Resolution 228-1989
RESOLUTION NO.
228
-1989
A RESOLUTION OF THE BOARD OF COUNTY COMMIS-
SIONERS OF MONROE COUNTY, FLORIDA, AUTHORIZ-
ING THE MAYOR/CHAIRMAN OF THE BOARD TO EXE-
CUTE AN APPLICATION BY AND BETWEEN FLORIDA
MUNICIPAL LIABILITY PROGRAM AND MONROE COUN-
TY CONCERNING THE SELF INSURERS PROGRAM.
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, that the Mayor/Chairman of the Board is
hereby authorized to execute an application by and between Flori-
da Municipal Liability Program and Monroe County concerning the
participation in Self-Insured Program a copy of same being at-
tached hereto.
PASSED AND ADOPTED by the Board of County Commissioners of
Monroe County, Florida, at a regular meeting of said Board held
on thetJ?f'-tJ. day of Ilt,..;} , A.D. 1989.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By //l/~~
Mayor/CnaJ.rman
(Seal)
Attest:DANNY L. KOLHAGEt gl~~
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AND LEGAL SUFF/CIENCJ*.
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BY
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APPLICATION TO
FLORIDA MUNICIPAL LIABILITY SELF-INSURERS PROGRAM
NAME: Monroe County Municipal Service District
ACCOUNT NUMBER:
FML 485
TYPE OF GOVERNMENTAL ENTITY:
Special District
ADDRESS: Wing 2. Room 207. Public Services Building. Stock Island. Key West. FL .33040
LIST OFFICIALS AUTHORIZED TO EXECUTE CONTRACTS:
I. Name:
Michael Puto
Mayo r
III. Name:
Title:
Title:
II. Name:
IV. Name:
Title:
Title:
PRIOR INSURANCE COVERAGE CARRIED BY:
I (we) hereby formally apl2ly for.~nYnuing membership for liability sil.lf:insurance coverage in the above named Program, to be effective
12:01 A.M" Aprl I 1 , ,19 ~ , and, if accepted by its duly authorized representative, do
hereby constitute and appoint the Florida League of Cities, rnc" to act as Administrator(s) of the Fund as our agent(s)-in-fact in all matters
relating to discharge of tort and wrongful death liability,
I (we) further agree as follows:
(a) That, by this reference, the terms and provisions of the Indemnity Agreement and/or Amendments thereto filed or which may hereafter
be filed are hereby adopted, approved, ratified and confirmed by us; and further, I (we) agree to assume all of the obligations set forth
therein, and I (we) will pay any premium the date the same shall become due, I (we) will pay all costs of the collection thereof, including
reasonable attorney's fees and the maximum rate of interest allowed by law on any past due premiums;
(b) To abide by the rules and regulations of the Trustees of the Program and to conform to the terms of the agreements they may enter
into with any authorized service company as long as we remain a member of the Program,
(c) That, in the event of any changes in corporate or business structure, or in legal entity, or if any locations are to be added to or
deleted from this coverage, I (we) agree to notify Florida Municipal Liability Self-Insurers Program immediately;
(d) That should I (we) desire to cancel our coverage, I (we) will give written notice at least 45 days prior to cancellation, and that the
Program will give written notice 45 days prior to cancellation should they desire to cancel our coverage; and
(e) We agree to save and hold harmless the Trust Fund and the Board of Trustees from any and all damages, causes of action, claims,
delinquencies or expenses, including reasonable attorney's fees, which would otherwise be incurred by the Trust Fund or the Board of
Trustees by reason of any default hereunder on our part,
WITNESSES TO SIGNATURE:
Name of Applicant
Name
CORPORATE
SEAL
Authorized Officer
Address
Clerk or Secretary
Name
Date
Address
IS HEREBY APPROVED FOR MEMBERSHIP IN THIS PROGRAM, AND COVERAGE IS EFFECTIVE THE
DAY OF ,19 _,
SIGNED THIS DAYOF ,19 _'
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'.<;ON_
BY:
Fund Administrator/Trustee
O1.(1()1 (6187)
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