Insurance
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ACORDw CERTIFICA'. f OF LIABILITY INSURANCE DATE (MIIIIDDIYYYY)
11/16/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Gulfshore Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4100 Goodlette Road N, #100 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW.
Naples, FL 34103 .3303
239 261.3646 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Amerisure Insurance Company
Forbis Systems, Inc. & Richard Forbis, INSURER B:
Contractors & Richard Forbis, Inc.; INSURER c:
1876 Trade Center Way INSURER D:
Naples, FL 34109 INSURER E:
From: FAXmaker To: County Administrator
Client#. 548"
Page: 2/3
Date: 11/16/2005 12: 1 0:55 PM
REL3
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 AN D CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR[ TYPE OF INSURANCE POLICY NUIIIBER PD~,r::~~8~ Pt\!fl,'f.~~~~N LIMITS
A ~NERAL LIABILITY GL201 077501 0004 06/24/05 06/24/06 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100000
I a.AIMS MADE [i] OCCUR MED EXP (Anyone person) $5 000
X. PO Ded:500 PERSONAL & ADV INJURY $1 000 000
GENERAL AGGREGATE $2 000 000
-
OEN\. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $2 000 000
~n PRO- n
POLICY JECT LOC
A AUTONOBILE LIABILITY CA2D1 077 4010004 06/24/05 06/24/06 COMBINED SINGLE LIMIT
- $1,000,000
X.- ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
X.- HIRED AUTOS BODILY INJURY
$
~ NON-oWNED AUTOS (Per accident)
- PROPERTY DNAAGE $
(Per accident)
==rAGE LIABIUTY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
F_ AUTO ONLY: AGG $
A - EXCESSAlMBRELLA LIABILITY CU2D177701 06/24/05 06/24/06 EACH OCCURRENCE $1 000 000
~ OCCUR D CLAIMS MADE AGGREGATE $1 000000
- $
~ DEDUCTIBLE $
X RETENTION $10000 - \,'" 'oO.' ( .;''= ~.~ :ql $
WORKERS COMPENSATION AND nl ~t:~lli,' ~JIH I ~I!}.~,~H:T~;, I lOn:-
EMPLOYERS'LIABIUTY 8{ ~~-~,--""\
11'---~J E,L, EACH ACCIDENT $
ANY PROPRIETORIPARTNERIEXECUTIVE .<::
OFFICERIMEMBER EXCLUDED'I ~=i E,L, DISEASE. EA EMPLOYEE $
If yes, destrlbe under DATE ------..-.
SPECIAL PROVISIONS below E,L, DISEASE. POLICY LIMIT $
OTHER WAIVER N/A _.1".... Y 1::::> --- -
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
County Administrator DATE THEREOF, THE ISSUING INSURER 1MLL ENDEAVOR TO MAIL -1.IL DAYS WRITTEN
Monroe County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
1100 Simonton Street IMPOSE NO OBLIGAl1ON OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Key West, FL 33040 REPRESENT AnvE5.
A~ORI2ED REPRESENTATIVE
'; ~ AI ~~~....
ACORD 25 (2001/08) 1 of 2
#S275250/M267007
CAH
€l ACORD CORPORATION 1988
From: FAXmaker
To: County Administrator
Page: 3/3
Date: 11/16/200512:10:55 PM
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-S (2D01/D8) 2 of 2
#S2752501M267007
NOV. 23. 2005 10:01AM,:2616229
Cllen1#'21948
To: SANDY
Page: '2J'J
uerte. 'Il.l:. II.€.'"'V..... c.,....., , .
FOR" -:L
NO 0536
P 2
. --- .
