12/15/2004 Agreement
Cleltllllhe
Circll Clln
Danny L. Kolhage
Phone: 305-292.3550 Fax: 305-295-3663
Memnrandum
To:
James R. "Reggie" Paros, Director
Public Safety
Attn:
Stacy De Vane, Executive Assistant
Isabel C. DeSantis, . .//
Deputy Clerk yV'
From:
Date:
Tuesday, February 15, 2005
At the Board meeting of December 15, 2005, the following was approved:
Lease Agreement between Monroe County and Sanctuary Friends of the Florida
Keys, Inc, to lease space at the Florida Keys Marathon Airport on a month-to-month
basis, effective January 1, 2005, contingent upon meeting all county requirements,
Enclosed is a fully executed duplicate original for your handling. Should you have
any questions concerning this matter, please feel free to contact this office.
Copies: Finance
County Attorney
File./
LEASE AGREEMENT
THIS LEASE is made and entered into on the 15th day of December, 2004, by and
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA,
a political subdivision of the State of Florida, hereinafter referred to as "Lessor," and
SANCTUARY FRIENDS OF THE FLORIDA KEYS, INC., hereinafter referred to as
"Lessee," whose address is 9400 Overseas Highway, Suite 125, Marathon, FL 33050.
IN CONSIDERATION of the mutual covenants, promises and premises herein
contained, the parties hereto agree as follows:
1. PREMISES. The Lessor leases unto the Lessee an area at the Florida Keys
Marathon Airport, Marathon, Monroe County, Florida, as follows:
A. Public Exposed Area of 130 square feet, located in the Airline Terminal, Suite
125, at a rate of $27.96 per square foot/annually (Exhibit A). Exhibit A is attached
hereto and made a part hereof.
2. TERM. The above-described premises are leased to the Lessee on a month-
to-month basis beginning January 1, 2005.
3. RENT. The Lessee hereby covenants and agrees to pay to the Lessor rent in
the amount of $302.90 per month, plus applicable sales tax, for the use of said
premises during the term of this lease. Said rent to be payable in advance on the
first day of each month during said term.
Rental rates are subject to revision each year, effective January 1, in
accordance with the percentage change in the Consumer Price Index for all urban
consumers (CPI-U) for the most recent 12 months available.
4. LESSOR'S COVENANTS. The Lessor hereby covenants and agrees with the
Lessee as follows:
A. The Lessee shall have reasonable ingress, egress and access privileges
to the leased premises.
B. The Lessee, on keeping the covenants and agreements by him herein
contained, shall have quiet and peaceful enjoyment of the demised premises without
any interruptions by the Lessor, or by any person or persons claiming by, through or
under it.
respon;ibility ~~i~~~~:~~e of the leased premis~711~I~H~P:i~ ~!g~l?r8jements are the
'1 ~.f . \~ 1:J . .", .
(1'7 'j' lid "I n. I
~J ~. l\ S G.Jj :JLJ
D. Electric, water, sewage and solid waste collection services are included.
The Lessee is responsible for telecommunications service, normal cleaning service
and routine maintenance of the premises.
5. LESSEE'S COVENANTS. The Lessee hereby covenants and agrees with the
Lessor as follows:
A. Lessee will utilize the leased areas for the following services:
Office space only, to provide clerical support for Sanctuary Friends of
the Florida Keys, Inc.
B. To pay the Lessor the rent at the times and in the manner provided for
by this lease.
C. Any commercial aeronautical activity shall be conducted in strict
compliance with the Minimum Standards for Commercial Aeronautical Activities.
D. To make no improper or unlawful or offensive use of said premises, and
to permit the Lessor or its agents to inspect the leased premises at all reasonable
times for the purpose of viewing the condition thereof.
