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Certificates of Insurance RECEIVED CERTIFICATE OF INSURANCE ~.~'~ ,.. OCT - j : ~;r.\::~':;~ MONROE BOARD / COUNTY COMMISSo 1100 SIMONTON ST. STE. 205 KEY WEST, FL 33040 PLEASE NOTE: t COUNlY ADMINISTRA'IOR "-- If the need of this Certificate is discontinued before its expiration, please check the box below and return to: USAA CASUALTY INSURANCE COMPANY 9800 Fredericksburg Road San Antonio, Texas 78288 D Discontinue issuing this Certificate of Insurance Date September 30, 2005 The USAA CASUALTY INSURANCE COMPANY of San Antonio, Texas, does hereby certify that the policyholder named above is insured as follows: Automobile Year Model & Trade Name Motor Number: Automobile Policy Number: CIC 00320 34 18C 7108 3 CIC 00320 34 18C 7108 3 2002 Chevrolet Suburban 2006 Mercedes SLK280 3GNFK16Z42G233806 WDBWK54F76F081602 September 21, 2005 Expiring: April 1, 2006 (12:01 A.M. Standard Time) Effective: LIMITS OF LIABILITY $ 100,000 Bodily Injury Liability $ 200,000 each person each accident Property Damage Liability $ 25,000 each accident This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by the above policy issued by USAA Casualty Insurance Company. If the USAA Casualty Insurance Company elects to cancel said policy 10 written notice of cancellation will be given to: days advance Monroe Board of County Commissioner 1100 Simonton St. Ste. 205 Key West, FL 33040 ~::!fl.~~~tW14 DATE... lv- 5 --0'" -~~'._-'-'-'--'~-- WAIVER N/A 3_YES 281 CIC(03) Rev. 7-93 USAA # 320 34 18-28753-65822-AO.A0294 ~., USAA CASUALTY INSURANCE COMPANY .. " (A Stock Insurance Company) USAA~ 9800 Fredericksburg Road - San Antonio, Texas 78288 FLORIDA AUTO POLICY AMENDED DECLARATIONS ATTACH TO PREVIOUS POLICY Named Insured and Address PAGE 3 MAIL MCH-M-S POLICY NUMBER Ten 00320 34 18C 7108 3 POLICY PERIOD: (12:01 A.M. standard time) EFFECTIVE EP 21 2005 TO OCT 01 2005 OPERATORS 01 WILLIAM R PFEIFFER 05 JULIE M PFEIFFER WILLIAM R PFEIFFER 3142 BARINGER HILL DR TALLAHASSEE FL 32311-3632 Oescri tion of Vehicle(s) VEH YEAR TRADE NAME MODEL BODY TYPE ANNUAL MILEAGE 5000 6000 IDENTIFICATION NUMBER 3GNFK16Z42G233806 WDBWK54F76F081602 VEH USE* WORK/SCHOOL Md~~s O~lrs SYM W. Week 13 P 24 W 04 5 14 02 CHEV SUBURBA 1500 UT L 4X4 40 16 06 MERCEDES SLK280 CON V 20 COVERAGES LIMITS OF LIABILITY (" ACV" MEANS ACTUAL CASH VALUE) PREMIUM $ PART A - LIABILITY BODILY INJURY EA PER $ 100,00 EA ACC $ 200,00 PROPERTY DAMAGE EA ACC $ 25,00 PART B - PERSONAL INJURY PROTECTIO MAXIMUM BENEFITS $25,000 PART C - UNINSURED MOTORISTS STACKED BODILY INJURY 64.87 64.87 41.76 41.76 34.96 47.26 EA PER $ EA ACC $ 100,00 200,00 64.34 88.48 REASO -------------------------------- -------------------------------ADJ POLICY ADJUSTMENT ADDITIONAL INTEREST - EMPLOYER MONROE BOARD OF COUNTY COMMISI, KEY WEST, FL LOSS PAYEE VEH 14 GRYPHUS FINANCIAL SERVICE, SARASOTA FL VEH 16 SUNTRUST BANK, SAN ANTONIO TX ENDORSEMENTS: ADDED 09-21-05 - A073(04) REMAIN IN EFFECT REFER TO PREVIOUS POLICY - \. I J Joseph H. Wehrle Jr., President 5000 C LAST PAGE 4 C I C 00320 34 18 ; "- 71.08 ADDITIONAL COVERED PERSON ENDORSEMENT This endorsement forms a part of the auto policy to which it is attached. It is effective from the policy effective date or from the date shown on the amended Declarations. We agree that. with respect to the covered aLlto described in the Declarations, Part A, Liability Coverage, applies to each additional covered person named in the Declarations, but only to the extent that such additional covered person qualifies as a covered person under Definition No. 3 of covered person in Part A of the policy. Our inclusion of this additional covered person does not operate to increase the limits shown in the Declarations. Countersigned by: A073(04) Rev. 9-98 This additional covered person is not responsible for the payment of any premiums. Any premiums returned and any dividend we may declare will be paid to the named insured. The named insured is authorized to act for the additional covered person in all matters pertaining to this insurance. We further agree that if the named insured elects to cancel the policy, we will mail a written notice of the cancellation and its effective date to the additional covered person at the address shown in the Deciarations. If we decide to cancel the policy, we will give the same advance notice of cancellation to the additional covered person as we give to the named insured shown in the Declarations. ,,;. CIC PAGE 1 MAIL MCH-M-S 00320 34 18 71083 SEPTEMBER 20, 2005 EFFECTIVE SEP 21 2005 TO OCT 01 2005 MONROE BOARD OF COUNTY COMMISI ONERS 1100 SIMONTON STREET STE 205 KEY WEST FL 33040 mf!r D ~S(. RECEIVE ~cg: SEP 2 9 2005 f. f! f' ; COUNTY ADMINISTRATOR IMPORTANT INSURANCE PAPERS ENCLOSED MCS05 ACORDN CERTIFICATE OF LIABILITY INSURANCE CSR DL I DATE (MMlDDIYYVY) MYERS 1 09/26/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Franklin Insurance Agency,Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O. Box 3145 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tallahassee FL 32315 Phone: 850-681-0433 Fax:850-222-8075 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Valley Forge Insurance Co. 20508 INSURER B' Continental Casualty Company 20443 I ~-~--_.~.- Myers & Fuller, P. A. INSURER C: POBox 14497 INSURER D: Tallahassee FL 32317-4497 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, L TR NSRC POLICY NUMBER PD~~~1,f~J~~E P8k~C;l(~~b'b"~~N A TYPE OF INSURANCE GENERAL LIABILITY X -xl COMMERCIAL GENERAL LIABILITY I CLAIMS MADE ~ OCCUR 2071695522 01/08/05 01/08/06 EACH OCCURRENCE ~~~~~E~ (E~~~~';'~nee) MED EXP (Anyone person) PERSONAL & ADV INJURY $ 1000000 $ 500000 $ 15000 -- --..-- .~------- $ EXCLUDED $2000000 PRODUCTS, COMP/OP AGG $ 2 000000 I , I H I GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: - ,nPRO- n I POLICY JECT LOC AUTOMOBILE LIABILITY - ANY AUTO - ALL OWNED AUTOS - SCHEDULED AUTOS - HIRED AUTOS - NON-OWNED AUTOS f--- f--- , GARAGE LIABILITY tJ ANY AUTO I EXCESS/UMBRELLA LIABILITY I tJ OCCUR D CLAIMS MADE I COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) APP= EJY'"m8K M~ Y\IJEMiJOi BY j 0 I ~ ){,h6' ul \ DATE I r, ~ ~~bs WAIVER I WI1 ':r-""'" -. PROPERTY DAMAGE (Per accident) AUTO ONLY, EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE RDEDUCTIBLE RETENTION $ I WORKERS COMPENSATION AND I EMPLOYERS' LIABILITY B I ~~~I~~~M~~1~~~~~m6~gECUTIVE I 2072177750 I If yes, describe under ' I SPECIAL PROVISIONS below i II OTHER I' I' X Professional Liab 267950879 01/01/05 01/01/06 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Attorney's office Certificate Holder Listed as Additional Insured in Regards to General Liability (Form #G134844A) LIMITS $ $ $ $ I $ EA ACC $ $ $ $ $ $ $ AGG 01/01/05 01/01/06 I TORY LIMITS I IU~~- E.L, EACH ACCIDENT I $ 100000 : EL DISEASE, EA EMPLOYEE; $ 100000 ~-_..._,._---..--- E.L. DISEASE, POLICY LIMIT i $ 500000 , I Aggregate Occur. CERTIFICATE HOLDER CANCELLATION -- ,-- 2,000,000 1,000,000 Monroe Co Board of Commissioners FX: 305/295-3179 POBox 1026 Key West FL 33041-1026 MONROEK 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEN ACORD 25 (2001/08) @ACORD CORPORATION 1988