Certificates of Insurance
INSURED NAME AND ADDRESS
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
~'I!~~.~~
THIS IS A
FONTICIELLA CONSTRUCTION CORPORATION
11400 W FLAGLER STREET SUITE 206
MIAMI, FL 33174
GENERAL BUSINESS
POLICY TERM 1/09/2006 TO 1/09/2007 AT 12,01 A.M. (EST) CITIZENS POLICY NO. 1096870
INCEPTION DATE EXPIRATION DATE THIS IS YOUR POLICY DECLARATION PAGE - This is not a Bill
PAGE 1
$
$
%
$
$
$
1
1,000,000
o
100
30,000
T-85
7,140
ONE STORY MASONRY MEDICAL EXAMINER'S FACILITY BLDG
UNDER CONSTRUCTION LOC:
565 33RD STREET GULF ~.1ARATHO!:J, r"i01JROE FL 33050
:~Gf)-S1k~
i.- 5y0d:
TOTAL AMOUNT OF COVERAGE
ACTUAL PREMIUM
PREMIUM SURCHARGES
Florida Hurricane Cat Fund
$
P I
TOTAL PREMIUM
DO NOT PAY
1 000 000
Subject to Form No(s) ,
7,140.00
Market Eq Sur 488.00
Tax-Exern t Sur125.00
.00
$
$
Reins/Cat Financing
$
1 071.00
8 824.00
($100 RETAINED)
CIT-W11 20 BUILDERS' RISK CIT CP2
CIT-W06
Mortgagee/Loss Payee,
MONROE COUNTY BOARD OF COUNT COMMISSIONERS
1100 SIMONTON STREET
KEY WEST, FL 33040
Agent,
T R JONES & COMPANY 0028
POBOX 1505
HOMESTEAD, FL 33030
Payor,
INSURED
crT-W03
(305) 247-5121
(7/02) 00283 Team 3
J
CC,~
Date, 3/27/2006
MORTGAGEE COPY -01
EGL
N
12207
331
ACOBQ. CERTIFICATE OF LIABILITY INSURANCE I DATE(MMfllIlIYYYVl
01/25/2007
PIIODUCER (305)247-5121 FAX (305) 248-8543 THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION
T.R. Jones " Caq>any ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1780 No..th K....... Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Home.tead, FL 33030
Melody Lowery INSURERS AFFORDING COVERAGE H NAlCII
~RED Font1c1ella Con.t..uct1on Co"p INSURER A: C..um " Fo...te.. Indemnity
11400 W Flagle.. Street INSURER 8: Ma..yland Ca.ualty Co.
Suite 206 INSURER c: No..th Rive.. In..Co ..
Miami, FL 33174 INSURER 0: eanme..ce " Indu.try In. Co ,.
INSURER E: ,nl/..-
...
THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO\IE FOR THE POLICY PERIOD INDICATED. N01WITHSTANllING
/oHf REQUIREMENT. TERM OR 00NDIT10N OF /oHf CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAI'l, THE INSURANCE AFFORDED BY THE POLICIES DESCRl3ED HEREIN IS SUB.ECT TO ALL THE TERMS. EXCLUSIONS AND CONDmONS OF SUCH
POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPeOl'INSUItANCI! POLICY NUMIJII!R ~ ~ ItATION L1M1Tll
~.""'LIAIIIUTY 543-711111-5 01/21/2007 01/21/2008 EflCH OCCURRENCE . 1 000.0001
X COMw=RCIAL GEftERAL UABIUTY DAMAGE TO RENTBJ . 100.0001
I Ct.ANS MACE [!] OCCUR tvED EXP (Anyone perKIn) . 5. oool
A - PERSONAL & ALN INJURY . 1.000.0001
~ GENERAl AGGREGATE . 2 000.0001
mLAGG~n ~ APPLIES PER: PRODUCTS - COMPIOP AGG . 2 000.00l
X POLICY JECT n LOC
~ELIABlLFTY 002151308 01/21/2007 01/21/2008 CQNBlNED SINGLE LIMIT
~ ANY AUTO (Ea_ . 1.000.00l
I- ALL. OWNED AUTOS ~, ~o.. "'% BOIJILYINJURY
SCHEDULED AIJTOEl; r (Pe<......l .
B -
- HIRED AUTOS BClOIl Y INJURY
.
- NON-OVVNED AUTOS . .... \ - d-.l.o- (Per.cc:ident]
- '--( .' PROPERTY DAMAGE .