E. Lessee covenants that he shall maintain and operate and use the
premises in compliance with 49 CFR, Part 21, Nondiscrimination in Federally Assisted
Programs of the Department of Transportation, as said Regulations may be
amended. More particularly, Lessee covenants that:
a) no person on the grounds of race, color, national origin, or sex shall be
excluded from participation in, denied the benefits of, or be otherwise subjected to
discrimination in the use of the premises; and
b) in the construction of any improvements on the premises and the
furnishing of services thereon, no person on the grounds of race, color, national
origin, or sex shall be excluded from participation in, denied the benefits of, or
otherwise be subjected to discrimination.
That in the event of breach of any of the above nondiscrimination covenants,
Owner shall have the right to terminate the lease and to re-enter and as if said lease
had never been made or issued. The provision shall not be effective until the
procedures of Title 49, Code of Federal Regulations, part 21 are followed and
completed including exercise or expiration of appeal rights.
F. That the Lessee expressly agrees for itself, its successors and assigns, to
restrict the height of structures, objects of natural growth and other obstructions on
the hereinafter described real property to such a height so as to comply with Federal
Aviation Regulations, Part 77.
2
G. That the Lessee expressly agrees for itself, its successors and assigns to
prevent any use of the hereinafter described real property which would interfere with
or adversely affect the operation or maintenance of the airport, or otherwise
constitute an airport hazard.
H. This lease and all provisions hereof are subject and subordinate to the
terms and conditions of the instruments and documents under which the Airport
Owner acquired the subject property from the United States of America and shall be
given only such effect as will not conflict or be inconsistent with the terms and
conditions contained in the lease of such lands from the Airport Owner, and any
existing or subsequent amendments thereto, and are subject to any ordinances,
rules or regulations which have been, or may hereafter be adopted by the Owner
pertaining to the Florida Keys Marathon Airport.
1. Notwithstanding anything herein contained that may be or appear to be,
to the contrary, it is expressly understood and agreed that the rights granted under
this agreement are nonexclusive and the Lessor herein reserves the right to grant
similar privileges to another Lessee or other Lessees on other parts of the airport.
6. HOLD HARMLESS AND INSURANCE
The Lessee agrees to indemnify and hold the Lessor harmless from any and all
claims for bodily injury (including death), personal injury, and property damage
(including property owned by Monroe County) and any other losses, damages, and
expenses (including attorney's fees) which arise out of, in connection with, or by
reason of services provided by the Lessee or any of its Contractors, occasioned by
the negligence, errors, or other wrongful act or omission of the Lessee or its
Contractor(s), their employees, or agents.
The extent of liability is in no way limited to, reduced, or lessened by the
insurance requirements contained elsewhere within this agreement.
Prior to execution of this agreement, the CONTRACTOR shall furnish the
Owner Certificates of Insurance indicating the following coverages or in excess
thereof, and naming Monroe County Board of County Commissioners as an additional
insured on all policies except Workers Compensation:
· General Liability (Premises operations, blanket contractual, expanded
definition of property damage, products, and completed operations, personal
injury) with $100,000.00 per Person, $300,000.00 per occurrence, $50,000.00
property damage, or $300,000.00 combined single limit; and fire legal liability
with limits equal to the fair market value of the leased property)
· Vehicle Liability with $100,000.00 per Person, $300,000.00 per occurrence,
$50,000.00 property damage, or $300,000.00 combined single limit;
· All Risk Property Insurance (to include the perils of Flood and Wind) with limits
no less that the Replacement Cost Value of the property leased or rented.
Coverage shall be maintained throughout the life of the Lease/Rental Agreement
and include, as a minimum, liability coverage for: Fire, Sprinkler Leakage,
Windstorm, Civil Commotion, Lightening, Sinkhole Collapse, Smoke, Aircarft and
Vehicle Damage, Vandalism, Falling Objects, Explosion and Flood.
3
Lessee shall obtain and maintain throughout the life of this agreement those
insurance coverages and amounts required. The Monroe County Board of County
Commissioners shall be named as Additional Insured on all policies issued to satisfy
the above requirements.
7. MUTUAL COVENANTS. It is mutually covenanted and agreed by and
between the Lessor and the Lessee as follows:
A. Lessee shall, upon thirty (30) days written notice from Lessor, abandon
said premises.
