Certificates of Insurance
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
TM 02/10/2005
PRODUCER (941) 92 3 -1218 FAX (941)923-1765 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Valek Insurance & Bonds ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 20709 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
2079 Constitution Blvd.
Sarasota, FL 34231 INSURERS AFFORDING COVERAGE NAIC#
INSURED RMPK Group, Inc INSURER A: Hartford Ins/Iroquois
Russell Moore INSURER B:
1519 Main Street INSURER C:
Sarasota, FL 34236 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.
'~f: ~~~l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 21 SBA KQS327 DV 08/28/2004 08/28/2005 EACH OCCURRENCE $ l,OOO,OOC
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,OOC
I CLAIMS MADE [I] OCCUR MED EXP (Anyone person) $ 10 , OOC
A X PERSONAL & ADV INJURY $ 1,000,000
f-- 2,000,00(
GENERAL AGGREGATE $
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,OOO,OOC
!Xl ' n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY 21 SBA KQS327 DV 08/28/2004 08/28/2005 COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO 1,000,000
-
ALL OWNED AUTOS BODilY INJURY
- (Per person) $
SCHEDULED AUTOS
A X X
HIRED AUTOS BODILY INJURY
X (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY J\Pi).~ ':~ MANA pEMENT AUTO ONLY - EA ACCIDENT $
R ANY AUTO 8Y_.._. , .. OTHER THAN EA ACC $
~_t>.._ '/11.~ f)~ '") AUTO ONLY:
AGG $
EXCESS/UMBRELLA LIABILITY DAE...,,__ f-~~jy' -6;;:L EACH OCCURRENCE $
~ OCCUR o CLAIMS MADE I AGGREGATE $
WAiVt:H ~ .' \/:"':: (:
,.A,,---. '~_ I I,..,.; ~-~_,~ "~_r^..,~ $
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND 21 WEC GE4842 03 08/28/2004 08/28/2005 X I T~~~I~J,~~ I 10J~'
EMPLOYERS' LIABILITY 500,000
A ANY PROPRIETORlPARTNERlEXECUTIVE EL. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ertificate holder listed below is an additional insured with re to liability
Monroe County
Board of County Commissioners
2798 Overseas Highway
Marathon, FL 33050
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 MAlL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Shelle Dutton
ACORD 25 (2001/08) FAX: (305)289-2536
@ACORDCORPORATION 1988
FEB-10-2005 14:13
lJALEK INSURANCE
9419231765
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED. the policy(i8S) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endOl'$ement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the polley, 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)
P.02
TOTAL P. 02
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