. . (PerllCCidenl)
_UAIllLITY f AUTOONl Y - EA ACCIDENT .
~' ANY AUTO OTHER THAN ""ACC .
AIJTOONLY: - .
EXCE8MJllIlRELLA UAIUUTY 553-089600-9 01/21/2007 01/21/2001 EACH OCCURRENCE . 4 000 _ 0001
:!J~R 0 ClAIMS MADE AGGREGATE . 4 000.0001
C . (
~ ~BLE .
RETENllON . .
WORKERS COIIPliN8ATIOH AND WC176-32-81 01/25/2007 01/25/2001 X we STATU- 10TH-
IIIIIPUlYI!RS'UAIllLITY
D /IHV PROPRIETORIPARTNER/EXECUTlVE E.L EACH ACCIDENT . 500 .0001
OFRCER./MEMBER EXCU.IlED? E.L DISEASE - EA. EMPLOVl;I S 500. oool
~'_..-
C1AL PROVIStONS below E,L DISEASE - POLICY LMT . 500.0001
OTHEft
~mOP~IL'lCATIOHll~'~""r.':=8Ym:"''''''''''/''''''''' PROYI.....
..t1 1cate No e.. 1. an 1t ona n.u W1t ..espect. to cam.e..cial Gene..al Liability
i-cI eanme..dal Aut~ile Liability
~ef: Project - Medical Ex..;ne... Facility, C...l Key, Monroe County, FL
~ except 10 day. fo.. non-pa~t of p..enriUII
SHOUlD AMY OF THE ABIl:NE DESCRIBED PClUCIES BE CANCI!Llm BEFORE! TIE
EXPtRAT10N DATE THEREOF, THE ISSUING INSURER WIll ENDEAVOR TO MAL
Monroe County _I'd of County Connri..ion.... JO* DAYS WRITTEN NOnCE TO THE CERTIfICATE HOlDER NAME!D TO TtE LEFT,
it. .....loyees and offidals I!IUT FAlLUIUE TO MAIL SUCH ND'nCE stW.L IMPOII! NO OBLKlAT1ON OR LIA8llITY
1100 Simonton St..eet OF AHY I<IND UPON TH! INSUIt!R, rTSAGENTSOft REPRESENTATIVES.
Key West. FL 33040 AUTHOIIIZI!D IU!Pftt!8l!NTATIW
Laur;e M l.ne
ACORD 25 (2001/01)
:;..
t:.c. .~
0','1 >4J C)e.~1<- I-"~,C'l
CACORD CORPORATION 1...
RECEIVED I
JAN 2 2 2007 J
AMERICAN ALTERNATIVE INSURANCE CORPORATION
555 COLLEGE ROAD EAST
PRINCETON NJ 08543-5241
NOTICE OF NONRENEWAL OF INSURANCE
Named Insured & Mailing Address:
Producer: B01108
FONTICIELLA CONSTRUCTION CORP.
MONROE COUNTY BOARD OF COMM.
11400 WEST FLAGLER STREET
SUITE 206
MIAMI FL 33174
BRITT PAULK INSURANCE AGENCY, INC.
100 GLEN EAGLES COURT
CARROLL TON GA 30117
r-.------
Policy No.:
Type of Policy:
Date of Expiration:
I
87A21M1000332-00
INLAND MARINE
03/09/2007: 12:01 A.M. Local Time at the mailing address of the Named Insured.
We are nonrenewing this policy. Coverage will cease on the Expiration Date shown above.
Our records indicate you are an "insured" or other party of interest under this policy. This is your notice that the
named insured's coverage under this policy is being non renewed on the Expiration Date indicated in the above
box.
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Mortgagee/LiEinhoider
Date Mailed:
17th day of January, 2007
MONROE COUNTY BOARD OF
COMMISSIONERS
500 WHITEHJ\D STREET
KEY WEST FL 33040
FORM# CN9697FL51995
ODEN3.0.06.12a / .
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CA, Y
Copy for Mortgagee/Lienholder
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FLCN16NONE APP
01082007MYNY
Page 1 of 1
DATE (MMIDDfYYYY)
01/25/2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER: IHIS CERTIFICATE DOES NOT AMEND, EXTEND OR
COVERAGE AFFORDED BY THE POLICIES BELOW.
R t~G t.~L~1 II RS A FORDING COVERAGE NAIC #
! INSURE A Cr m & Forster Indemni ty '10 (I .. r IL- I_;A 9 -IJ 17
l JAIl 2 6 ".~ljURE B Ma yland Casualty Co. -:0,
:1 '1~~uRERe, No th River Ins.Co
INSURERiD Co merce & Industry Ins Co ^
''It-;';'HOFciiU~]1!lsuRER E .
cnVERA<>E" HI",.1,,, ".c,ML jJJ.j/
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITI:!SJ.8IIllWG
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 DO'
ACORD
. ,.
CERTIFICATE OF LIABILITY INSURANCE
I
PRODUCER (305)247-5121
T.R. Jones & Company
1780 North Krome Avenue
Homestead, FL 33030
Melody Lowery
INSURED Fonticiella Construction
11400 W Flagler Street
Suite 206
Miami, FL 33174
FAX (305)248-8543
Cor
TYPE OF INSURANCE
GENERAL LIABILITY
rx COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE 0 OCCUR
POLICY NUMBER
POLICY EFFECTIVE P~!.l.9J EXPIRATION
LIMITS
B
GEN'L AGGR;.EFGAT'fE ~ LIMIT AP FPlIEyS PER:
=Ox PRQ*
X I POLICY JEer LOC
~TOMOBllE LIABILITY
~ ANY AUTO
ALL OWNED AUTOS
-
_ SCHEDULED AUTOS
_ HIRED AUTOS
-
-
543-711118-5 01/21/2007 01/21/2008 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED $ 100 , 000
MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
002151308 01/21/2007 01/21/2008 COMBINED SINGLE LIMIT
(Ea accident) $ l,OOO,oor
A
NON-OWNED AUTOS
)1\. \OJ.{I~'"
\-C R~ Q-J".-
,
~".-
BODILY INJURY
(Per person)
$
BODlL Y INJURY
(Per accident)
$
PROPERTY DAMAGE
{Per accident)
$
o
~ESSIUMBRELL.A LIABILITY
~ OCCUR D CLAIMS MADE
~ DEDUCTIBLE
H RETENTION $
WORKERS, COMPENSATION AND
EMPLOYEItS' LIABILITY
ANY PROPRIETORlPARTNERlEXECUTIVE
OFFICER/MEMBER EXCLUDED?
Iryes, dezcribeunder
SPECiAl PROVISIONS below
OTHER
553-089600-9 01/21/2007 01/21/2008
AUTO ONLY - EA ACCIDENT $
$
$
$
$
$
$
$
OTHER THAN
AUTO QNL Y:
EA ACe
~~GE LIABILITY
I ANY AUTO
AGG
EACH OCCURRENCE
4,000,000
4,OOO,OO(
(
AGGREGATE
C
WC176-32-81 01/25/2007
01/25/2008 X I we STATU, IOJ.!;"
E.L. EACH ACCIDENT $
EL DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
500,OO(
500,000
500,OOC
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES 1 EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS
ertificate Holder is an Additional Insured with respects to Commercial General Liability
nd Commercial Automobile Liability
~ef: Project - Medical Examiners Facility, Crawl Key, Monroe County, FL
except 10 days for non-payment of premium
Monroe County Board of County Commissioners
its employees and officials
1100 Simonton Street
Key West, FL 33040
C TI N
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 MAIL SUCH NOTiCE SHALL IMPOSE NO OBLIGATION OR LIABILITY
II
ee: ~~ a.n ve- I t 1'7 t.j
ACORD 25 (2001/08)
Laurie M Lane
PM! 2, TillS 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 POLlCY,
POLICY TERM
CITIZENS PROPERTY INSURANCE C
6676 Corporate Center Park ay, Jackson~f~rEi 'VEf)973
~ JLrAN_~~'071,,,
MOf~ROE COUNTY
"'" "'"hcEMeNT
1/09/2007 TO 1/09/2008 AT 12,01 A,M,.(OOT' ',"'~l"2= P""~CY NO,
INCEPTION OATE EXPIRATION DATE THIS IS YOUR POLICY DECLARATION PAGE
INSURED NAME AND ADDRESS
FONTICIELLA CONSTRUCTION CORPORATION
11400 W FLAGLER ST STE 206
MIAMI, FL 33174
$ $
1 1,000,000
.
$ $
87,000 T-85
o
ONE STORY MASONRY MEDICAL EXAMINER'S FACILITY BUILDING
UNDER CONSTRUCTION LOC:
565 33RD STREET GULF MARATHON, MONROE FL 33050-2301
)~ l'\iSI<~G'-"nIT
:-::rn~ M L-==-
[C'___,__ \ -8'-0 I -
N/A__$.- YES
Wf.,[\!EFl
$
23,577,00
2005 FHCF Emer Ass
$ 236,00
1 000 000
Subject to Form No(a) ,
Reins/Cat Financing
$
Tax-Exem t Sur413.00
3 537.00
CIT-Wll 20 BUILDERS' RISK CIT-Wll 19 CIT CP2
Mortgagee/Loss Payee;
CIT-W06
MONROE COUNTY
1100 SIMONTON
KEY WEST, FL
BOARD OF
STREET
33040
COUNT COMMISSIONERS
~'. ~."--
Agent,
Payor,
T R JONES & COMPANY 0028
POBOX 1505
HOMESTEAD, FL 33030
INSURED
(305) 247-5121
CIT-WO) (7/02) 00283 Team 3
Date '12 /2 8 /2 006
QSY R 40111
MORTGAGEE COPY -01
L BUSINESS
096870
This is not a Bill
$
23,577
ltk:
P I
$
PAGE 1
DO NOT PAY
27 763,00
($100 RETAINED
3475
ACORD~ CERTIFICA TE OF LIABILITY INSURANCE DATE IMMIDDNYYY)
1/24/2008
PRODUCER (305) 247-5121 FAX: (305)248 8543 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
T.R. Jones & Company . . . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
-.--
1780 N Krome Avenue ! ::;a,iTERTHECOVERAGE AFFORDED BY THE POLICIES BELOW.
,,";,_~:~-J..+i. .....0
Homestead FL 33030 INSURER AFF RDING COVERAGE NAIC#
INSURED JAN 2 9 111.I<:1 1l:;>I:R A rum & Forster Indemnitv
Fonticiella Construction Corp ~RB he orth River Insurance
11400 W Flagler St.z:'eet INSURER c: ort River Insurance
Suite 206 MONROE CO REFt5:'Comm erae & Industry Ins
Miami FL 33174 RISK MANAGE AllRER E
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 r~F:~~~~ ~~, THE POLlC~E"S, DESCRIBED ~~~~,I~<IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
LIMIT MA HOlM
INSR ADO'L TYPE OF INSURANCE POLICY NUMBER Prl'l+~~~~~6g,w'IE PgkIW(~':l;~~N LIMITS
~NERAL LIABILITY "ACH nCC""R"NC" . 1,900,000
X COMMERCIAL GENERAL LIABILITY ~~~~~J9E~~~uE~nce\ . 100,000
A I CLAIMS MADE W OCCUR 543-712370-4 1/21/200B 1/21/2009 MED EXP IAn one """son\ . 5,000
- 9 ^nVIN"'RY . 1,000,000
- GENERAL AGGREGATE . 2,000,000
~<~ AGG~EnEIllMIT AnE~ PER: PRno"CT< JnMP,np AOO . 2,000,000
X POLICY ~~WT LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT . 1,000,000
~ ANY AUTO (Eaaccident)
B ALL OIfoJNED AUTOS 133-725217-5 1/21/2008 1/21/2009 BODILY INJURY
- {Per person) .
f-- SCHEDULED AUTOS
I- HIRED AUTOS BODILY INJURY .
NON-O\rVNED AUTOS \r\5 ( t\ (Per accident}
r- j
r- bI:s <_ PROPERTY DAMAGE .
"....: (Peraccidenl)
--
RRAG" LIABILITY 'ciiP6 AUTO ONLY - EA ACCIDENT .
.. HACC .
ANY AUTO 'X OTHER THAN
AUTO ONLY AGG .
~ESSlUMBRELLA L1AEIlLlTY I ".Ow .
OCCUR D CLAIMS MADE AGGREGATE .
.
C f;1 DEDUCTIBLE 553-090B50-1 1/21/2008 1/21/2009 .
X RETENTION It 10 000 .
D WORKI;RS COMPENSATION ANI) X I T~$rfJI~~ 1 OJ~-'
EMPLOYERS' LIABILITY 500,000
ANY PROPRIETORlPARTNERlEXECUTIVE E.l. EACH ACCIDENT .
OFFICERlMEMBER EXCLUDED? Renewal of WCI76-32-81 1/25/2008 1/25/2009 E.l DISEASE - EA EMPLOYEE $ 500,000
, ~~es, desc~~v~~~~~,~ I. 500,000
PECIAL PR VI I N below E.l DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERA TlONS/tOCA T10NSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is an Additional Insured with respects to Commercial General Liability and Commercial Automobile
Liability Ref: Project - Medical Examiners Facility, Crawl Key, Monroe County, FL * except 10 days for non-payment
of premium
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Monroe County Board of CountyCommissione EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
its employees and officials 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
1100 Simonton Street 1);';9,jo &~ FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Key West, FL 33040
( . >. ') . INSURER ITS AGENTS OR REPRESENTATIVES.