B. This lease shall be binding upon the parties hereto, their successors,
executors, administrators and assigns. Any assignment of this lease shall not
become effective until approved in writing by Lessor. The premises shall not be sub-
let.
8. COMPLIANCE WITH LAWS. Both parties shall comply with all federal,
state and local laws governing the activities under this lease.
This lease agreement is governed by the laws of the State of Florida. Venue
for any litigation arising under this lease agreement must be in a court of competent
jurisdiction in Monroe County, Florida.
This written lease represents the parties final mutual agreement and
supersedes any prior agreements concerning the premises, whether written or oral.
This lease agreement may only be modified by a written amendment signed by both
parties.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be
executed on the day and year first above written.
.~. . . (SEAt~ I.~
\~ ',A-rrESTbOANNY L/KOLHAGE, CLERK
";"~;G~/ ~ ~.
~t:,~---_'"^ C. ~
I "',0"___"'"' Deputy lerk u
/,J../,s-.or
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By L~# >n ~.~)
Mayor/Chair an
4
Oil'
. -I
.~
~ . - . . . -
'.
I~: ..
I : .
I -
~~ :
r.~
, ' " if
~d '. ba.
- -- --r
1-.(- , /'., .1
r.l E C H _
l/25 ]
0< .;.
~1EN'" :..:.
'121
! --',
. r . . ~ . . ~ ,'" - ...... ' - ," '. - .' . - .' t
-I .1. :.
-f ,,' ...;.
" I;'......
,~. ~d ~ ':,~:~
/ . . fDi.:..:.__
i .
-Pt~lT A[I
I ..., ::)
'-, ,........ i \
/:
" ..~ - .d"+ :"-:-'I"~'~' :-:"'-f-" ;-.,
.' .' . ;'~.'-:-~:<:..}~': ;.':,'r;~::+:;:::::: ::j~~9tJ~~~G~if:r:~<._"
;. ,'..; ,J_ _~._I" _I-~~ ~;. ~i.... ;_..:...~_\.-.:.._.:.~;.~....l
1,': ;;1' :dC" .:-,~..:~;:jl(":"~'-':";"';I
CONCOURSE .,:.'. '1':":';-<_: ...-.--- d'"
-. ,--, ...----.-----...--..
'I: . d fIZZ:]..::. T :~:::-=.==::~::-::::::,
[ll" . .... .;.;., f.",L,;'
.. .lnlLd. L"".; -:.~.:!:..... U i+'...." .
. r. .~ '. :
4
~-7-..~
.Bf~hf~ ::: \ :
''-.r:-A.Tfh.fr- j.
,:>_l'i\J .
. . , ~ ..!
.1
, .
I.
ID~
~ -. I -
--. q-.. -'
~ .
... ~ .. '.."- ~
..-/
. "STAI RW A Y: .
.~ -'{-'TZ"":"!'-->'.;! :
_:;.':". ~~I::'.:=:.t::tU n
L:;:::~:L:~::L~:L:U U
., 'f:L.!: :U'Ui~ I'
. ;1:-
:......:::::::::::~I.:.
. ; : ;1'
......:,.:
~
; I ..
r 127
]
\- '.
=(~"SORT~-:l
=O~?'T~. :~.'.:~.. :=.:
. . , . .
- _~ __ __ _' '. ... I.
.. .'
~ - . _. . -.. . ~ . - . . . I
. . .-. ". - -.. - , ~ - . ;
, I I 1 I I ~ t I \ 'I I
1 I II II
_l,-~-r I
~"II)"II'~
-------
L_______
I
I
I
I
I
I
I
I
I
PLANTER
. . ..'
- .~.......-..-- .,,-,,---'_.~'.'._""- ...-..-
. . .
~. .... - ... - .......... ....... -. .
........... ~_........-" _. ..-.
. . . .
~ -.':..
. . . . - . .. .
r:;::f::[:: ::rT~::~+.:+: :~~TI~::~:ITT:r:rr~~:r: :Y:i::
. t . f ,'" "... ..,.. ..1..... .........,--f-.'..I..,..'.....-... · I
ttH:: JUH j: :;:l ::Ii;I:l:~'{;:--: :~; ;:;"'.. ..
.. .. ,. ., .' . .. .. ._, .'..... I . -. .
.~_.:..:...:.. _.~..;..':"._..:u ..:.. ..~"."':' ~"_~"~h~..I.:"I.~~.~-~.,,:-.-~'''r'''' --t..
. . . . . .
........ ............-.....-..- --.,
., .......
.........~._-._~. --...... .'''..-. -- .........-... -.
:U:':I:t:'c:;:
JrIr: . TiIII111'
C' ': --:. .. i "/: r
..........\.. ..1..
~.: .:
. . ......
,.. .... '1'
. . .
. - ......
-.. ..... .
, . .
. . ......
'.~ . '. .. ..... .
EXHIBIT A
r.
. I .
. . - ~
'..
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
5 ct Y\. C + u 4. 'fj F'r t.e ill ds of F"'L- K. eyS warrants that he@as not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
Section 2 of 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 this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to t
Date: I ~ d Lf - 0 5
STATE OF
F"/OY) cl~
(VI on rD E:
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
G eo\'" j e.... K _ J\J e. U 1R n + who, after first being sworn by me, affixed@her
signature (name of individual signing) in the space provided above on this c7 Lf day of
JanUQY"7 ,2005
~ENC~
NOT PUBLIC
My commission expires:
,~RY PUJ>.
..0......;"C' CATHY E. HARPE
* &~ * MY COMMISSION # DO 216064
"'~~ EXPIRES: August 23,2007
-1I"(,OFfl.o<f:' Bonded Thru Budget Notary Services
OMB - MCP FORM #4
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 contract.
Contractor:
Sanctuary Friends of the Florida Kevs, Inc.
Contract for:
Lease office space in the Florida Kevs Marathon Airport terminal
Address of Contractor:
P.O. Box 504301, Marathon, FL 33050
Phone:
/ '., ,'- ~'
( ?) f' Cj ) r) ))'; (( r-:)..- .-+ 0 J
- >
Scope of Work:
(-
:;; \~\ y e 1) ~ -t
\ \\ C\ '( \ \1 <Z-
('. "
II lIe" \- L _ \-<'OJ s N cd l ol\O-I
r- .+ .... (
_~C\. II C ,U(\ I 'j .
Reason for Waiver:
[\J (\ -~
I . (
n (' C (\, (cl, U (l (' ({ I, X ~; C l A) Q
["(1 V 1:?,
Policies Waiver
will apply to:
pc '{SCll(( (
\
Vehic1e Insurance
!\\':.".;'Cc.',\I(.e ~)()\'\(I\2'-::on c r
) Vi) f, I C (c _S
Date
(I (\"n~L\ +j(U(~C
(') \
APP~ '" .' Not Approv,d
~t)\.~
0.'<6 ,..()5
Signature of Contractor:
Risk Management
County Administrator appeal:
Approved:
Not Approved:
Date:
Board of County Commissioners appeal:
Approved:
Not Approved:
Meeting Date:
MONROE COUNTY, FLORIDA
Request For Waiver
of
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule ofInsurance
Requirements, be waived or modified on the following contract.
Contractor: Sanctuary Friends of the Florida Keys, Inc.
Contract for: Lease office space in the Florida Keys Marathon Airport terminal
Address of Contractor: P.O. Box 504301, Marathon, FL 33050
Scope of Work:
( '). ,,;--)1 <7 Or '\ \ C' c~
,)\.) ) ) ,-J.-. ,) ~ ,_7- d 6 ,~
~) '.' ? p u v.t '-\ \"\.Q/ (' L. K--"''-6 s 1" j (\.'i\ D ntzJ
,I.
