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Certificates of Insurance
OP ID P DATE (MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE SALUT-3 080s 05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Johnsons Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 30975 Avenue A Big Pine Key FL 33043 Phone:305-872-2888 Sa.lite Fran Gonzon 1000 Atlantic Blvd. Kett West FL 33040 rnVFRAf:F_Q INSURERS AFFORDING COVERAGE INSURER A: QBE Insurance C INSURER B: INSURER C: INSURER D: INSURER E: ration NAIC # 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DDlYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES(Eaoccurence) $50,000 A X COMMERCIAL GENERAL LIABILITY SIG10043405 07/05/05 07/05/06 MED EXP (Any one person) $ 5 r 000 CLAIMS MADE FX] OCCUR PERSONAL & ADV INJURY $ 1 r 000 , 000 X liquor liability GENERAL AGGREGATE $ 1 , 000 r 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1 , 000 , 000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY - AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY; AGG $ ANY AUTO HJ ^ r ail i .:ii ell"1V;�t -iy" $ EXCESS/UMBRELLA LIABILITY -7 - V. EACH OCCURRENCE $ OCCUR CLAIMS MADE r V (�� AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND TDRY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER � ' (AA ki DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS restaurant (receipts breakdown: 420000 food/180000 liquor)*The amount of coverage on this certificate applies for the total amount of coverage available for all jobs and locations.*ADDITIONAL INSURED IS MONROE COUNTY BOCC* CERTIFICATE HOLDER CANCELLATION MONRO— 6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Monroe County BOCC IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 Simonton Street Key West FL 33040 REP ESENTATIVES__ Jo#hthan H . Dia:d $hd ' - - " `" ' - — '`_` ACORD 25 (2001 8) © ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE CSR JD I DATE(MM/DD/YYYY) SALUT-3 12 29 05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Johnsons Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 30975 Avenue A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Big Pine Key FL 33043 Phone : 305-872-2888 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: QBE Insurance Corporation Key West Hospitality LLC DBA INSURER B: Salute INSURER C: Fran Gonzon 1000 Atlantic Blvd. INSURERD: Key West FL 33040 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EF/D TIVE DATE MMDlYY P IRATI ON DATE MMlDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR SIG10043405 07/05/05 07/05/06 PREMISES(Eaoccurence) $50,000 MED EXP (Any one person) $ 5,000 X liquor liability PERSONAL &ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 1 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS - BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS ' PAV=RIiS y F1( AGE d� VE s, - PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO vn 6 C _ 7 - 7 �-� '-'"` AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ $ WAIVE v�sAUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY 71 OCCUR CLAIMS MADE V ` EACH OCCURRENCE $ AGGREGATE $ Y�2 DEDUCTIBLE RETENTION $ - $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMT I JOTH- ITS ER E.L. EACH ACCIDENT -- $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS restaurant (receipts breakdown: 420000 food/180000 liquor)*The amount of coverage on this certificate applies for the total amount of coverage available for all jobs and locations.