are subject to the General Aggregate Limit.
Fully Premium is: r::p{:::.:.....::::::::'::::..::::: :.
!Xl Adjustable (Soe Premium Base ,','..:.. "...' :...::;.. All Other Prod.-C.Ops
:,.:':-'::"":' .,;';' ".;';:',;..:',,'
Premium AuditConditionsl :'.:: :..:..:......:>.... .
0 Flat (Not Adjustablel Rate Per 1,000 $ 129.794 $
AllMISSIOOS, 37 900
D Fully Earned When Written Advance Premium: $ 4,919.00 $
Loc. No. Location Address (Premises you own,rent or occupy): County,
1 5101 OVERSEAS HIGHWAY Borough or Rating Terr.
Bldg. No. Parish
MARATHON FL 33050
1 MONROE 006
Code No. Classification
49950 Additional Interest
Premium is: ::::.:::,::..:':..':....:.::- ....;. :.:.....:,..,::'::'
0 Adjustable {See Premium Base '.......:.....::....:::.::. ...... All Other Prod.-C.Ops
I::.:::.:::::.:...,::,::::.::::::::::
Premium AuditConditionsl
[Zl Flat INotAdjusteblel RatePer Each $FLAT CHG. $
AODTL . INSCS.: 4
0 Fully Earned When Written Advance Premium: $ 400.00 $
D See Schedule of Classifications and Rates (IFG-G-0003) for additional locations you own, rent or
occupy and applicable classifications and rates and premiums.
IFG-G-0002-DL 0303
Page 2 of 2
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
(TENDER OF ANY LOSS TO OTHER AVAILABLE INSURANCE, AND EXCLUSION OF EMPLOYEE INJURY)
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
This endorsement changes the polley effective on the inception date of the policy unless another date is indicated
below.
Attached to and forming a part of Policy
Number
mm
Name of Person or Organization:
SEE SCHEDULE OF ADDITIONAL INSUREDS
SCHEDULE
Endorsement Number
A.M.
Authorized Representative
Date
Premium: 400.00
This endorsement Is provided in consideration of an additional premium.
Oassiflcatlon Code: 49950
Exposure: Only the person or organization named
Who Is An Insured (Section II) is amended to Include
as an Insured the person or organization shown in the
SCHEDULE, but only with respect to liability arising out
of your ongoing operations performed for that Insured,
including acts or omissions of the Additional Insured in
connection with the general supervision of such
operations.
Except as provided above, this insurance does not
apply to any "bodily injury," Nproperty damage" or
"personal and advertising injury" arising out of or
resulting from the neglect or negligence of the
Additional Insured described in this endorsement.
If other valid and collectible insurance Is avaHable to the
person or organization shown In the SCHEDULE for a
loss we cover under Coverage A or B of the Coverage
Form to which this endorsement attaches, then the
person or organization shown must also. as a condition
for coverage hereunder, tender any loss to each such
other Insurance.
This insurance does not apply to any -bodily Injury" to:
a. An "employee" of any insured, or a person hired
to do work for or on behalf of any Insured or a
BG-G-370 0101
tenant of any insured, that arises out of and In
the course of:
(1) Employment by any insured; or
(2) Performing duties related to the conduct of
any Insured's business; or
b. The spouse, child, parent, brother or sister of
that NemployeeN as a consequence of
Paragraph a. above.
This exclusion applies:
a. Whether an Insured may be liable as an
employer or in any other capacity; and
b. To any obligation to share damages with or
repay someone else who must pay damages
because of the injury.
These provisions and exclusions apply in addition to
those contained in the Coverage Form. All of the
provisions and exclusions of the policy that apply to
UABILlTY COVERAGES also apply to this
endorsement.
. ..'
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 03 00 0196
DEDUCTIBLE LIABILITY INSURANCE
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
This endorsement changes the policy effective on the Inception date of the policy unless another date is Indicated
below.
Endorsement effective 10/20/2003 Policy No. 289BOOO765
12:01 A.M. standard time
Named Insured Countersigned by
MARATHON COMMUNITY THEATRE
(Authorized Representative)
SCHEDULE
Coverage
Amount and Basis of Deductible
PER CLAIM or PER OCCURRENCE
Bodily Injury Liability
OR
Property Damage liability
OR
$
$
$
$
Bodily Injury Liability and/or
Property Damage Liability Combined
$
500
$
(If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
APPLICATION OF ENDORSEMENT (Enter below any limitations on the application of this endorsement. If no
limitation is entered, the deductlbles apply to damages for all "bodily Injury" and "property damage," however
caused) :
A. Our obligation under the Bodily Injury Liability
and Property Damage Liability Coverages to pay
damages on your behalf applies only to the
amount of damages in excess of any deductible
amounts stated in the Schedule above as
applicable to such coverages.