l\\n \ \ \ \C. ~.JO. \\( ~ v (\ Y' \-j
Phone:
Policies Waiver
will apply to:
\) 0 t (\ ~~) \ \ ((\ b \ c \)e C {( U 'J e ~cJc n r e
(\U-\ \ ('fe';" n 5 '~\" e ,0 nh "e to \,', \ C\; \\~)
All Risk Property Insurance
Reason for Waiver:
',c J ;,,:"rl ~'-:\ HCt"r-
Appmved ~ Not Appmved
01\.~
~"8'DS
Signature of Contractor:
Risk Management
Date
County Administrator appeal:
Approved:
Not Approved:
Date:
Board of County Commissioners appeal:
Approved:
Not Approved:
Meeting Date:
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYV)
TM 02/04/2005
~~R (305)743-0494 FAX (305) 743-0582 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Keys Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 500280 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Marathon, FL 33050-0280
INSURERS AFFORDING COVERAGE NAIC#
INSURED Sanctuary Friends of the Florida Keys, Inc. INSURER A: Century Surety Ins Group
P.O. Box 504301 INSURER B:
Marathon, FL 33050 INSURER C:
INSURER D:
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.
INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY TBA 02/01/2005 02/01/2006 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ 2,00(J
A PERSONAL & ADV INJURY $ Included
f--
GENERAL AGGREGATE $ 2 ,000 , OO(J
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Excluded
n .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- $
ANY AUTO (Ea accident)
f--
ALL OWNED AUTOS BODILY INJURY
f-- $
SCHEDULED AUTOS (Per person)
f--
HIRED AUTOS BODILY INJURY
f-- $
NON-OWNED AUTOS (Per accident)
f--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY \Q ~;:;J};i EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AP GEMENT AGGREGATE $
BY 1\ 1 \, $
d- ~.~~ ;;.:---
~ DEDUCTIBLE 2. .. $
RETENTION $ DATE $
WORKERS COMPENSATION AND WAIVt:R N/A~ YF " T ~VXSJT~T.\;!;.T 10J,tl-
EMPLOYERS' LIABILITY _._,......---~......-
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
he following is listed as Additional Insured
C
C
Monroe County BOCC
5100 College Road
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
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) FAX: (305)292-4590
'~M CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDNYVY)
02/04/2005
PRODUCER (305)743-0494 FAX (305)743-0582 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Keys Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
P.O. Box 500280 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Marathon, FL 33050-0280
INSURERS AFFORDING COVERAGE NAIC#
INSURED Sanctuary Friends of the Florida Keys, Inc. INSURER A: Century Surety Ins Group
P.O. Box 504301 INSURER B:
Marathon, FL 33050 INSURER C:
INSURER D:
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.
I,N~: ~~~~ TYPE OF INSURANCE POLICY NUMBER p~.Ll~Y EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE [K] OCCUR
-
GEN'L AGGREGATE LIMIT APPLIES PER:
---, r-l PRO- n
I POLICY I I JECT LOC
AUTOMOBILE LIABILITY
-
-
TBA 02/01/2005 02/01/2006 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED $ 50,000
MED EXP (Anyone person) $ 2,000
PERSONAL & ADV INJURY $ Included
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ Excluded
A
t--
GARAGE LIABILITY
=1 ANY AUTO
EXCESs/UMBRELLA LIABILITY
:=J OCCUR 0 CLAIMS MADE
I DEDUCTIBLE
I RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
APPAO I.-I'
BY 1\ ~)'
v
DATE
I"\PAS K M/~'( EM E In
\\11'111 11 .~
~- ~-T1;
~'/AI__YES __
COMBINED SINGLE LIMIT $
(Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per eccident)
AUTO ONLY - EAACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $
AGGREGATE $
$
$
$
I T"X~JTfH,lt~ I 10J~-
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
ANY AUTO
-
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
-
-
-
-
WAI\fEB
itP.,ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
I.he following is listed as Additional Insured
r
L (;) P'j '. "\ I '"'"~ r. (~
Monroe County BOCC
5100 College Road
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
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Lourdes Monta ne
ACORD 25 (2001/08) FAX: (305)292-4590
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)