*ADDITIONAL INSURED IS MONROE COUNTY BOCC* %.crc i irra.h i c nvi-ucm UANUtLLA I IUN Monroe County BOCC 1100 Simonton Street Key West FL 33040 MONRO— 6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMP NO OBLIGATION 07 LIABILITY 7A/JJY KIN PON THE INSURER, ITS AGENTS OR / R ENTATIVES, i / A H. Diamond ACORD 25 (2001/08) GG = © ACORD CORPORATION 1988 Part 2: TIIIS DECLARATION PAGE, WITII POLICY PROVISIONS - PART I AND ENDORSEMENTS, IF ANY ISSUED TO FORM A PART TIIEREOF, COMPLETE ; Ilh BEI,C:W NLJMAERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY. CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY 6676 Corporate Center Parkway, Jacksonville, Florida 32216-0973 INSURED NAME AND ADDRESS CITIZENS THIS IS A KEY WEST HOSPITALITY LLC DBA SALUTE GENERAL BUSINESS 1000 ATLANTIC BLVD KEY WEST, FI, 33040 POLICY TERM 7j 05/2005 TO 7/05/2006 AT 12:01 A.N. (EST) CITIZENS POLICY NO. 1413349 INCEPTION DATE EXPIRATION DATE THIS IS YOUR POLICY llECLARATION PAGE - This is not a Bill 1 150,000 80 4,500 T-86 771 50,000 80 1,500 T-86 257 ONE STORY MASONRY RESTAURANT BLDG LOC: 1000 ATLANTIC BLVD KEY WEST, MONROE FL 33040-4852 OATE IAIAIVE-R P - I PAGE 1 Florida Hurricane Cat Fund I DO NOT PAY $ 1,028.00 S 00 $ Reins/Cat Financing Subject to Form No(s) : (.5100 RETAINED) CIT CP2 CIT-W06 Mortgagee/Loss Payee: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON STREET KEY WEST, FL 33040 C� : ) y`Q �,�C ¢___. Agent: HARRIS JOHNSON CORP 0739 THE JOHNSONS INS AGENCY 30975 AVENUE A BIG PINE KEY, FL 33043 (305) 872-2888 CIT-W03 (7/02) 07398 Team 3 r: INSURED Date: 8/24/2005 MORTGAGEE COPY AXG N 39517 139 ACORD CERTIFICATE OF LIABRI ITY INSURANCE OP ID P DATE(MM/DDnrrY) SALUT-3 4 OS 10 06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Johnsons Insurance Agenc _. _, --__ .._ R. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 30975 Avenue A p r '; rrl ALTE THE COVERAGE AFFORDED BY THE POLICIES BELOW. Big Pine Key FL 33043 RECENt0 Phone:305-872-2888 I SURE S AFFORDING COVERAGE NAIC# INSURED:: IN URER Florida Retail Federation. — Salute MAY 1 2 L�U6 IN URER Fran Gonzon IN URERC 1000 Atlantic Blvd. IN URERO Key west FL 33040 MONROE COUNTY --- INSURER E rnviceer_ec 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. NaK LTR NSRE TYPE OF INSURANCE POLICY NUMBER DATE MM/DDIYY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AL LIABILITY CLAIMS MADE OCCUR a MIS PREES (Eoo a ourence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO - LOG PRODUCTS - COMPIOP AGO $ AU AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS - _ � - BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY accident) $(Per PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY j AUTO ONLY - EA ACCIDENT $ ANY AUTO v THAN EA ACC $ AUTO ON AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY -] OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 520339190000 07/05/05 07/05/06 TORV'TAT LIMITS ER E.L. EACHACCIDENT $500000 OFFICERIMEMBER EXCLUDED' S yes, tlesPRO under SPECIAL PROVISIONS below E.L. DISEASE -EA EMPLOYEE $ 500000 E.L. DISEASE -POLICY LIMIT $5QQ 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *The amount of coverage on this certificate applies for the total amount of coverage available for all jobs and locations.*Certificate holder is also additional insured.* MONRO-6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATM DATE THEREOF, THE. ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1100 Simonton Street Monroe County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Key west FL 33040 R SENTATIVES. — GG . t, .�)4 r?Gie� Proc...ed 6y: /merican POLICY #: 87024521882005 PZeeurenee ProceeCenterAIN, P..O.O. Box 2057 kellepell ll Prf S990J-305'i is RECEIVED JUL 2 5 2015 srt , For payment steins, call: 10591 245-7274 �raw FLOOD POLICY DECLARATIONS New Policy TYPE: GENERAL POLICY PERIOD: 8/04/2005 to 8/04/2006 CG These Declarations are effective as of: 8/04/2005 at 12:01 AM PRODUCER MAKE a MAILING ADDRESS PRODUCER$: 06840-00862-000 HARRIS JOHNSON CORP DBA JOHNSONS INSURANCE AGENCY PO BOX 522346 MARATHON SHORES, FL 33052-2346 POLICY INFORMATION PRE241 M PAYOR: Insured INSURED PROPERTY ADDRESS 1000 ATLANTIC BLVD KEY WEST, FL 33040-4852 BUILDING DESCRIPTION Non -Residential One Floor No Baeselant PROGRAM Regular INSURED NAME a ADDRESS SALUTE