Addendum 03/04/1993
ADDENDUM TO AGREEMENT
(Jackson Square Janitorial)
4-#. THIS ADDENDUM TO AGREEMENT is made and entered into this
day 0 f March, 1993, between the COUNTY OF MONROE and ACE
BUILDING MAINTENANCE in order to amend that certain agreement
between the parties dated April 1, 1992, as follows:
1. In accordance with Paragraph X of aforementioned
agreement, the County hereby exercises its option to renew said
Agreement and hereby amend paragraph X to read as follows:
"X The Owner shall have the option to renew this
agreement after the second year for one additional year. The
contract amount agreed to herein may be adjusted annually in
accordance with the percentage change in the Consumer Price Index
(CPI) for Wage Earners and Clerical Workers in the Miami,
Florida area index, and shall be based upon the annual average
CPI computation from January 1 through December 31 of the
previous year."
-7 .-fl
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2. Payment by the County to Ace Building ~attitenBnce~for
the performance of said service remains at $17,16~QO~pe~yea~ to
be paid $1,430.00 per month." I'L, ~;;;
- ,'0
3. In all other respects, the agreement bet~ei1" th~par.1Bies
dated April 1, 1992 remains in full force and effec~. ~ I~
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IN WITNESS WHEREOF, the parties have hereunto
hands and seal, the day and year first written above.
(Seal)
COUNTY COMMISSIONERS
COUNTY, FLORIDA
By:
Attest: DANNY L. KOLHAGE, CLERK
BY:"~ t-J-C. /f)p ~
Deputy C~rk
ACE BUILDING MAINTENANCE
C'~\.{"\6.\.A. '~\~BY:
') 'Wi tness
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February 9, 1993
Monroe County Public Works
Jr. College Road
Key West, Fla 33040
ATTN: Cindy
REF: Janitorial for Jackson Square
Dear Cindy,
I received your letter with reference
to the renewal of the Jackson Square
janitorial contract.
Yes, I would be pleased to continue my
janitorial services for the county for
this complex.
Thank you,
0itCjMdC
Judy Bobick
Owner
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
~J (~ f3@ci- warrants that heli t has not employed,
retained or otherwise had act on he/its behalf any former County officer
or employee subject to the prohibition 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 the former County officer or
employee.
Date:
STATE OF d ~
COUNTY OF ~
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
,
~ ~~~ who, after first being sworn by me,
affixed his/her signature (name of individual signing) in the space
0Cti"-
provided above on this Q(J
day of
~o
, 19 9?J
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;c r,~:i/,,~~!~UC STAn:: UF FLORIOA
".. <-'-"1h~.)..lON EXP. MAR.14.1995
A"yDr8dMih~~i!oftrSe1q)ires :
NOTARY PUBLIC
ISLAND
INSURANCE
AGENCY
3229 FLAGLER AVENUE. UNIT 112. KEY WEST. FLORIDA 33040 · 305-294-6666
FEBRUARY 18TH, 1993
RISK MANAGEMENT OFFICE
BOARD OF COUNTY COMMISSIONERS
5100 COLLEGE ROAD
KEY WEST FL 33040
ATTENTION: KAY BAHLEDA
RE: JUDY T. BOBICK, D/B/A ACE BUILDING MAINTENANCE
1200 20TH TERRACE
KEY WEST, FL 33040
THE ABOVE MENTIONED INSURED IS PRESENTLY INSURED WITH
BANKERS & SHIPPERS INSURANCE COMPANY, P. O. BOX 2510,
BURLINGTON,uNORTH CAROLINA 27215.
AT THE PRESENT TIME THE BANKERS & SHIPPERS INSURANCE
COMPANY CANNOT LIST ANY GOVERNMENT ENTITY AS AN ADDITIONAL
INSURED.
THERE WILL BE A FOLLOW UP LETTER FROM BANKERS & SHIPPERS
INSURANCE COMPANY STATING THAT THEY ARE UNABLE TO LIST
THE BO~RD OF COUNTY COMMISSIONERS AS AN ADDITIONAL INSURED.
IF THERE ARE ANY QUESTIONS PLEASE CALL OUR OFFICE.
Applicant's
This application Is In compliance With Section 626.752 Florida StaMes.