,; ,. AUTHORIZED REPRESENTATIVE
'-c....~'- ., Laurie M Lane Agt of Record
ACORD 25 (2001/08) 1'\Y @ACORDCORPORATION1988
INS025 (0108),08a
Page 1 of2
INSURED NAME AND ADDRESS
Part 2, TillS DECLARATION PAGE, WITH POLICY PROVISIONS - PART 1 AND ENDORSEMENTS, IF ANY ISSUED TO FORM
A PART 11lEIREOF, COMPLETE TIlE BELOW NUMBERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY.
CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY
6676 Corporate Center Parkway, Jacksonville, Florida 32216-0973
~m~~.~$
THIS IS A
FONTICIELLA CONSTRUCTION CORPORATION
11400 W FLAGLER ST STE 206
MIAMI, FL 33174
GENERAL BUSINESS
POLICY TERM 1/09/200E: TO 1/09/2009 AT 12:01 A.M. (EST) CITIZENS POLICY NO. 1096870
INCEPTION DATI' EXPIRATION DATE This is your Policy Declaration Page . This is not a Bill . DO NOT PAY
1
$
1,000,000
$
.
$ $
87,000
$
o
T-85
23,577
ONE STORY M~SONRY MEDICAL EXAMINER'S FACILITY BUILDING
UNDER CONSTRUCTION LOC,
Non-Homestead Property
565 33RD STREET GULF MARATHON, MONROE FL 33050-2301
f:f\~. .
. .
" .~ .! . -
'~Q <.6
. 1-'-
~---
fa---
()rly 'k C!./u-k bJ'JOk
I'll
Total Conra e:
$1000000
Pa ent Plan:
uarterl
Total Premium:
$28 581
Premium Amount
Tax Exempt Surcharge
2005 Citizens Emergency Assessment
2005 Market Equalization Surcharge
$23,577
$413
$330
$488
2005 Florida Hurricane Catastrophe Pund Emergency Assessment
Catastrophe Reinsurance Surcharge
$236
$3,537
Subject to Porm No(o) :
CIT-Wl1 20 BUILDERS' RISK CIT Wl1 19 CIT CP2
Mortgagee/Loss Payee:
CIT-W06
MONROE COUNTY
1100 SIMONTON
KEY WEST, FL
BOARD OF
STREET
33040
COUNT COMMISSIONERS
Agent:
Payor:
T R JONES & COMPANY 0028
POBOX 1505
HOMESTEAD, FL 33030
INSURED
(305) 247--5121
CIT w03-h o~ 08 00283 Team 3
L-c..:~
Date. 1/22/2008
MORTGAGEE COPY -01
QSY R 40111
1686
CERTIFICATE OF INSURANCE
This certificate is provided as evidence of insurance under policy # 66675 78
of the company named herein.
Mortgagee Name and Address
Monroe County Board of County Commissioners, its employees &
officials
Key West, FL 33040
Insured Name and Address
Fonticiella Construction Corporation and Monroe County Board of County C
11400 W Flagler Street #206
Maimi, FL 33174
Amount of Coverage Per Building
(Completed Value)$ 3,300,000
r-
I
I MAR 2 4 ~CJ0
I
....-.-. "~"----"'."--. "'-'-"-,,~-,-~,-,~
r,I,-"";,,,,)
-..,......-.,.,..-- "1
!
, ';1
Premium $ 17,810.76
Effective Date (Date Construction Began) 03/09/2008
Term: 12 Months
Description and Location of Property to be Insured
MM 56.5 US Hwy 1
Marathon, FL 33050
This is to certify that the above is an insured under a builders risk policy issued by a company of the Zurich Financial
Services Group, covering property identified above from the inception date shown, subject to all terms and conditions
contained in the policy. Insurance as provided under the aforementioned policy is subject to all terms, conditions and
limitations thereof and shall in no event extend beyond date of termination of the insured's interest in the articles
described herein. ~
/r9.0()~-{JA.;-Z In ~
ire~ (Month, Day and Year) utliorized Agent
Agency Producer Number 18883843
Agency Name T. R. Jones & Companv
Mailing Address 1780 N Krome Ave
City Homestead
State FL
Zip Code 33030-3236
o Y'ty .Jp f:'fe.--l}...Sa.,..hj t.)er/&
'.
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