HOSPITALITY LLC KEY WEST 1000 ATLANTIC BLVD KEY WEST, FL 33040-4852 C01MU gITY lam COMMONITY NUMBER KEY WEST, CITY OF 1201681516K Coverage Limitations May Apply, Refer to your Standard Flood Insurance Policy for details. FLOOD ZONE VE C WEIZAGE S RATING INFORMATION BUILDING CONTINTS Coverage: $150,000 Coverage: $50,000 Deductible: $5,000 Deductible: $5,000 Rates: 1.100/ 2.660 Rates: 2.140/ 2.670 FIRST MORTGAGEE MONROE COUNTY BOARD OF COUNTY 1100 SIMDNTON ST KEY WEST, FL 33040.3110 POLICY TERM: One Year CONTESTS LOCATION Lowest Floor Only Above Ground Level Pre -Firm Construction a- opj' —:..1 Premium Subtotal: $2,420.00 Previous Premium Subtotal: $2,420.00 ICC Premium: $75.00 CBS Discount: $.00 Expense Constant: $.00 Federal Policy Fee: $30.00 Endorsement Amount: $.00 Total Premium: 2ND MORTGAGEE $2,525.00 1�a This Declarations Page, in conjuntion with the policy, Constitutes your Flood Insurance Policy. IN WITNESS WHEREOF, we have this policy be1o, w yE hereby t!r i to this Insurance Agreement. F S/t.//+7 (/r CJYWPRODUCER COPY BLD President CreTaty 7/20/2005 American Strategic Ins ce 3N A17 anc 2, Part 2: THIS DECLARATION PAGE, WITH POLICY PROVISIONS - PART 1 AND ENDORSEMENTS, IF ANY ISSUED TO FORM A PART THEREOF, COMPLETE THE BELOW NUMBERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY. CITIZENS PROPERTY INSURANCE CORPORATION; WIND ONLY POLICY 6676 Corporate Center parkw;% Jackgpuydlle, Florida 31216-0973 INSURED NAME AND ADDRESS , ITIZENS THIS IS A KEY WEST HOSPITALITY LLC DBA SALUTE J�^`P' GENERAL BUSINESS 1000 ATLANTIC BLVD p i KEY WEST, FL 3304.0 L--------------1 { MO'siOE COL'PiTY } POLICY TERM 7 95/2"6 TO 7/05 2007 rx-ff. ES --""—POLICY NO, 1413349 I CEPT ON DATE UPIEATION FATE THIS IS YOUR POLICY DECLARATION PAGE - This is not a Bill 1 $ $ 1 $ $ 161,000 80 4,830 T-86 54,000 80 1,620 T-86 ONE STORY MASONAY RESTAURANT BLDG LOC: 1000 ATLANTIC BLVD KEY WEST, MONROE FL 33040-4852 C�. P - I 828 278 Florida Hurricane Cat Fund DO NOT PAY $ 1,106.00 $ .00 $ Market Eq Sur 76.00 aeinaiCat Financing O1 G nnn m-- a.... --I o...- � o nn $ "1 — .�.. GC MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON STREET KEY WEST, FL 33040 HARRIS JOHNSON CORP 0739 THE JOHNSONS INS AGENCY 30975 AVENUE A BIG PINE KEY, FL 33043 INSURED (305) 872-2888 CIT-won (7/021 07398 Team 3 Date: 7/21/2006 MORTGAGEE COPY -01 R 40111 1743 ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID P DATE(/15/07 SALUT-3 Ol 15 07 =RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Johnsons Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURED _Y_ " ---__--- -_--- ----- — -` -�ISUR S AFFORDING COVERAGE — BELOW. 30975 Avenue A —LTE THE COVERAGE AFFORDED BY THE POLICIES Big Pine Key FL 33043 Bhone-305-872 -2888 NAIC#._ Salute Fran Gonzon 1000 Atlantic Blvd. Key West FL 33040 COVERAGES JAN 17 C07 )i1 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY AED UIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PEPTAIN. 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. LTR I11Nq TYPE OF INSURANCE OLICY EFFECTIVE I POLICY NUMBER DATE MM/DDIYY POLICYE PJT IRAOEIO DATE MM/DDIYY --' "-------- LIMITS GENERAL LIABILITY A �x COMMERCIAL GENERAL LIABILITY SIG10043406 _--I CLAIMS MADE L,'OCCUR . 07/05/06 07/05/071 EACH OCCURRENCE $ 1 r 000 , 000 PREMISES (Ea $1QOr000 MED EXP(Any ane person) $SrQQQ PERSONAL B ADV INJURY S 1 r 000 r 000 _}{ liquor liability GENERAGGREGATE 31 OOOrOQO 6 NI AGGREGATE UNIT APPLIES PER POLICY PRO _JECT LAC PRODUCTSI-COMPIOp qGG - $1,000r OOO — AD OMOSILE LIABILITY RNY AUTO COMBINED tSINGLE LIMIT $ 'IF OWNEDAU-OS - C4 EDUCED ALTOS BODILYINJURY '', (Per person) -- -- HILLS AUTOS - N OWNED WrUS �. BODILY INJURY (Per ao,'dent) — -- $ �- -- - --- I �� I - C PROPERTY DAMAGE (Per accitlenl) $ GARAGE LI ABILITY r — 4 ~ ANY'IITO i - AUTO ONLY - EA ACCIDENT $ - _-- - $ _— OTHER THAN EAADD AUTO ONLY. AGG $ EXCE$S/UMBRELLA LIABILITY i �EAGHOGGURRENCE CLAIMS MADEAGGREGATE $OCCUR DEDUCTIBLE� RETENTION $ Is WORKERS COMPENSATION AND LIABILITY II 'TORV LIMIT$ ER E. L. EACH ACCIDENT IS _ ANY PROPRIETOR/PARTNERIEXEGUTIVE OFFICER/MEMBER EXCLUDED'-"--- p yes tlescnbe antler SPECIAL PROVISIONSbelow E.L. DISEASE - EA EMPLOYEE, - $ E. L. DISEASE -POLICY LIMIT is _ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS restaurant*The amount of coverage on this certificate applies for the total amount of coverage available for all jobs and locations* HOLDER IS ALSO ADDITIONAL INSURED*HOLDER: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS* CERTIFICATE HOLDER CANCELLATION MGNRG-6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Monroe County BOCC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $0 SHALL 1100 Simonton Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Key West FL 33040 4EPIESENTATIVES. �. ALIT REFINES TAfiIVE. _ J nathan H. Diamond ACORD 25 (200108) ©ACORD CORPORATION 1981 GG= 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 ACOR-a CERTIFICATE OF LIABILITY INSURANCE CADID D P� DA'E1(M ^DDDIWY() TST PRODUCER The Johnsons Insurance Agen 30975 Avenue A Big Pine Key FL 33043 Phone:305-872-2888 INSURED Salute Fran Gonzon 1000 Atlantic Blvd. 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 THE COVERAGE AFFORDED BY THE POLICIES BELOW. �RECEIVED --- I SURE DEC 5 I LId It SURER SURER SURER MONROE COUNTY -11 SURER INSURER IS AFFORDING COVERAGE Insurance NAIC # 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. IRISHPOLICY LTR NSR TYPE OF INSURANCE NUMBER POLICYEFFECTIVE DATE MM/DD/YY P LICYEXPIRATI N DATE MM/DD/Y1' LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 PREMISES(Eeoccurence) $100,000 A X COMMERCIAL GENERAL LIABILITY SIG10043406 07/05�06 07/05/07 CLAIMS MADE � OCCUR MED EXP (Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 K liquor liability GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 PO_ICY PRO- LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ - GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ ` AUTO ONLY'. AGO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AI1 AGGREGATE $ 1A. $ $ DEDUCTIBLE $ RETENTION $_ .__-_. ... WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC sm� TORY LIMITS I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE$ OFFICERIMEMBER EXCLUDED? t 1 If yes describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT 1 $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS restaurant*The amount of coverage on this certificate applies for the total amount of coverage available for all jobs and locations* HOLDER IS ALSO ADDITIONAL INSURED* CG,' r4 -1 'n�i A-if�t MONRO- 6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Monroe County BOCC IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 1100 Simonton Street Key West FL 33040 REP SENTATIVES. ACORD 25 (20011081 n ACnRn (nFHs TRATInM IQRR Pan 2: THIS UP(TARA17ON PAGH. WI'FH P(11.I('Y PROVISIONS- PART I AND INDORSI'MLN1R. IP ANI, IS,ti I -IF) 101 ORM APART THEREO1:. ( OMPI.1: H; THE BELOW NIA113ERED C["D/ENS PROPER I'Y INSURAN(T CORPORA I ION POLICY CITIZENS PROPERTY INSURANCI} CORPORATION, WIND ONLY POLICY 6676( Ip,lrnla (\mI k1naks{11jAl. thTida 322i6-0073 I(c I'MIE D II, kr�.,� KEY WEST HOSPITALITY LLC DBA SALUTE 1f SC�TIZ�IVst _- j THIS IS A GENERAL BUSINESS 1000 ATLANTIC BLVD EP KEY WEST, FL 33040 J PnLICY TERM 9/20/220-1TO 9/20/2008 A't12 :01 A.M (E619 '�i CITIZENS PpLICY 110, 1413349 INCEPTION HATE EXPIRATION DATE TILE is your Policy Dechiration I — this is not a Bill - DO NOT PAY rn�a 1 " -` V DEDUCTIBLES. -�' Co ntenCs �j, ili : Tetu Cety Fremrum 1 172,000 80 5,160 T-86 884 54,000 80 1,620 T-86 278 ONE STORY MASONRY RESTAURANT BLDG LOC: 2000.ATLANTIC BLVD KEY WEST, MONROE FL 33040-4852 Total Coverage amount: $226000 'Total Premium amount: $1 408 Premium Amount $1, 162 2005 Florida I lulTicane Calasnnphe