A coF"{ has been submitted to the applicant or i ured and coverage is:
~ .!k'lund EffectiveJ 0',. S~ (timel. . q:3datel 0 ('lot ~und
Dote
This application is in compliance with Section 626.752 FIOfido SloMes ond
subll)itIed in the best interest of the appicant Of insIXed to whom 0 copy has
bee'i1 been furnished and coverage Is: ...\ , _\ ^"'"
~~n4 Effective \p: 55 .---.{timel~date)
o
~1'
oourjd
by the brokering agent:
~
is not a binder unless indicated os
NOTE: WHERE SPECIFIC CLASSIFICATIONS INDICATE PRESCRIBED EXPOSURES OR OPERATIONS, THE APPLICANT AFFIRN\S THAT SUCH
OPERATIONS AND EXPOSURES DO NOT EXIST. IF THE APPLICATION IS ACCEPTED, THE RESULTING POLICY WILL BE ISSUED EXCLUDING
SAID OPERATIONS~AND EXPOSURES.
TOTAL
CONTRACTOR'S EQUIPMENT
MINI COMPUTER
CRIlv\E
PROPERTY
GENERAL LIABILITY
Contractor's Equipment Sub-Total
5
d
o Scheduled Equipment
$3,000 [maximum limit)
o Tools and Equipment IACVl
o Hand Tools
$500 I maximum)
Ded $250
Ded $
00
x = $50 (minimum)
X = $75 (minimum)
VALUE
RATE
PREMIUM
_/uled Equipment
.:Jding Serial No's)
I
I
/
I
:/ L.."-XI",.III , Y \L..I "4
"
.fof Hand Tools
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SWORN" STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTF..s, ~N PUBLIC ENTITY CRIMES
TIllS FORM MUST BE SIGNED AND SWORN TQ-JN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATiIS.
1.
[print name of the public entity]
Cor
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whose business address is
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KE'f
'^C>1h lb 'WrCL 1
WerT Ft.A- 750 (j-f ~
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{; 5- o~().6f 3 IJ.
and (If applicable) Its Federal Employer Identification Number (FEIN) Is
(If the entity has no FEIN, Include the Social Security Number oC the Individual signing this
sworn statement:
.)
2. I understand that a wpublic entity crimew as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
violation oC any state or federal law by a person with respect to and dh'ectly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or of the United
States, including, but not limited to, any bid or contract for goods or services to be provided to any public
entity or an agency or political subdivision oC any other state or oC the United States and involving antitrust,
fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
3. I under~tand that wconvictedW or wconvictionw as defined in Par~graph 287.133(1)(b), Florida Statutes. means
a finding of guilt-or a conviction oC a public entity crime, with or without an adjudication of guilt, In any
Cederal or state. trial cour~ oC record relating to charges brought by indictment or inCormation after July 1,
1989, as a res~F'oLa J1!ry_v~rdfct, nonjury-trial, or entry of a plea of guilty or nolo contendere. .
4. I understand t~at.an -a"rlili_ateW as definc<l in Paragraph Z87.133(1)(a), Florida Statutes, means: '
I. A predecessor or successor oC a person convicted or a. public entity crime; or
2. An entity under the control of any natural person who is active in the management of the entity and
who has been convicted oC a public entity crime. The term waffiliateW includes those officers, directors,
:..executives~ partners, shareholders, employees, members, and agents who are active in the management of
.arinfliliate., The ownership by one person of shares constituting a controlling interest In another person,
o'r a pooling of equipment or inccme among persons when not for Cair market value under an arm's length
. agreement, shall be a prima facie case that one person controls another person. A person who knowingly
enters into a joint venture with a person who has been convicted of a public entity crime in Florida during
Ihe preceding 36 months shall be ,considered an affiliate.
5. I understand that a wpersonw as defined in Paragraph 287.133(l)(e), Florida Statutes, means any natural
person or entity organized under the laws of any state or oC the United States with the legal power to enter
into a binding contract and which bids or applies to bid on contracts for the provision of goods or services
let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The
term wpersonw includes those officers, directors, executives, partners, shareholders, employees, members and
agents who are active in management of an entity. '
',1_, :". ~ J 2.':'; '.... ) I ~ ) i r l ; .
6. Balled on information and belfer, the statement which I have marked below Is true In relation to .the entity
submitting Ihis sworn statement [Indlcnte which stntement npplles.]
V Neilher the entitysubmitting..this sworn statemen~, nOr, any of Its onicers, direclors, executive"
partners, shareholders, employees, members, or agents who are active In the management of the entity, nor
any affiliate of the enlily has been charged with and convicted of a public entity crime subsequent to July
1, 1989. _
,;: "
- The entity submitting this sworn statement, or one. or more of its onicers, dIrectors; executives,
p:lrtners, shareholders, employee,;, members, or agents who are active In the management of the entity, or
an affiliate of the entity has been charged wilh and convicted of. a public entity crime subsequent to Ju'y
, 1, 1989. .. - '. .', '___.,_
~~~.~)-.~J .: to_': ..i..
--.-:.- TIle enllty submitting Ihis sworn statement" or one or mQre of Its officers, directors, executives,
partners, shareholders, employee'J,Jitem~~J"!l/b(a.t~t~(w~o are active hfth~, management oCthe entity, or
an affiliate of Ihe enllty has been charged with, and convicted of a public entity crime subseq..ent to Ju'y
1, 1989. However, thcre has bcen a subsequent proceeding before a Hearing Officer of the State of Florida,
Oivi!;ion of Adminislralive Hearings and the Final Order entered by the Hearing Onicer determIned that
it was not in the public interest to place Ihe entitysubmiuing this sworn statement on the convicted vendor
list (nUnch n copy of the nnnl orderJ.._'U-:-,)~ ',',::) \. {\f. .,~.. _.J/' l
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I ,UNDERSTAND THAT TIlE SUBMISSION o~-TiIlS FORM'TO TilE CONTRACTING OFFICER FOR TIlE
PUnLlC ENTITY ID'EN'rIJ[IED IN PARAGRAPII 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTIlY ONLY AND,
THAT TIllS FORM IS VALID THROUGH DECEMnER 31 OF TilE CALENDAR YEAR IN wlllcn IT IS FILED.
I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM TIlE PUBLIC ENTIlY PRIOR TO ENTERING
INTO A CONTRA..CT IN EXCE..~S OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
STATUTES FOR CATEGORY lWO OF ANY CHANGE IN TilE INFORMATION CONTAINED IN TIllS FORM.
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,Sworn to and subscribed before'me this
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day of
Notary PubUc - State of
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Personally known
OR Produced idenlilication"\)r~""e1> ,L~~
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My comml~1Qd;'~u~ . .TIMOTHY L. TOM i\
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" .",?f.,~,'"'' BONDED THRU' ,
, (Printed typed or stamped
commissioned name of notary public)
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IRES
(Type of identification) ..
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Form PUR 7068 (Rev. 06/18192)
. .
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C .'1STRUCTlON INDUSTRY
NOTICE OF ELECTION TO BE EXEMPT FROM
THE PROVISIONS OF THE FLORIDA WORKERS' COMPENSATION LAW
STATE USE ONLY
~~ IJ otq roSTMARK DATE I
\.U """p ~ l Thla nollc:e thaU be In dfm for two (2) )'CIlS ffom &he
errCC1lvo dale or unlil
:30 ~\ ~~ l~~~tL TYPt J~(~lNT: or until ~. whichever comes lint
RF.: _~~ C:E- 2J\}'1 LA IN 0- N1 Pti t\J\.DJ\} PtN c.L..
II...,~I n".\"\us "'~~. or Sole Proprictonh~ Pt.nn4&Ip. or Corpamloll) ~AI 'I ~)
.rO-b))( .} 'lLo ~ .. ~d-b() ~. ~~~ rty
I~b,hnl \~'-\ lUes, noR, &A )6()'10 (SlRd~'~5~ t{lf i5q to
IC"yl (Sl&le) (ZJp) (ndtnl ~ IcIatir-uo. H~
Nature of I3usiness or Trade: .....'tA.0 rlVR I A L . Sf /).. 1/1U-
MAIl. TO: Department of Labor &. Employment Security
Bureau of W.C. Compliance ,
2728 Centerview Drive, 100 Forrest Bldg.
Tallahassee, Florida 32399-0661
.~I
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It:C'rr .r__
As of 12;01 a.m. 30 days following the date of the mailing of this (onn, you arc hereby notified that the (ollowing Sole Proprictor,
Panncr N Corporate Officer of the above named business does elect 10 be exempt from. the provisions of the Florida Woders'
Compensation uw. I unde~tand that by this Betion I am not entitled to benefia under chapter 440, Florida Statute:!. By filing this
flJfnl I hJ\'c nol exceedcd the exemption limit of three Partners or three Corporate Officers. 1 further certify that any employees of the
business named above arc covered by workers' compensation Insurance,
The: following are the cenificd or registered licenses held ~ meqursuant 10 chapter~tatutel arnone, so state):
(I) T~pc: ~~ ~ . Number: -==*SCO 1 1.3 oj m 1)rpe: . Number. ';;)'&5b (~
INSURANCE CARRIER INfORMATION (If Applicable): A construction industry employer with one (1) or more employees mu~t
maintain Workcrs' Compensation coverage. Failure to comply will result in" five-hundred doUar ($~) fine and on -h.mdrcd
dollar (S 100) fine: for each day of noncompliance (see section 440.43, ES.).
~
~
~
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Signature Social Security Number
l)'pc/I"rint Name I:-u E:.~ 1'(: .l
Position: Proprietor ~rtnerl-'or/orflcer (litle) . :.:'
. ..:'.. -
IMPORTANT: Individual exemption filing fee, pursua~t to Section 44O.0S, f.s:;K'~n dollara and fifty c::entJ (Si.sO) and is
r3)'~hle only by money ordcr or cashier's check. to w.e. Administrative ihJst Fund. nilure to enclose fee wiIJ resullln return of
fcq\le~t :lnd delay of cenification.
Name.of Carrier
.........................
C:ml'tT Address
~
Policy Number
Insurance Agent (Agency)
Agency Address
AT
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CERTIFICATE OF INSURANCE
ISSUE DATE (MMIDD/YY)
The Fullers Inc
3600 Roosevelt Blvd
Key West, FL 33040
02-18-93
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON"[YANO----.
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
~,,,.." -'~-~"--'~-~'-~-'~'~--""'''''---'''' ~""-'-""'-'" '__',,~-,-~'
PRODUCER
COMPANIES AFFORDING COVERAGE
f~T~~~NY A
Bankers
INSURED
f~T~~~NY B
Western
Judy Bobick dba
Ace Building Maintenance
PO Box 2763
Key West, FL 33045
f~T~~~NY C
f~T~~~Y D
f~T~~~NY E
COVERAGES
THIS IS TO CERTIFY THAT 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDD/VY) DATE (MMIDD/YY)
LIMITS
GENERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR, 93-179
OWNER'S & CONTRACTOR'S PROTo
02-18-93
02-18-94
GENERAL AGGREGATE $500,000
PRODUCTS-COMP/OP AGG. $500,000
PERSONAL & ADV, INJURY $500,000
EACH OCCURRENCE $500,000
FIRE DAMAGE (Anyone fire) $ 50,000
MED, EXPENSE (Anyone person) $ 5,000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
COMBINED SINGLE
LIMIT
$
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
AGGREGATE
$
$
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY LIMITS
EACH ACCIDENT
DISEASE-POLICY LIMIT $
DISEASE-EACH EMPLOYEE $
OTHER
B Janitorial Services
Bond
TBA
Applied For
$5,000
DESCRIPTION OF OPERA TIONS/LOCA TIONSIVEHICLES/SPECIAL ITEMS
Janitorial Services
CERTIFICATE HOLDER AND ADDITIONAL. INSURED:
CANCELLATION
Board of Monroe County Commissioners
5100 College Rd, Stock Island
Key West, FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY 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 COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-5 (7/90)
A.~..llIt~ . CERTIFICATE OF INSURANCE
ISSUE DATE (MMiDDIYY)
2/18/93
PRODUCER
ISLAND INSURANCE
3229 FLAGLER AVE #112
KEY WEST,FL. 33040
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
COMPANIES AFFORDING COVERAGE
~~~~~NY E
'~U),'
.~~"
J
- ,
co.
~~~~YA BANKERS AND SHIPPERS
CODE
SUB-CODE
INSURED
~~~~~NY B
JUDY T. BOBICK
ACE BUILDING MAINTENANCE
1200 20 TH TERR
KEY WEST,FL. 33040
~~~~~NY C
~~T~~~NY D
COVEfitAQES
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMiDDIYY) DATE (MMiDDIYY)
ALL LIMITS IN THOUSANDS
CLAIMS MADE
OCCUR.
GENERAL AGGREGATE
PRODUCTS-COMPIOPS AGGREGATE $
PERSONAL & ADVERTISING INJURY $
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
OWNER'S & CONTRACTOR'S PROT,
EACH OCCURRENCE
$
FIRE DAMAGE (Anyone fire) $
MEDICAL EXPENSE (Anyone person) $
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
XX SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
COMBINED
SINGLE
LIMIT
BODILY
INJURY
(Per person)
BODILY
INJURY
(Per accident)
$
$ 300
PROPERTY
DAMAGE
$
EXCESS LIABILITY
EACH AGGREGATE
OCCURRENCE
$ $
OTHER THII,N UMBRELLA FORM
STATUTORY
WORKER'S COMPENSATION
(EACH ACCIDENT)
$
I
(DISEASE-POLICY LIMIT) I
(DISEASE-EACH EMPLOYEEI
AND
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS
1987 NISSAN STANZA
VIN:JNIHM05S1HX071568
CERTIFtCATEHOL.OER
BOARD OF COUNTY
5100 COLLEGE RD
KEY WEST,FL. 33040
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOF~ TO
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO rHE
LEFT, BUT FAILURE TO SUCH NOTI HALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY K D UPO PANY, IT AGENTS OR REPRESENTATIVES,
~~~5e REP ,
ACORD 25.S '3/88
i
i
@ACORD CORPORATION 1988: