Certificates of Insurance
DATE (MMlDDIYYYYI
FREIL-1 08 27 04
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 POLICIES BELOW.
ACORDN
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Haake Companies
4650 Colleqe Blvd.,Suite *300
Overland Park KS 66211-1626
Phone: 913-491-1999 Fax: 913-906-0088
INSURERS AFFORDING COVERAGE
.._._--_._-~~~._~-_..__._--._~
INSURER A: The Hartford ITT
INSURED
Freilich, Leitner & Carlisle
1150 One Main Plaza
4435 Main Street
Kansas City MO 64111-7727
COVERAGES
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 CERTIFICA TE 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.
INSR-:ADD'C- -------- _______..
L TR INSRD TYPE OF INSURANCE POLICY NUMBER
GENERAL LIABILITY
A
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurence)
MED EXP (Anyone pernonl
X COMMERCIAL GENERAL LIABILITY
- -
CLAIMS MADE X OCCUR
37SBAAM5833
04/05/04
04/05/05
GEN'l AGGREGATE LIMIT APPLIES PER:
POLICY i . rr8-i
AUTOMOBILE LIABILITY
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
lOC
A
37DBAAM5833
04/05/05
COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO
All OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
04/05/04
BODilY INJURY
(Per pernon)
ANY QUESTIONS-PLEASE CONTACT
SHELLEY NEWMAN
(913) 491- 1999
BODilY INJURY
(Per aCCIdent)
PROPERTY DAMAGE
(per accIdent)
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
EXCESSJUMBRELLA LIABILITY
OTHER THAN
AUTO ONLY,
EA ACC
AGG
A
EACH OCCURRENCE
AGGREGATE
X OCCUR
CLAIMS MADE
37SBAAM5833
04/05/04
04/05/05
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
A ANY PROPRIETORlPARTNERlEXECUTIVE
OFFICERlMEMBER EXCLUDED?
~~~~11tS~~~VIS1cfNS below
OTHER
W A U-
X . TORYUMITS. ER
EL EACH ACCIDENT $
EL. DISEASE - EA EMPLOYEE $
EL DISEASE - POLICY LIMIT $
-----..,.-..-..
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
AGGREGATE LIMITS AT INCEPTION- MONROE COUNT BOARD OF COUNTY COMMISSIONERS IS
NAMED AS AN ADDITIONAL INSURED BUT ONLY AS THEIR INTEREST MAY APPEAR TO THE
NAMED INSURED.
CERTIFICA TE HOLDER
CANCELLATION
MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS
MAYRA/FAX: 305-289-2854
2798 OVERSEAS HIGHWAY, STE 400
MARATHON F.L 33050
GROWTHM
NAIC#
LIMITS
$1,000,000
$300,000
$10,000
. $ 1,000,000
$2,000,000
. $ 2,000,000
$1,000,000
$
$
$4,000,000
$4,000,000
$
$
$
500,000
500,000
500 000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -.!.Q... DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
ACORD 25 (2001/08)
C CORD CORPORA nON 1988
.ACllRl1u. CERTIFICATE OF LIABILITY INSURANCE I DATE (1VI1V1/DD/YY)
06130104
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Agency Co. (KS) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
6700 Antioch, Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Merriam, KS 66214
913671-7877 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Philadelphia Indemnity Insurance
Freilich, Leitner & Carlisle INSURER B:Admirallnsurance Company
4435 Main Street INSURER c:
Suite 1150 INSURER 0:
I Kansas City, MO 64111-1858 INSURER E:
Client#: 11543
FRELEI
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOlWlTHSTANDING
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 UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY ElCPlRATIO LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAl LIABilITY I
CLAIMS MADeO OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO-
lOC
EACH OCCURRENCE $
FIRE DAMAGE (Anyone' ire $
ME 0 EXP (Anyone person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGGl $
1
I
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT $
(Ea accident)
BODIL Y INJURY
(Per person)
1
:$
1$
I
I
:s
1
GARAGE LIABILITY
ANY AUTO
AUTO ONlY- EAACCIDENT $
APP,il.. \
OTHER THAN
AUTO ONL Y:
EAACC ,$
-I
AGG '$
EXCESS LIABILITY I
I OCCUR D CLAIMS MADE
A i OTHER Lawyers Prof
BExcess Profe
I PHSD075226
9612245
101/01/04
101/01/04
!
101/01/05
01/01/05
I
EACH OCCURRENCE $
AGGREGATE $
1$
.-1 $
, $
WC STATU- OTH~
E.L. EACH ACCIDENT I $
.E.L.OISEASE-EAEMPLOYEJ $
I E.L. DISEASE -POLICY LIMIT $
I $5,000,000/$5,000,000
I $5,000,000 Excess
i
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WAIVER
N'A
,-Qd~
X' Y' 'e;
(l. ",'__~"___
I
DATE
-"~~."'-'--
DESCRIPTION OF OPERATIONS/LOCA TIONSIVEHICLES/EXCLUSIONS AD OED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER
i ADDmONAL INSlR:D'INSURER lETTER:
CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBEDPOUCES BE CANCELLED BEFORE THE EXPIRATlON
DATETHEREOF,THE ISSUING INSURER WILLENDEAVOR TO MAIL31L- DAYSWRllTEN
NOTlCETOTHE CERT1FICATE HOLOERNAMED TOTI-ElEFT, BUTFAlLURE TO DO SO SHALL
IMPOSE NO OBLlGATlON OR LIABILITY OF ANY KINO UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHO IzeD REPRESENTATIVE
Monroe County Growth Management
Attn: Kelly Papa
2798 Overseas Highway
Suite 400
Marathon, FL 33050
ACORD 25. S (7/97)1 of 1
#S372059/M368163
OAK
@ ACORD CORPORATION 198;