Fund Emergency Assessment $12 Tux Exempt Surcharge $20 Catastrophe Reinsmance Surc'h:u'ge $174 2005 C1117Cns Emergency Assessment $16 2005 Market Equalmition Smchage $24 Subject to Form No(s)- CIT CP2 CIT-W06 Moetgaiee/Lose Payee: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON STREET KEY WEST, FL 33040 c : r l.A-. Kan �� Aa=nt: HARRIS JOHNSON CORP 0739 THE JOHNSONS INS AGENCY 30975 AVENUE A BIG PINE KEY, FL 33043 ayoi: INSURED (305) 872-2888 I Date9/20/2007 CIT-?!03 07 07 07398 Team 3 MORTGAGEE COPY -01 QSY R 40111 1878 Certificate of Insurance Page 1 of 1 t;LI-IJv_r7f? Florida Retail Federation { I Self Insurers SEP 1 1 Board of Trustees Fund — I "Bill" Kund a, ice Chairman _� 'eore¢ Sandefer, Vice C'Gurrnvun h'i 1 ti I!y John D. flansclman Adu.Fnistered An Sun+uai/since 1979 — _ _� cylT N15 Nissen P_O- Box 98S • Lakeland, Fl- 33802-0988 • unvx.s.,uiholdlrrgs.com ----_, Thomas S. Petcoff Telephone (863) W-6060 or I-800-282-7648 • Fax (863) 666-1958 Charles R. Wintz CERTZ€-'Ia,ATE OF'»1dSSURANCe RE:0520-33919 ISSUED TO: Monroe County BOCC 1100 Simonton St Key West, FL 33040 This is to certify that Key West Hoitality, LLC 100.0. Atlantic Boulevard Key Wes00 t FL 33040-0, being subject to the provisions of the Florida Workers' Compensation Law, has secured the payment of any workers' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund. POLICY NUMBER: 0520-33_919 WC Statutory Limits --State of Florida Employers Liability EFFECTIVE DATE: July 05,._2007 500,000 (Each Accident) 500,000 (Disease --Each Employee) EXPIRATION DATE: July_05, 2008 500,000 (Disease --Policy Limit) This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be construed as amending, extending, or altering coverage not afforded by the policy shown above or affording insurance to any insured not named above. The policy of insurance listed above has been issued to the named insured for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document to which this certificate may pertain, the insurance made available by the described policy in this certificate is subject to only the terms, exclusions and conditions of such policy. Paid claims may have reduced the shown limits. If the policy described above is cancelled before the expiration date indicated, the issuing company will attempt to mail 30 days' written notice to the certificate holder named above, although if cancellation is for nonpayment of premium, then the issuing company will attempt to mail 10 days' written notice to the certificate holder. In any event, the issuing company, its agents, and representatives accept no obligation or liability of any kind for failure to mail such notice. Date: September 18 2007 ,�umnnt, .administrator Florida Retail Federation Self Insurers Fund https://www.sumniitholdings.com/summitweb/secure.nsf/coi_coiaddprint?openform&polio..- 9/18/2007 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID JD 7INFORMATIO Y) SALUT-3 B PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OIOONLY AND CONFERS NO RIGHTS UPON THE C The Johnsons Insurance Agency F IS CERTIFICATE DOES NOT AMENOR13361 overseas E[ighray TER THE OVERAGE AFFORDED BY THE POOWMarathon FL 33050�Phone:305-289-0:213 ---`"-'"-" 7N§U RE_tS AF ORDING COVERAGE..._..-__ Salute Fran Gonzon 1000 Atlantic Blvd. Rey West FL 33040 1' U . INSURER yrj`,— V '� I"NT$YUeER EE: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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_ LTft INSRE TYPE OF INSURANCE POLICY NUMBER P L EFF IVE DATE MMIDDIYV ICY I I DATE MMIDDIYY LIMITS X GENERAL LIABILITY TXCCMMERCIAL CIENERAL LIABILITY MADE ❑OCCUR Llibility CPFLQQQQ71 CPFL000071 01/09/08 Ol/09/08 01/09/09PREMISES 01/09/09 EACH OCCURRENCE $11000,000 (Ea occurenca) $1QQ, QQQCLAIMS MED E%P (Any one person) gS, QQQquor PERsoNALagov lNJuftv $1, 000, 000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIM ITAPPLIES PER'. POLICY F'R6 ECT El CC PRODUCTS-COMPIOPgGG $1, QQQ, OOO AUTOMOBILE LIABILITY UTO OWNED AUTOS ULED AUTOS \\' 1 I I YYY Il!/�/ ,-;.j- COMBINED SINGLE LIMIT (Ea accident) $ BODILYINJURV (Parpenon) $ AUTOS W NED AUTOS — BODILY INJURY (Peraccident) $ PROPERTY DAMAGE (Per accident) $ BILITYAUTO tSO UTOOTHER ONLY -EA ACCIDENT $ TNAN EA ACC AUTO ONLY: AGG 8 $ BRELLA IJABILITY ❑CLAIMS MADE y _�VI11'/JAGGREGATE \ EACH OCCURRENCE $ $ TIBLE TION 8 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDEDi E L. EACH ACCIDENT $ If yes, deecdce under SPECIAL PROVISIONS Im Iow OTHER E.L. DISEASE - EA EMPLOYE E.L. DISEASE -POLICY LIMIT $ $ A Property Section LL100043-1 09/19/07 09/19/08 Building 150,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS HOLDER IS ALSO ADDITIONAL INSURED Contents 75,000 CG��ha�rc� CERTIFICATE NnI nFR ,...,.._.. __._.. MONRO-6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Monroe County BOCC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1100 Simonton Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR Rey West FL 33040 REPRESENTATIVES. AUT119IRTZEIP PAPRIESENTATIVE w Lam'" Untitled (32).max Part 2: THIS DECLARATION PAGE, WITH POLICY PROVISIONS - PART 1 AND ENDORSEMENTS, IF ANY ISSUED TO FORM A PART THEREOF, COMPLETE THE BELOW NUMBF,RED CITIZENS PROPERTY INSURANCE CORPORATION POLICY. CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY 6676 Corporate Center Parkway, Jacksonville, Florida 32216-0973 INSURED NAME AND ADDRESS <""CITIZENS THIS IS A 1000 ATLANTIC BOULEVARD, LLC 729 THOMAS ST KEY WEST, FL 33040 GENERAL BUSINESS POLICY TERM 10/16/2010 TO 10/16/2011 AT 12:01 A.M. (EST) CITIZENS POLICY NO. 1473301 INCEPTION DATE EXPIRATION DATE This is your Policy Declaration Page - This is not a Bill - DO NOT PAY PAGE 1 AM UNT OF INSURANCE Percent. of DEDUCTIBLES Territory Premium Coinsurance Item No. Building Contents Applicable 1 351,000 80 10,530 T-86 2,381 150,000 80 4,500 T-86 933 ONE STORY MASONRY RESTAURANT BLDG & CONTENTS NOT TO INCLUDE FABRIC CANOPY LOC: 1000 ATLANTIC BLVD KEY WEST, MONROE FL 33040-4852 2 58,000 0 80 1,740 T-86 393 ONE STORY MASONRY RESTAURANT AUXILIARY BLDG V CV 0 N O Go O v) 00 O Q a Total Coverage: $559 000 Payment Plan: Full ay Total Premium: $4 469 Premium Amount $ 3 , 7 07 2005 Citizens Property Insurance Corporation Emergency Assessment $ 5 2 Tax Exempt Surcharge $ 65 2005 Florida Hurricane Catastrophe Fund (FHCF) Emergency Assessment $ 37 p Catastrophe Reinsurance Surcharge $ 5 5 6 2007 Florida Insurance Guaranty Association Regular Assessment $16 2009 Florida Insurance Guaranty Association Regular Assessment $ 36 Subject to Form No(s): Mortgagee/Loss Payee: MORTGAGEE/LOSS PAYEES LIST ON ADDITIONAL, PAGE �= Agent: —y— KEYS INS SERVICES, INC. 5017 INSURED P.O. BOX 500280 MARATHON, FL 33050 Date: 9/13/2010 (305) 743-0494 CIT W03-CNR 01 10 50176 Team 3 MORTGAGEE COPY -02 QSY R 40111 80 LTOSO TO££LPT 39V511dON MONROE COUNTY BOCC (LOSS PAYEE) 1100 SIMONTON ST KEY WEST, FL 33040 OSO££ 73 'NOHIV'dVW OBZOOS XOH '0'd LTOS 'ONI 'SZOIA'dHS SNI S)CHM Part 2: THIS DECLARATION PAGE, WITH POLICY PROVISIONS - PART I AND ENDORSEMENTS, IF ANY ISSUED TO FORM A PART THEREOF, COMPLETE THE BELOW NUMBERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY. CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY 6676 Corporate Center Parkway, Jacksonville, Florida 32216-0973 49""CIT1ZENS THIS IS A INSURED NAME AND ADDRESS 1000 ATLANTIC BOULEVARD, LLC 729 THOMAS ST KEY WEST, FL 33040 GENERAL BUSINESS POLICY TERM 10/16/2010 TO 10/16/2011 AT 12:01 A.M. (EST) CITIZENS POLICY NO. 1473301 INCEPTION DATE EXPIRATION DATE This is your Policy Declaration Page - This is not a Bill - DO NOT PAY PAGE 2 AM UNT F IN URAN E Percent of DEDUCTIBLES Premium Item Coinsurance Territory No. Building Contents Applicable MORTGAGEE/LOSS PAYEES: 1 TIB BANK OF THE FL KEYS ISAOA P 0 BOX 280 KEY LARGO, FL 33037 LOAN #141419529156 2 MONROE COUNTY BOCC (LOSS PAYEE) 1100 SIMONTON ST KEY WEST, FL 33040 I Total Coveraee• Payment Plan: Total Premium: Subject to Form No(s): CIT CP2 01 10 CNRW 01 10 01 10 CIT 18 18 01 10 Mortgagee/Loss Payee: Agent KEYS INS SERVICES, INC. 5017 P.O. BOX 500280 MARATHON, FL 33050 Payor: INSURED Date: 9/13/2010 (305) 743-0499 CIT W03-CNR 01 10 50176 Team 3 MORTGAGEE COPY -02 QSY R 40111 81 LTOSO TO££LPT HSV5lx0w 65 MONROE COUNTY BOCC (LOSS PAYEE) 1100 SIMONTON ST KEY WEST, FL 33040 O90££ 73 'NOHIV'd W 0 eOOS XOH 'O'd LTOS "ONI 'S33IA2iZS SNI SXHM .aco CERTIFICATE OF LIABILITY INSURANCE 1/4M/DD/YY �� 11/40 /2010 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 5800 Overseas Hwy #43 E AFFORDED BY THE POLICIES BELOW. P.O. Box 500280 .6L1 VI r Marathon FL 33050-0280 ERS-A ING OVERAGE NAIC# INSURED INSURER A. Lloyds of london 1000 Atlantic Blvd LLC, DBA: Salute Res our nt I URERJFNIDS ita ity Mutual Ins Co 729 Thomas Street INSURER C: Key West, FL 33040 UNTY nnVFRenFC Orl 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 ADD'LI D TYPE OF INSURANCEPOLICY NUMBER LTR INSX f POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MM/DDNYYYI GENERALMMERCALL EACH OCCURRENCE $ 1, 000, 000 0, _._ GENERAL LIABILITY A X r i ETORENTED $ PREMIDAMASES ! PREMISES1Ea occurrence - 50, 000 CLAIMS MADE X OCCUR ARPI6829B1D 10/16/2010 !, 10/16/2011 �MEDEXP(Any one person) 1, 000 PERSONAL& ADV INJURY $ 1,000,000 ' GENERAL AGGREGATE $ I 2, 000, 0_0_0_ GEN'LAGGRE GATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 000,-000 X I POLICY PRO- JECT LOC _1, p AUTOMOBILE LIABILITY, COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO - -� ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS Y, (Per person) $ HIRED AUTOS - - -- --- - r- BODILY INJURY $ NON -OWNED AUTOS t Per accident - ---- -- _ _ PROPERTY YDAMAGE 1 GARAGE LIABILITY`. t n - AUTO ONLY_- EA ACCIDENT $ - - ANY AUTO OTHER THAN EA ACC $ —.- AUTO ONLY: AGG$ _EXCESS �—� I OCCUR UMBRELLA LIABILITYLAIS MADE L—,1 / tv EACH OCCURRENCE $ f - AGGREGATE $ - - DEDUCTIBLEk. 1 Jf / - -- $ -� $ - — —.— � $ --L '� $ $ WORKERS COMPENSATION SATION � � � WC STATU- I IOTH- AND EMPLOYERS' LIABILITY Y/N ANY ❑' :OC30600058172010 ,.____-LOSY_LIMLTS� �_ EACH ~$ 100,000 (Mandatory in If es, describe under yy 1 1 2010 1 1/2011 / / / E L_D SEASECIDENT EA EMPLOYE $ 100,000 SPECIALsPROVnder below E E.L. DISEASE POLICY LIMIT $ 500,000 OTHER i I DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Monroe County Board Of County Commissione DATE THEREOF, THE I I INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 1100 Simonton Street NOTICE TO THE CE IFI TE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Key West, FL 33040 IMPOSE NO OB ; IS')�J OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR TIVE tom,.,,..•„ . / kO I %10 f-ZUUU AUUKU cU11PORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD ® Policy Number:87043272272010 !?Y�!ncan5elect[nsuranceCompany FLOOD POLICY DECLARATIONS Liberty American Select Insurance Company - LU T �� TAVJAA) 7- Type: Renewal To report a claim call: (800) 759-8656 Policy Period: 10/16/2010 To 10/16/2011 These Declarations are effective Form: General Property as of: 10/16/2010 at 12:01 AM Producer Name and Mailing Address: Insured Name and Mailing Address: KEYS INSURANCE SERVICES INC PO BOX 51000 ATLANTIC BLVD LLC MARATHON,, FFL 33050-0280 729 THOMAS ST tN L KEY WEST, FL 33040-7334 ►r M Agent/Agency #: 2921 Reference #: 08443 - 00807 - 000 Phone k (305)743-0494 Insured Property Address: 1000 ATLANTIC BLVD KEY WEST, FL 33040-4852 Premium Payor: Insured Rated Zone: VE Current Zone: Community Number: 12 0168 1516 K Community Name: KEY WEST, CITY OF Grandfathered: No Pre -Firm Construction Program Type: Regular Type Coverage Rates n Building. 200,000 1.100 / 2.960 Contents: 150,000 2.140 / 4.700 Contents Lowest Floor Only Above Location; �� ..�� First Mortgage: TIB BANK PO BOX 2808 0 ;. KEY LARGO, FL 33037 Second Mortgage: Processed by: Flood Insurance Processing Center P.O. Box 2057 Kalispell MT 59903-2057 Coverage Limitations May Apply, Refer to Your Flood Insurance Policy for Details. Building Description: Non -Residential One Floor Slab On Grade RESTAURANT Replacement Cost: $596,250 Number of Units: 1 one 187 Sub Total Premium Calculation 200,187 Premium Suhtotal: 5,463.00 225 150, 225 ICC Premium: 70.00 CRS Discount: Federal Policy Pee: ' . 00 40.00 Probation Surcharge. Endorsement Amount: .00 . 00 Total Premium Paid: 5, 573.00 Third Mortgage: MONROE COUNTY BOCC 1100 SIMONTON ST KEY WEST, FL 33040-3110 Fourth Mortgage: i nis lieclaration Page, in conjunction with the policy, constitutes your Flood Insurance Policy. In WITNESS WHEREOF, we have signed this policy below and herby enter into this Insurance Agreement. President Secretary 87043272272010 09/14/2.10 Part 2: THIS DECLARATION PAGE, WITH POLICY PROVISIONS - PART 1 AND ENDORSEMENTS, IF ANY ISSUED TO FORM A PART THEREOF, COMPLETE THE BELOW NUMBERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY. CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY 6676 Corporate Center Parkway, Jacksonville, Florida 32216-0973 A drAiW- INSURED NAME AND ADDRESS CITIZENS THIS IS A 1000 ATLANTIC BOULEVARD, LLC 729 THOMAS ST KEY WEST, FL 33040 GENERAL BUSINESS POLICY TERM 10/16/2010 PO 10/16/2011 AT 12:01 A.M. (EST) CITIZENS POLICY NO. 1473301 INCEPTION DATE EXPIRATION DATE This is your Policy Declaration Page - This is not a Bill - DO NOT PAY Item No. YF1Ci1; L Percent of AM UNT F IN URAN E DEDUCTIBLES Builaing Contents Coinsurance Territory Premium Applicable MORTGAGEE/LOSS PAYEES: 1 TIB BANK OF THE FL KEYS ISAOA P 0 BOX 280 KEY LARGO, FL 33037 LOAN #141419529156 2 MONROE COUNTY BOCC (LOSS PAYEE) 1100 SIMONTON ST KEY WEST, FL 33040 Total Coverage: Pa went Plan: Total Premium: Subject to Form No(s): CIT CP2 01 10 CNRW 01 10 01 10 CIT 18 18 01 10 Mortgagee/Loss Payee: i i Agent:p KEYS INS SERVICES, INC. 5017 P.O. BOX 500280 MARATHON, FL 33050 s INSURED (305) 743-0494 CIT W03-CNR 01 10 50176 Team 3 Date: 9/13/2010 MORTGAGEE COPY -02 QSY R 40111 81 Part 2: THIS DECLARATION PAGE, WITH POLICY PROVISIONS - PART 1 AND ENDORSEMENTS, IF ANY ISSUED TO FORM A PART THEREOF, COMPLETE THE BELOW NUMBERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY. CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY 6676 Corporate Center Parkway, Jacksonville, Florida 32216-0973 ` INSURED NAME AND ADDRESS QT!ZENS THIS IS A 1000 ATLANTIC BOULEVARD, LLC ...+% 729 THOMAS ST GENERAL BUSINESS KEY WEST, FL 33040 POLICY TERM 10/16/2010 TO 10/16/2011 AT 12:01 A.M. (EST) CITIZENS POLICY NO. INCEPTION DATE EXPIRATION DATE 3301 This is your Policy Declaration Page - This is not a Bill DO NOT PAY Item AM UNT F IN U E Percent. of PAGE 1 No. Builot ng Contents Coinsurance DEDUCTIBLES Territory Premium Applicable 1 351,000 80 10,530 T-86 2,381 150,000 80 4,500 T-86 933 ONE STORY MASONRY RESTAURANT BLDG & CONTENTS NOT TO INCLUDE FABRIC CANOPY LOC: 1000 ATLANTIC BLVD KEY WEST, MONROE FL 33040-4852 21 58,000 0 80 1,740 T-86 393 ONE STORY MASONRY RESTAURANT AUXILIARY BLDG ��O t� �a�auriar� 'jA7..j (V O (V O 00 O tr) tD O O n O Premium Amount Tax Exempt Surcharge (Subject to Form No(s): IMortgagee/Loss Payee: Agent $ 3 , 7 0 7 2005 Citizens Property Insurance Corporation Emergency Assessment $ 5 2 $ 65 2005 Florida Hurricane Catastrophe Fund (FHCF) Emergency Assessment $ 37 Catastrophe Reinsurance Surcharge $556 2007 Florida Insurance Guaranty Association Regular Assessment $16 2009 Florida Insurance Guaranty Association Regular Assessment $ 3 6 MORTGAGEE/LOSS PAYEES LIST ON ADDITIONAL PAGE KEYS INS SERVICES, INC. 5017 P.O. BOX 500280 MARATHON, FL 33050 Payor: INSURED (305) 743-0494 I Date: 9/13/2010 CIT W03-CNR 01 10 50176 Team 3 MORTGAGEE COPY -02 QSY R 40111 80