ACORDTU CERTIFICATE OF LIABILITY INSURA~CE \ DATE \lW'IIIPwrNYI
11/21/05
PRoOUCER THIS CERTIFICATE IS ISSUED AS A MATT~ of INFORMATION
Brown & Brown. Inc. ~ Naplas ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NoT AMEND, EXTEND OR
999 Vanderbilt Beach Road,#S01 ALlER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Naphts, FL 34108-3507
239 262-5143 lNSUREFeS AF~OFeDING Co"ERAGE NAIe #
INSUftEO INSURE1\ (>:. Zenith Insurance cornpany
Forbis systeMS Inc. INSUlER B:
& Richard Forbis Inc. INSU~ c:
1818 Trade Center Way IN5UREFl 0:
Naples, FL 34109 IN5U~ E;
THE P()l,ICIi$ of ~SU.'NC."ISTED aa.ow "Avi oa;tllSSUED TO .". 1M""'" "A"ED ABOVE !'OR THE POL''''' PER'OO 1",,'''''lEO, NO'IW"M"'AKO~.
ANY RSQUIRI5MENT. "fiRM OR CONDITION OF ANY CONiRAci OR OTHEfl. OOCUMSNT WITl-! RESPEC1' 'TO WHICH TIiIS CEP.'TIFICA1E MAY 13E ISSUliiD OR
1M" PGRTAI<, THE ~""""CE "FaAoED BY TME POUClES "..,,"".'0 """"'" . ,U.,EC'fTO ALl - TeRMS. EXCLUO- ANt> ooNO",,"' OF ,UCH
";"OUCES. A..........","" ..,.,..w.v HAVE.... .EDUCEll IV pA~ ~
~= TYf'C Of'INsuAANllE POucY NUNIIlER P UC !'WCY UMITIi
~iRALLJA81UTY liACH occuRRENCE ~
c;OlIolMERCIAL GEtlEAAL UABIIJTY D"""f,GE: TClRJ::j\ftEO $
I ClAlMS w.oe 0 OCCUR MEC ED<!> IJ.zt'I ona P8f'Dn) I
I...- PERSONAL & NJV INJI,IRY $
I-- GENev.L AGGREGATE $
nA~rr1MliAPPnSPER: PRODUcTS. COMPIOP ,r.,GG $
POLICY ~~8r LOC
~tMlIlU! LWIIlnY CoMBiNeD SIIIIGLIi UMrT $
~ Nf( AUTo (Ell accldOnl) -
I-- ALL 0'v"JNeO AUTOS BOOIL Y INJuRY
5ctlEDUl.EO AUTOS (PIIJ plllllOll) , -
~ ~~;I':~'~~ ~'f\
H\RElJ AUTOS J"QO~t.. ~
I-- I'!' 1 . \ . BODIL V INJURY
$
~ NOl'I-ovYNEtl AUTOS f:i .,...._,".,-"-'. ."...~,. (PM acddenl)
~> ~.,,"_. -"
i-- D /\ f t: ...,-'" . _\J::-c:t-3.: OS. pl\Of'El\TY DAMIU3E $
(P'" ecddenl)
RilE LWIUTY \(>II:\.IVEH !~; ,;\ . _:i.YES ' AurO ONL V . CA. ACCIDiNf ,
i,!JH\, ..--....
fIN'( AUTO Ol1iEf\ 11-lJIIl EA ACC $
Al1T'0 0.... V: AGG ,
[jESSAlM81Ulu.A uAIIllJlY eACH OCCURIlBICel S
oCCUR 0 ClJdMS w.oo AGGReGAlC $
,
H oecUCTICllE $
~IOH $ S
A WQRIlEItS CONl'ENSATlON AND 2066108101 12/21104 12/21105 x-I ~S1AT1J'J 10m-
I!MPLoYEAS'LI,ABlUI'l' ,500.000
Ntf~~CUTNE e,L EACH ACCIDENT
0FFl excLuDED? I!.L. tllSEASI! .1iA eMP\.OYIre 5500 000
I ~~"~~~~!''''''' ,SOO 000
ECI ISI S E:.L tJlSEASE: . POLICY LIMIT
0'T1fER
,~ ' ',' - ~ ~. -,,- ,~ ".
nESCldPTlQt.l OF CPliRATIONS J LOcA~S Iv&HIC1.J!S J EllClUSIONS ADDED 8Y EMDQRSSMENT I St'ECuu. PRc1IISlONS ,~'{ ~m~~Y-e.:,'/>'a)
ELECTRICAL CONTRACTOR
-,
,'i'-, \ (-).6-Q7
.)'\1...--'---'---
\N,~XIFP ',It; 'I-_,YES_-
-
COVERAG~S
~
ACORD as (2001108) 1 of 2.
CANe LLATION
IHOUUlItN'f OFTHE AJjDVl! DESCIEEO poLICES 85 ~CE1..l.ED BifOlU! THE ElC...v.TION
DATE THPEOI". THE ISSUItIG INIiURER WILL ENDEAVOR TO MAIL -JO- DAYS WRJ1'TEN
NOllCE TDlltE CEflTf'IcATE HOl.DER ~ TO THE LiFT, BUT FAILURE 1'0 DO SO S1fAU.
IMPOSE)lO OBUGAT\CIlI ()l{ UABLI1'Y OF Atft J(N) UPON rHE INSURER. ITS AGEN1'S OR
INTA1'NES.
Al1T1f0RlZED Rl!!'~A1IIIE
'1r (I. tJAdI
NAP 0 ACORD CORPORATION 19B5
CERTIFICATE HOL ER
COUNlY OF MONROE
ATTN: OOAL YS MAYAN
2'798 OVERSEAS HIGHWAY 1300
MARATHON, FL. 33050
11071063
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
12/21/2005
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown - Naples, FL ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
999 Vanderbilt Beach Road,#507 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Naples FL 34108-3507
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zenith Insurance Company
Forbis Systems Inc. INSURER B:
& Richard Forbis Inc. INSURER C:
1876 Trade Center Way INSURER D:
Naples FL 34109
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 r..~~~ POLICY NUMBER P~}+~~~r;~~,!?m'~ Pgk!fl,~J:~t~N LIMITS
LTR
~ERAL LIABILITY EACH OCCURRENCE $
e-- OMMERCIAL GENE~IABILITY ~~~~ISES lEa o~~~~ncel $
e-- CLAIMS MADE U OCCUR MED EXP (Anyone person) $
e-- PERSONAL & ADV INJURY $
e-- GENERAL AGGREGATE $
n'L AGGREnE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $
POLICY ~~2T n LOC
~TOMOBILE LIABILITY '\j" ;'Yh'i~\ P ~~i ~~I~t!~G!~_~ L ~.: f COMBINED SINGLE LIMIT $
,., "..... , (Ea accident)
ANY AUTO
e-- I...
ALL OWNED AUTOS
~ BODILY INJURY $
SCHEDULED AUTOS \lk ~l~ :::-:: (Per person)
e-- ~."._, ~.
e-- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS INAi'.;: (Per accident)
e--
PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
:=]ESSlUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
=l DEDUCTIBLE $
RETENTION $ $
A ' WORKERSCOMPENSATlONAND Z066708101 12/21/2005 12/21/2006 X I T"X~~T~W~ ! IOJ~'
EMPLOYERS' LIABILITY $500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? EL DISEASE. EA EMPLOYEE $ 500,000
g~~c~~R~~rs1~NS below E,L, DISEASE - POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Electrical Contractor
*Workers Compensation - 30 days Notice of Cancellation Except for 10 Days for Non-Payment of Premium as Per Florida
Statute.
Monroe County
P.O. Box 1026
Key West FL 33041-1026
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL *30 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.
CERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVE
~'1.~
ACORD 25 (2001/08)
@ACORDCORPORATION1988
From: FAXmaker
To: County Administrator
Page: 1/3
Date: 11/16/200512:05:37 PM
--1 (J.-c G'v'~'4. 'f~
INSURANCE, INC.
FAX TRANSMISSION
NAPLES: 4100 GOODLETTE ROAD NORTH. SUITE 100. NAPLES, FL 34103. (239) 261-3646. FAX (239) 435-0598
MARCO ISLAND: 950 N, COLLIER BLVD. . SUITE 101 . MARCO ISLAND, FL 34145 . (239) 394-3133. FAX (239) 394-9482
E-mail gsi@gulfshoreinsurance.com
To:
County Administrator
'f"fom:
Carol Heaney
Gulfshore Insuranoe, Ino.
Email: oheaney@gulfshoreinsuranoe.oom
Subject:
Message: