Certificates of Insurance
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID'l~ DATE ~MMlDDJYVYYt
OTAKG-l OS/22/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
All Lines Insurance Aqency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4828 Blanding Blvd Suite 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Jacksonville FL 32210-7329
Phone:904-3B4-0783 Fax: 904 1384-055 .,..'" AFFORDING COVERAGE NAlC.
INSURED VL.-U INSUR.:.R A;. Auto-OwMr. In.u~.ft.:. Co/IplIny 18988
,"S RERB: OWners Insurance comnanv 32700
g~ ~r01,1P Inc. MAY 23 2006 '"S RERC: ..-
02 Hi~h~~? 17 '"S RERD:
Yulee FL 2
'"S RERE:
COVERAGES ~
THE POlICIES OF INSURANCE laSTED BELOW HAVE ~ ISSUED TO 'fISH ,~~~~!2~!'" (.,:,?LICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY C ICH THIS CERTIFICATE MA,V BE ISSueD OR
tNly 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 EN PAID CLAIMS.
'il'A~lM ~~-
LTR N TYPE OF INSURANCe POLICY NUMBER TS MNVO UMITB
~ERAl LIABfLlTY EACH OCCURRENce .1000000
A X X COMMERCIA.l GENERAL LIABILITY 78612118-066 02/10/06 02/10/07 ;:REWSESrE1. oca.nncel o 100000
- I CLAIMS MADE [!] OCCUR
t..ED EXP (Any one person) 010000
PERSONAl & AOV INJURY 01000000
GENERAL AGGREGATE 02000000
~'~AGG~EnE LIMl~ A?!Y PER: PRODUCTS. COMPJOP AGG 02000000
pOLtCY ~o,: LOC
~TOM08lLE l.IABlL1TY COMBINED SINGLE ur.t1T 01,000,000
B NfYAUTO 4306617400 10/16/05 10/16/06 (Eaaccidenl)
-
-- ALL OWNED AuYOS BODILY INJURY
0
.!.- sCHEDULEr;> AUTOS (Perf*$Ol1)
~ HIRED AUTOS BODILY INJURY
0
~ NON-QWNED AUTOS (Peraccid$nl)
f- PROPERTY DAMAGE 0
(P9r9Ccidenl)
RRAGE UA."'TY AUTO ONLY ~ EAACCIDENT 0
ANY AUTO . ,. ..... N"\. · C ( 1..~fC;.~i ' .,1\ n . ^ ~fRTHAN EAACC 0
- -., ,/I".." o ONLY: AGO 0
EXCESSIUMBREU.A L1ASlUTV ...~\\.- Ic.... ...- .... ..
EACH OCCURRENCE .
O-OCCUR 0 ClAIMS MADE 03=Q1.. AGGREGATE .
5... .- ~_ 0-
.
=i ~DUCTlBlE .'f,. .~.- .--~_..- 0
,..
RETENTION 0 0
WORKERS COMPI:NSATION AND I TO.'v't'~Ws r I"ER'
EMPLOYERS" LIABILITY
ANY PROPRIETORIPAAT~ERJEXECUTIVE E.l. EACH ACCIDENT 0
OFFICERIMEMBER EXCLUDED? E.l. DISEASE. EA EMPLOYE .
.~ ....... ,-
SetAL PROvtSIQN$ below E.L. DtSEASE M POLICY LIMIT .
OTHER
A Equipment Floater 78625662-05 11/08/05 11/08/06 Rent Eqpt $150000
oed $500
DIICRPTJON 0' OPettATIONS I LOCATIONS' VliHICLiS I DeLUSIONS AOD&D BY IiHDOASlillliNT /SP&CW. PRQVlSK)NS
Certificate holder is additiona~ insured with respects to general liability
and auto liability per policy wording.
I
CANCELLATION
SHOULD ANY OF THE AllOW DESCRBED POLICIES BE. CANCELLED BEFORe THE EXPmATION
DATE TtlEREOF, tHE ISIUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOncE TO THE CERTIFICATE HOLOER NAMIO TO TtlE LEFT, BUT FAILllRE. TO DO SO SHALL
IMPOSE NO OBlJGATION OR UABll.lTY OF ANY KIND UPON THE INSUReR, 1T5ltGENTS OR
REPRESENTATIVes.
AU REPRES~
@ACORDCORPORATION 1988
CERTIFICATE HOLDER
Monroe County BOCC
1100 Simonton St. am 268
Keywest FL 33040
ACORO 25 (2001/08)
"
A
3 2006 4 20PM
N 5" 16
D ~
pr. - D. D~~ j
ACDBD,. CERTIFICATE OF LIABILITY INSURANCE DAtt\MllllfOomvy)
04/03/2006
PROOUCU (904)441-9777 FAX (904)441-9711 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICAT~ DOES NOT AMEND, EXTEND OR
2700 University Blvd. ALTER THE CovERAGE AFFORDED BY TH~ POLICIES BELOW.
West Building B
Ja~ksonville, Fl 32217 INSURERS AFFORDING COVERAGE NAIC#
~RED Ot~k Group. Inc. ... Bridgefield EmplQyers Ins. (0. 10701
INSUl'U:RA:
850022 Highway 17 .__. -
lNl:)Ut<t;RIS:
Yulee, Fl 32097 ",,- .-...--
INSlJRfiR('.;
INSURER 0:
...
INSURER E
COIlERAG~S
TliE POlICIES OF INSURANCe LISTED BE;lOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE fOR TtIE POLICY PERIOD INDICATED. NOTWITHSTANDING
AN'( REQUiReMENT. TERM OR CONDITION OF AN'f CONTRACT OR orHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE:.O OR
MAY PERTAIN. THF.. INSURANCE A.FfORDED BY THE POLtClES DESCRIBED HEREIN IS SUBJECT' 'f0 All THE TERMS, EXClUSJONS AND CONDITIONS OF SUCH
POl.ICIES. AGGREGATE LIMITS SHOWN MAY HAVE 8F.EN REDUCED BY PAlO ClAIMS.
1_ T'fPE.OFlMIURANCE . ." ..OUCYNUMUIl f'~..~1'U"F' """ IIOUCY UJllU.l1ON ..
L1MI'tS
~"IiR"""lIA.IUTY l::ACH OCCURRt:Nce .
~~q~!O Rr::WCO .
COUMFRCIAl nc;NCRhL. LIABILITY .
I ClAIMS MADe 0 OCcu~ ..
MEOt:)O' (ArlyOl'lC perwI) .
'"
H ~ERSON^l .. IlrN INJlffl .
.-
GENeRAL ACCt\l:CA I'E .
...
rlN'L AGc:r;E LIMn 7~f.I,f>tR: ~OOCTS - OOMPKJP ",r,t; .
POlICY 1f!r LOC = ..
~0DIlE UAISIUT"f COMBINEO S1NllLE L1MI1 .
ANt"AUl'O (1=",;K:cidtnlt)
f-- -. ...-
I- All OWMiO AUTOS nnOl.V IN.1UAY
0
setICOULf.O AUTOS (.....person)
I- ..
HIHt:U AUlOS 9ODI.Y INJURY
.
NON-OWNrcO AlJmS tPel'accldenl)
I- ....
I- ..._" rROl"l;KIV DAMAGE .
(~rIlWIJt!I\I)
GARAGE UAlUUTV AUTO ONl '1-I;AACCI~N'1 . ._-
~'''''',,"TO . _.,-
01Ht:.A"TI1AN U. Ace .
._-,,,-
^umONLY: AG" 0
S~StlU--Ell.A LLABlll'TY EACH OCCUARE~_._. .., ,S
. - OCCU,lf 0 CL4JUS "'AOF AGGR~qATI= .
=1" .
....
OEQUCTt5lE _.. 0
..
Rtlt:NlION . 0
WORKI::R8CO"'IUilSAnOH AND 0830-34098 04/01/2006 04/01/2007 ..!J.1~tf~"..L I",));'
eMflLCY!6R5'I.IA1lIUTY .1.....l lXS
A 4NV PP,OPRltTORIPARTNEIVEXECU'TlVE t:.L. EACH ACClf)FNT . 500,O,C!l!
Or-I'ICERI~H 8(CLUOF.n1 C,L. DISUSE - ~.~Mf'L.U~~.~. ' ~oo.riOCi
~.wCI~:SoalOW E.L D15t:AS1: - /-'OLleY' LIMN . 500.00~
anteR
DErl\lf'TlON OF OI"li!tATlOHS I LOCItT1OHS I '<<HICl!S I ~LUSlOM1 AODED &... IlNDOA,MENT I SfECIM. PRDYt$IOJilS
1 day. not'ce of ~ancellatjon or non-payment 0 prem'u~.
~e: DEP COntra~t No DC641-
This revise.s . replaces previously faxed certificate
HnlOER CANCELLATION
9HOl.110 IMY OF' THE ABOVE DESCRt6ED rol.le." BE CANCELLED KI=ORE THE
f)lJl'MllDN DATE THl::MEOF, THE ts&UING INSURER WILL ENDEAVOR TO MAIL
~ OAYlWRITTEN NOTICE TO THf eEtltTlf'lca.'fE MOLtlER NAMm TO THE LEn.
Departlllent of Environmental Prote(;tion aUT t"A11.Ult2' TOMNl. SUCH NOTICE SHALL.IMIJOSE. NO OfIlIGATIONOR UA8IllT'f
3900 Conmonwealth Blvd. ot' AHVKtMD UPON THE INSURER. ITS AGeNTS OR ~f.PRE"NT.TI\J'S.
Tall ahusee. Fl 32399 AUTHmUZE'D REPfIESE'Jrn"ATlVli! -1" =,<.~..;#-/
Steve GoddardlKATHY
ACORD 25(2001108)
@ACORD CORPORATION 1988
05/23/2006 10:16
6502226075
FRANKLIN INSURANCE
PAGE 01/01
FRANKLIN INSURANCE AGENCY, INC.
May 23, 2006
Capital Insurance Agency, Inc
Attn: Barbara Catney
POBox 15949
TaUahassee,FL 32317~949
RE: Travelers Indemnity Co of CT
#BA591 W332805SEL
Dear Barbara:
A Certificate of Insurance has been issued to the Monroe County Board of
County Commissioners. Please note that we are unable to comply with the
request to name the Certificate Holder as an Additional Insured as regards the
Auto Liability on the certificate as this is not permitted by the insurance
company providing the coverage.
Please let us know any time We .may be of assistance with you.r insurance
matters.
Sincerely,
~ ::}...l4"rJI..J
Carlton. W. Franklin" CPCU
PINIlWOOD PROfESSIONAL OFFICES. 209 P1NEWOOD DRIVE' TALLAHASSEE. fl\..C)IUDA 32303
po. BOX 31.,. TALLAItASSEIi.I'l.ORIDA 3231S
{8SOl68100433 .rou. FREE 1-8lJO.681004]1. FAX (8SO) 222.807$
~
. -. -.--...-.-.,~....- . ..~'.... .........,-.........~............. ,...... ""^"'... .-....1...
904-225-1001 p.2
vale: l:V.ltlf.lOoti O~~57 PM Page: 2 of 3
Oct 27 06 03:47p Aaron Kato
ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 lni OAT! lW1'tOD!"t'YYr;
O:i'AKG-l 09/28/06
""""""". THIS CERTIFICATE IS ISSUED AS A MATTEA OF INFORMATION
ONlY AND CONFERS "0 RIGHTS UPON THE CERTIFICATE
~l Lines In$utance Aqehcy ruc HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
4828 Blanding B1vd Suite 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES Be LOW.
Jacksonvi11e FL 32210-7329
~hone:904-384-0783 Fax; 904-384-0550 INSURERS AFFORDING COVERAGE NAlC.
INSURED _k llU"~rI:Enlaracw:.~.r,ny 18988
tIJS~RB: owners Insuxanee Company 32700
Otak Gt'Oup. Inc:. ~RC: I:verest. Nat.iohal Ins '. Co. 10120
850022 Hi~hwa~ 17 tJSLf(ERO;
'fu1ee n 209
~RE" i
COVERAGES
'n1E POLICIES QF WSl..AANCelISTEO 8aClW ~\IE BEErllSSl.'ED JO TttI! II'&JREO IWlEO,6BO\'e feR: lt1E POlICYPefUOD INOK:A1ED.lN01WI1IiSl~
1Hr REOl.mEM:Nr. TBlMOR c::or'Dlrlorta= NlY awtRACrOROttEROOCl.AoEtII'W1l'H Rl!SPfCTto WttQi THs OERnFlCA1E MA.Y &::: lS$I..EPCR .
Mb..Y PERtN"'- 1M! ~Nf'amEDffrTHE POUaESOESCRlBB>tlE:AE:lN.S Sl8JECT TO.ALl lHETERMS. EXClUSlOf\lSMD CONOfTIot-tS OF su:H
POUCIES. AGQ;lEG;I,Tt; LIMITS SHOWN~" HA.VE 6EEH REDUCEOB'f PAlO aAM;.
.1R tlSR TVn (}f NtURAHCE POUCY /,UJiIl8ER "oA11i~ DATE MMIDOI'r'Yl l.lMlfS
~ERAl L'MlUTY EAOiOCClRREtlC! . 1009000
A X COUMERClM. GENERH..llPBM..tlY 78612118-06 02/10/06 02/10/07 PREMISES a 1DCClnMIt) . 100909
I QAlMS """" ~ <><=R VF.1)€XPCAnyonq~) . 10000
PERSONt,z. &ADV INJI.RY .1000000
GEtEPA AGGREGATE . 2000000
h~~rtMtNRnFER: PAo~. CO'IIProPN;G 12000000
1"a.1CY ~ ~oc
~l11'OlI'Ioatl.E UA8l.lJY COM:IJIlED SINGLE llMll . 1000000
B H<YIWfO 4306617400 10/16/06 10/16/07 I.Eucddlll'll)
I- R.L OY<<'a)M.lTOS
K BCOIL Y ItUJR"l'
SOifOUlW.AUJClS (pelpgI1lOn) .
~
~ HU>B>"""'" BCOA. Y INJLR'f
.
~ tJCN..O'\WED.IfJJOS [DereccidJnl:)
PAOPERlY DAWlGE .
tpw"""""l
~~ UABlJ1Y AUTO O~ '(. ~ACX:lOENT .
-""'" Qn-eR'llWJ ...= .
mro ONLY: """ .
IttESSJUtAJREU.A LlABlLrlY EAOiO<:ClllllEOCE .
:j"""" Da.J\IMSIMCe AGGREGATE .
.
=1 DEOOC''''E . .'
RETEMI~ I .
YtlORtai:RliC~llONNCl hom- LHlm I IUE~
EUPt.O'VEfit$'" W.81LrrY
NN FRCPRIE'tOlWARURlEXl:CUfNE E..L EAOI.&.CCIOl:NT I
Cl'FICERM!r.tBeRE.XCU.U01 E.\.. DlSEASE. I:A EroR.ovee .
Irves.llhaibra~
SPfCl.'.L. PROViSIONS belrNf EL.OJSEASE. POlICYLlMIl I
OllOE'
A 8quipmeDt Floa~er 78625662-05 U/08/05 11/08/06 Ren~JLea.s 150,ODO
c POllution Po1icv ! 40PHOO3605-061 05/30/06 05/30/07
'~Vl'eIU'IIOHB' LOCtI.TlONS' V!HI~IiS tE)cr:(U$IONSAI)DalaY'ENOOIQ:IiMENT' SPEW.L PROVl IONS
Ra:OEP project No. 6B02! ~omt Kazbor Cqt F~shiD9 Platfo~ - Boa~d of County
Ccmmissioo.ers, Monroe C07.Iaty, St:.ate of Florida. Dept. of Envi%'onment:al
l"a:otection aDd Board of' '1'rllstee$ oE the lntemal Trus't Fund are iD.Qll1ded
under the 9eneral liability as acIditi.ollal i.n...urec:b with respects to Genera1
Liability pe~ po1icy wo~dinq.
CERTIFICATE HO~OER
Monroe C01Ul ty BOCC
R.oom, 268
1100 S~n~on St.
Key Ne:st FI. 33040
CANCELLATION
MONaoJtJ. !St4D1JLO)Rn OF 'lWE AIlOVEDE8.CAlBa) POLtCQ IfEC;ANtaLEC BEFORE THE mlPUlATlON
DATE THEREOf, N& ISSIJINC INS~ WILl EtlDeA~ TO Mq. ~ DA'fSWRmEN
Ncmclli 10".. CERTlFIC'ATE 'HOL.OEA NAMl!D TO 1WE LE:N. IIUT F.lLURE TO DO !SO ~L\.
IUPO$& N() QelIOA.T10N OR UABlutY 011 IoNY lOttO l..f"Ot4 THE IN$UAf:R.ln AGan'$ OR
REflRe$S","Tf'JE$
RSffl!:n:~~
ill ACORO CORPORAllON 1988
ACORO 25 (2001188)
Oct 27 06 03"47p
V~\. L'. lUVU II : LO#\IYI No, 34U9TP:..,Ln"""",,,
AC..;ut<LJ,. CSRTIFICATE OF LIABILITY INSURANCE 10 /27 /2006
"0""""0 (904)448-9777 FAX (904)448-9788 THIS CER11FICATE IS ISSUED AS A MATTER OF INFORMATION
Insurance Office of America. Inc. ONl V AND CONFERS NO RIGHTS UPON THE CERTIFICATE
flOlDER. TfllS CERllFICATE ODES NOT AMEND, EXTEND OR
2700 University Blvd. AL TEA THE COVERAGE AFFOROED BY THE POLICIES BELOW,
West Buil ding B
Jacksonville, FL 32217 INSURERS AFFORDING COVERAGE NAIC *
Il'duRJ;;O Otak oroup J Inc. lHSllRERk Briclgefield Employers Ins. Co. 10701
850022 Highway 17 lNWRERa:
Yulee, Fl 32097 1N9...I'S\C~
lI'ISl.AERD:
INSlRERE~
T1-E POliCIES OF' JN5l.IRANCE LISTED 8ElOW HAVE SEEN ISSUEO TO lKE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWItHSTANDING
N<< REOUIREMENT. TERM OR CONDmOll 01' AllY CONTRACT OR OTHER DOCUMENT WllH RESPECT TO NiICH THIS CERTifiCATE MAY BE ISSUED OR
UAY PERT.Mt. WE jNS\lRPNCE AFFOftOEO 8Y THE POUCIES DESCRI8ED HEREIN IS SUBJECT 1'0 ALL TIE. TERMS, EXCLUSIONS mo CONOITIOf\lS OF SUCti
lifiiir' AGGREGI\TE llMlTSSHOWN MAY.........E BEaI REDUCED BY PAID ClAIMS, ~
INSR lYPSOFNlUIWtICE POUCYNuaeER uevEFF&CT1'lJi PlAvrEXP N UMlTS
.................,.., EPQi 0""","""", $
..:: COWlEAC'ALGEJERIll-l.IABllI'fY j:i=i~r?AENTeO .
I ClAIMS tMIE 0 oCClR tIEDe<.P(AttJOIWpeI'!on) .
- PeRSONAL. & KJV IN.un' F
- GEJIIERAL AGGREGA1E .
';~~n~I~~nFf~: PRODUCTS- ~AGG $
POtICY ~& ux:
~LlABLI1Y COMSINIEO StlGLE Ll!ltIl' .
_Nf'r.lUl'O tEn.l!IOCId8rtl
- ALLO\"o1EOA.lTOS BCOUII'l/lfl'r
.
SOtEOOLIDMQS [PIIJplllUnl
-
I- HIRED Jl,UTOS 'BCOll y IN.UlV
(PurICddlrtI $
I- NOf+~ED AUTOS ,
PROPERlY ttNwlAGE .