B. You may select a deductible amount on either a
per claim or a per "occurrence" basis. Your
selected deductible applies to the coverage
option and to the basis of the deductible
Indicated by the placement of the deductible
amount In the Schedule above. The deductible
amount stated In the Schedule above applies as
follows:
1. PER CLAIM BASIS. If the deductible amount
indicated In the Schedule above is on a per
claim basis, that deductible applies as
follows:
a. Under Bodily Injury Liability Coverage. to
all damages sustained by anyone per-
son because of "bodily Injury";
b. Under Property Damage Liability Cov-
erage, to all damages sustained by any
one person because of "property
damage"; or
c. Under Bodily Injury Liability and/or
Property Damage LIability Coverage
CL838 (1-96)
CG03000196
Copyright, Insurance Services Office, Inc,. 1994
Page 1 of 2
;' ~
CARRIER: Florida Retail Federation Self Insurers Fund
P.O. Box 988
Lakeland, FL 33802-0988 (863)665-6060
AGENCY: The Johnsons Insurance Agency- 3526
FLORIDA
Team 09
PHONE NUMBER: (305)289-0213
f\I\R~AT-~
wC--s
I-~
ESTIMATED PREMIUM SUMMARY STATEMENT
Page 1 of 1
CLIENT:
Marathon Community Cinema
P.O. Box 500124
Marathon, FL 33050
Client Number: 520 194750000
Policy Period: 1101104 - 1101/05
Plan: 010
12:01 am
RATING PERIOD 1101104
to 1/01/05
WORK
CODE CLASSIFICATION
88W CLERICAL NOCJDRAFfSMEN
9154 THEATER NOC-ALL OTHER EMPWYEE
PAYROU
5,339.00
111,081.00
PRO
RATA
1.000
1.000
RATE
.62
4.57
PREMIUM
33.10
5,076.40
Total Manual Premium
Drug Free Workplace Credit
5,109.50
.00
5,109.50
1.00
5,109.50
I 1.94
5,097.56
200.00
34.93
100.00
5,432.49
5,432A9
Experience Mod
Standard Premium .
Discount
Expense Constant
Terrorism - Certified Acts
*Plus FRF Membership Dues
Policy Grand Total
RECEWEO NOV ~ ~ -
Minimum Premium:
$451.00
TOTAL PREMIUM IS SHOWN ON THE LAST PAGE
OF TIlE PREMIUM SUMMARY STATEMENT
NA9/FLORIDA
Date Prepared: 11/06103
Time Prepared: 16:38:22
AN
.
'f
WORKERS COMPENSATION AND EMPLOYERS UABll..ITY INSURANCE POLICY
Date prepared: November 14,2003
Fonn no. WC 99 04 03
(12/01)
Fund: Florida Retail Federation Self Insurers Fund
Effective date of attachment: January 1,2004
Member Number: 520-19475
FEIN: 59-1692300
Member:
Marathon Community Theatre, Inc.
DBA:Marathon Community Cinema
P.O. Box 500124
Marathon, FL 33050
Physical address:
5101 Overseas Hwy.
Marathon, FL 33050
INTENT:
PREMIUM DUE DATE AITACHMENT
This attachment is made a part of the Agreement for Participation in the Florida Retail Federation Self
Insurers Fund.
You will pay all premium, including audit and retrospective premiums, when due as set forth by the
billing. You will pay the premium even if part or all of a workers compensation law is not valid.
This attachment changes the agreement to which it is attached and is effective on the date issued
unless otbelWise stated.
NA9 ;;~
Cmmtersignedby:~~ jJ ~
cc: Marathon Community Cinema
The Johnsons Insurance Agency 3526
Mr. William 1. Danaher
The Johnsons Insurance Agency
P.O. Box 522346
Marathon Shores, FL 33052-2346
Date: November 14.2003
WC 99 04 03 (12/01)
Includes copyright material
of the National Council on
Compensation Insurance, Inc.
Used with its permission.
Copyright 2000 NCCI