CPerilOCldeltj
R~UY AUTOOllly.eA"-CCDENf $
""'''-''0 OTHeR '"*' ....ACe $
PUlOOI<<.Y: "'"' F
OIiUJMBRELLAllABlU1Y eAQ{OCCIJRRa.a $
OCCllt 0 Cl.,AW.tS lAADE """""""'" .
R=e $
.
$ $
WORKERS c:OWPEHtAilON ANti 0830-3409B 04/01/2006 04/01/2007 X I WCSl.\lUo_1 io;~
ElPLO'f'ERI'lNlLlT't ., 500 om
1\ JdI'(PAOPRI'El'~aJJlVE I!: L I!AQoIAttICEHl ' $
OA"lceRtMEMBER ElCQ..1X:ED? EL,OISEASE-eAEI'CF\..OVE , SOO~
~~l1~Sbtb'''' E,L,01SEIoSE-POl.lCYI,.IMlT $ 500,
......
b~ION OF OI'~TD\ISJ LOt:A.l1ON'tvaiHlCLS4 EXQ.USIOtI'.IDOI!D BVEN;)ORSE;MENTI speCIALP,IlOVl$lONS
I'Oject: /I 23
&HOll.D ANY (71HE AllOW DESCfUIED POLICIES ee CANCIM...I..E:O BEPClRE'THE
E~'nON DIITE tHEREOF, THEtsBl.lNO INSUReI\ WILL ENOEttVCR. 'to w.a.
~!jAw. WNTT'EN NOllCl! TO THlI!i CEImFlCATE HOLDER NAMED lO'n-IElEFT,
""nroe County DOCC M FAlLURETO WAIL SUOI NO'11CE SHAU. "'POSE NO o&lJGII,noN OR. W8LlTY
1100 Simonton St, Room 268 OF NlYKftD UPON THE INSUfIllR. mil ACiENfS OR MPRESEHt'ATMiS.
Key \'lest, FL 33040 AUlHORlZ&D RlPftESENtAllV( ~P-/
Steve Godd"rd/KIITHY
Aaron Kato
904-225-1001
p,3
ACORD ZS (2D01J08)
@ACORD CORPORATION 18BB
ACORQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY)
10/27 /2006
PRODUCER (904)448-9777 FAX (904)448-9788 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Insurance Office of America, Inc. ~~L Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
University Blvd. - . LDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2700 I R '."'.'i. :~O ALfER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West Building B \ ,~. I l-:;' t-
,l- '.j ._~ J 0- INSl
Jacksonville, 32217 ,."'.'" ~...__."~..~-----, RERS AFFORDING COVERAGE . +N~IC #_
FL
Bri dgefi el.<l__EmJ>l oyers. -
INSURED Otak Group, Inc. INSUR RA Ins. Co. 1-10701
OCT 30 -------- -_.---
850022 Highway 17 INSUR R8
Yulee, FL 32097 1-_ m
INSUR RC:
'----. ------------- --
INSUR RD
MONROE GOUNTY -----
INSUR RE:
COVERAGE"
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
I~i'~ ~~i . ..~_._,---- - POUCY--EFFECTIVE-POL.ICy'eXPIRATlON - -.
TYPE OF INSURANCE POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
- DAMAGE T9~ ~ENTED ----- -----.
COMMERCIAL GENERAL LIABILITY 5
! CLAIMS MADE o OCCUR .-
MED EXP (Anyone person) ,
-. -_..----
I-- PERSONAL & ADV INJURY S
--
I-- GENERAL AGGREGATE $
h'L AGGREGATE LIMIT APnSIPER PRODUCTS - COMPIOP AGG $
(n:RO-
POLICY JECT LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
- -.. ..-
- ALL OWNED AUTOS BUOIL Y INJURY --.1-
SCHEDULED AUTOS '\'\\ CI ;....JJv (Per pel,;onl
- -_...~---- --. .-
- HIRED AUTOS I
, BODILY INJURY ~
NON-OWNED AUTOS '--" b<)\-Ob ~(fJeraCCltlenl) _:i:
- \ ----- -~-----~-- -
- PROPERTY DAMAGE S
.1 (Per accident)
(\. .-
RRAGE LIABlLlTY AUTO ONLY - EA ACCIDENT $
------- .
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY .- -
AGG $
OESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE -,----
AGGREGATE $
---- -----
S
.- -'--.--- .. -.
==i DEDUCTIBLE $
..- m - -- --"
RETENTION $ $
WORKERS COMPENSATION AND 0830-34098 04/01/2006 04/01/2007 X I_~~,:>:~;.l IOJb"- .-
EMPLOYERS' LIABILITY -.---' - -----
A ANY PROPRIETOR/PARTNER/EXECUTIVE tool, EACH ACCIOI::NT S 500,000
OFFICFRIMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE S 500,000
If yes, describe under ---~, - - - ----- silo, 0001
SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $
OTHER
tfrESqRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS
rO)ect: #6G023
RT I A
A
LL I N
Monroe County BOCC
1100 Simonton St, Room 268
Key West, FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER 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 INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~Cl -;f4-I
Steve Goddard/KATHY
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP ID.,~ DATE (MMIDDNYYY)
OTAKG-1 10/27/06
PRODUCER ~~I~,~.ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
NO CONFERS NO RIGHTS UPON THE CERTIFICATE
All Lines Insurance Agency nc RECEIVED HOLDlR. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4828 Blanding Blvd Suite 1 AL TE THE COVERAGE AFFORDED 8Y THE POLICIES BELOW.
Jacksonville FL 32210-7329 --....- I~SURE
Phone: 904-384-0783 Fax: 904 384 0550 S AFFORDING COVERAGE NAIC#
INSURED NOV 2 IN~URER Auto-Owners Insurance Company 18988
IN~URER Owners Insurance Companv 32700
Otak Group Inc. ~.._.- URER Everest National Ins. Co. 10120
850022 Hi~hwa7 17 MONROE COUN1Y INSURER 0
Yulee FL 209 RISK MANAGEMENT
RE:
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.
1 POL.ICY NUMBER I PD~~~~:~r6.r,~lXE DATE' fM~b~~!gN LIMITS
LT. N'. TYPE OF INSURANCE
~NERAL. LIABILITY EACH OCCURRENCE $ 1000000
A X X COMMERCIAL GENERAL LIABILITY 78612118-06 02/10/06 02/10/07 PREMISES (Ea occurence) $ 100000
I CLAIMS MADE [!J OCCUR MED EXP (Anyone person) $ 10000
I-- PERSONAL & ADV INJURY ,1000000
I-- GENERAL AGGREGATE $2000000
ril'L AGGREGATE LIMIT APAS PER PRODUCTS - COMP/OP AGG $ 2000000
X (n:RO-
POLICY JECT LOC
~TOMOBIL.E L.IABIL.ITY COMBINED SINGLE LIMIT $ 1000000
B ANY AUTO 4306617400 10/16/06 10/16/07 (Eaaccident)
I--
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
~ SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY
(Peraccidenl) $
.~ NON-OWNED AUTOS
I - PROPERTY DAMAGE $
(Pereccident)
I ==lAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN ,.-
AUTO ONLY AGG $
[jESS/UMBREL.L.A LIABILITY (I ,,., h '(l,j EACH OCCURRENCE $
OCCUR D CLAIMS MADE tQ-,' AGGREGATE $
... .. $
R DEDUCTIBLE '"'t .-2rVh $
RETENTION $ IV . _ $
WORKERS COMPENSATION AND TTOR/LIMITS I IUE~-
EMPL.OYERS' LIABILITY I
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
~~E(;I~tSp~bOV~S?ONS belOW E.L. DISEASE - POLICY LIMIT $
OTHER
A Equipment Floater 78625662-06 11/08/06 11/08/07 Rent/Leas 150,000
C Pollution Policv 40PH003605-061 05/30/06 05/30/07
DESCRIPTION OF OPERATIONS I L.OCATIONS I VEHICL.ES / EXCL.USIONS ADDED BY ENDORSEMENT J SPECIAL. PROVISIONS
Certificate holder is additional insured with respects to general liability
and auto liability per policy wording.
CERTIFICATE HOLDER
COVERAGES
Monroe County BOCC
1100 Simonton St. Rm 268
Keywest FL 33040
CANCELLATION
SHOUL.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL.L.ED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WIL.L. ENDEAVOR TO MAIL. ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE L.EFT, BUT FAIL.URE TO DO SO SHAL.L
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUT REPRESE:Z-~
@ACORDCORPORATION1988
ACORD 25 (2001/08)
ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP 1D.1n1 DATE (MM/DDNYVY)
OTAKG-1 10/27/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
All Lines ~~~ ;:t~D CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agency 109-------- H THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4828 Blanding Blvd suite 1 FTI'C'\ f[f ALTER ritE COVERAGE AFFORDED BY THE POLICIES BELOW.
Jacksonville FL 32210-7329 ,...." "_u~J V r..t T i
Phone: 904-384-0783 Fax: 904-3 4-0 50.-....----- I INS RERS ~FFORDING COVERAGE NAIC# -
INSURED INSU ERA \ Auto-Owners !rlliluranCQ Company 18988__
NOV 2 INSU ER B Owners Insurance Comoanv 32700
Otak Group Inc. INSU ERC Everest National Ins. Co. 10120
850022 Hi~hwa7 17 D~2"N,ROE COUNTY R D-
Yulee FL 209
INSURER 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 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 I PD~~~1ri~rJ8~E P DATE MM/bRDA~~'1N LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY 78612118-06 02/10/06 02/10/07 PREMISES (Ea occurence) $ 100000
__J CLAIMS MADE ~ OCCUR MEO EXP (Anyone person) $ 10000
-
e- PERSONAL & AOV INJURY $ 1000000
e- GENERAL AGGREGATE $ 2000000
il'L AGGREGATE LIMIT APPlS PER PRODUCTS - COMPIOP AGG $ 2000000
X pOllc;-h ~r8i LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000
B ANY AUTO 4306617400 10/16/06 10/16/07 (Eaaccident)
-
- ALL OWNED AUTOS BODILY INJURY
$
~ SCHEDULED AUTOS (Per person)
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
>- PROPERTY DAMAGE $
"'1" (Peraccidenl)
I R~GE LIABILITY U _ \l),... ItbJ AUTO ONLY - EA ACCIDENT $
ANY AUTO 11-03 0)0 OTHER THAN EA ACC $
AUTO ONLY: AGG $
:=JESSfUMBRELLA LIABILITY ~ EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I !'-ER-
EMPLOYERS' LIABILITY
ANY PROPRiETORfPARTNERfEXECUTIVE E.L EACH ACCIDENT $
~__..__ _._.___M__.~.
OFFICERIMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $
~~~~l~~s~~~v~S?O~S below E.L. DISEASE - POLICY LIMIT $
OTHER
A Equipment Floater 78625662-06 11/08/06 11/08/07 Rent/Leas 150,000
C Pollution Policy 40PH003605-061 05/30/06 05/30/07
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS
Re:DEP Project No. 6G023 Tom1 Harbor Cut Fishing Platforms - Board of County
Commissioners, Monroe County, state of Florida, Dept of Environmental
Protection and Board of Trustees of the Internal Trust Fund are included
under the general liability as additional insureds with respects to General
Liability per policy wording.
CERTIFICATE HOLDER
CANCELLATION
COVERAGES
Monroe County BOCC
Room 268
1100 Simonton St.
Key West FL 33040
MONROE 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL.
IMPOSE NO OBL.IGATION OR L.IABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUT REPRES~~
@ACORD CORPORATION 1988
ACORD 25 (2001108)
...-.-......-.-.,............
. ..~._. .........,-........................ ,.....JUt"'=' ,-".""
904-225-1001 p.2
uate: l:lF..ltV..lOD6 03;57 PM Page: 2013
Oct 27 06 03:47p
Aaron Kala
ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP ID lnj OAn IW"ODm'Yl'J
OTAKG-l 09/28/06
"""""tER THIS CERTIFICATE IS ISSUED AS AMATTEft OF INFORMATION
ONLY AND CONFERS tlo RIGHTS UPOfl THE CERTIFICATE
All Lines :Insurance Agency :Ine HOLDER. THIS CERTIFICATE OOES NOT AMEND. EXTEND OR
4828 Blanding Blvd suite 1 ALTER THE COVliRAGE AFFORDED BY THE POLICIES BBLOW.
Jacksonville FL 32210-7329
~hone:904-384-0783 Fax:904-384-05S0 INSURERS AFFORDING COVERAGE NAlC.
INSURED """""" lIvto-owt'l4on J:N;urapea c...,WIY 18988
1NSl..m:~e owners InSUraD(;e CODlpany 32700
Otak GrOup IDC. -..... '" Everes~ Na~ional Ins'. Co. 10120
8S0022 Hij~wa~ 17 I'lSl.JiERO.
rulee:!'L 209 i
I~RE'
lHEPCt.lOesCF~llSTEOeaOWl-lA\IE BEErJIS:SlJED ro N II'8.lReDf'olME;D.AaO\.'e F~1HEPOLtcYPERJ()D ItaCAlEO.1NOlWI1IiS1N()11o.G
AAYfEQl.JlREt.ENJ'. TERM~ OQtK)InC>>lCF NtY CQoJTPJtCrOROttEROOCU\I'EtIfWl'rH RESPfCTlO WI1CHlHS CEROFlCAlE MAY Ee lSSLEDOR .
lM.V PERTN"'. nE ~ NFCROEOfffnE POUClESOl;:SCRlBEOtIEJ*:lt.1lS SlBJECT lOA"'.. lHETeRMS. E)CO.USIONSmo COI'IOmot.sOF SlOt
POLIClES. AGOREGATE t.ltilR'S 6HO'MII ,*,Y!-VlvE. BEEHREDtJceoel' PAlO aAilo'& ~
,m tIS" 'lVJ'E OF NSURANCE. POI..1CVl'fl..lMGeR DA:'IE(MWDDf'l"Vl UMlfS
~ERA1..LIMI..ITY EAOiOCClRREtlCE . 1008000
A X ~(;&~lLA9IL1TY 78612119-06 02/10/06 02/10/07 -..... ._1 . 100000
I- --.JOAWMACE ~OCWR IoEl)EXP4hvonq pnort) . 10000
PERSONfIrI. &. PDY r-a.RY .1000000
GEtEP.A. PoGGREGAlE '2000000
n~ pi;GR~r'~tFlMrr N'FllESFER: PAOOOCTS. CO/ltProP N:;G 12000000
POLICY ~ n lOC
~UTOrtlOBtI.& UABILJJY COftBl'IED~LELlMIl .1000000
B - _""0 430661.7400 10/16/06 10/16{07 lEI''Icdo1Ml}
- R.L~.-JJlOS BOOll.l'lPU.IRY
(P41plln01l; .
!. SC'HEOUl.fOJlOIOS
!. HIRED AIJIOS 8OOA.VINJI.RY
(<>er 8cddWi) ,
!. ~""os
- PROPERlY 06.WlGE .
t~llecldllil
~C.UAS_ AUTO 0... y. 6,,, AOCIIJENT .
__0 OT>eA'lli"otJ EAI'oCC ,
AUlO QRY: AGO ,
5$SIUNBREU.A LIABIIJ1Y EAOt~ .
0C<;Ul 0 WolloISWOE AGGREGATE .
,
=i~"'E . .
RETENtION , :JirRY!..W1TS I IUel:" .
WOf:lKERS COllFlJ4A'nCN.tHO
EWt.0VEi\$" UA8LIrv
f4l{PRCPAt~AR~NE E.l. EAOt.N:ClOet-lT ,
-
c:f'~ICERWEM9EREXCt.t.UO? E.\.. DISEASE. EA Er4R..O't'EE ,
IIVtS.oasalbeUllcW
SPtClAl...PAO\IlStoN3t>>ICMt E l. DiseASE. POl.ICY LIMY I
"""'.
A EquipmeDt. Floater 78625662-0S 11/08105 U/08/06 Rent/Leas 1S0,DOO
C pOllution l'Olicv ! 40l!HOO:U;OS-061 OS/30/06 05/30/07
noN I LOC'.lmQNSI VDdCLES rexct..V$1ONS ADDEO fiJIt Ef.II)MSIjMEN1' , SPECW. I'ROVI ON$
Re:DEP pJ:oject No. 68023 'rem' Ha:boJ: CQt FishiDCJ Plat.f'o%:IILS - DO&:I:'d of County
cormaissioners, Monroe County, S'bIte o~ Florida. Dep~ of .nv1ro~nta1
protection and Board of ~~ustee$ of the l~temill '1'rU$'t Fund are included
u_ the 9eneJ:'iiJ~ liability as additioDal insureda with reltpeets to Ge~al
Liability ~ po1iey WOXd~Dq.
COVERAGES
CERTIFICATE HOLDER
C,,"CELLATION
MONROl!:1
SloIDUI"QHN OF TlEABOVEDEa:Cn1BS) P'Ol.lCIES BE It:AI'fl;:ELLED IlE'l'"OIlE lIE SQIIlRAtloN
DA7E lHEFlEOF, 1N& ISSUING INSI.lRSl WI..L EHD!SAVQA TO MAL ~ DAYS WRITTEN
ND1lC1I! m THI camFICATE ttDt..OER NAMl!O TO lttE LIOFT. auTF,lIrLURE ro DO !SO $MIlLI..
lIWO$& fIlO lJ8I.JCA.TlOtf ORUA91UTY Of' /JI/Y IONO "'POt, me INs:lJRER. IT'-AGEN1'S I:lR
REPRE$S<<.LTlVes
"""'0
R~'S!:Wll::!F~
,.cJ- '4...~
III ACORO CORPORATION 19811
Monroe cou.nty BOCC
ElQrOUl. 268
1100 simonton St...
Key We;st FL 33040
ACORO 2S (ZIXl1'09)
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
'" 01/21/2008
PRODUCER (904)448-9777 FAX (904)448-9788 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Insurance Offi ce of Ameri ca, Inc. ~~~ ~~~~9NFERS NO RIGHTS UPON THE CERTIFICATE
H . CERTIFICATE DOES NOT AMEND, EXTEND OR
2700 University Blvd. A;mER THE C WERAGE AFFORDED BY THE POLICIES BELOW.
West Building B , ,. "
Jacksonville, Fl 32217 illisURERS AFF RDING COVERAGE NAIC#
INSURED Otak Group, Inc. JAN _ ''iiiYilfiRA< Ins. Office of Pennsylvania
850022 Highway 17 , ~
L___. ' '~l'RB
Yulee, FL 32097 INSURER C
MON'WE C U'rm'RER 0
RISK MI,NAG .~ERE:
C"VERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ll~.$i~ ~~~l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PO~~..v EXPIRATION
~NERAL. L1^BILlTY
COMMERCIAL GENEFlAL LIABILITY
I CL.AIMS MADE [J OCCUR
EACH OCCURRENCE
DAMAGE TO RENTED
-
-
~'L. AGGREGATE LIMIT APPLIES PER:
I POL.lCY n j~8T n LOC
~OMOBIL.E L1ABIL.lTY
_ ANY AUTO
AL.L OWNED AUTOS
-
_ SCHEDULED AUTOS
_ HIRED AUTOS
NON-OWNED AUTOS
-
~
$
$
$
$
PRODUCTS - COMP/OP AGG $
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
\[~ -\o~,iS}: --
, 1-9f~-=
COMBINED SINGLE LIMIT
(Eaaccident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Peraccidenl)
hRAGE LIABILITY
H ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY:
IA
~ESS/UMBRELLA L1ABIL.ITY
W OCCUR D CLAIMS MADE
R DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPL.OYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OF!="ICER/M[~,1BER EXCLUDED':'
If yes, describe under
SPECIAL PROViSIONS below
OTHER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYE $
E.L. DISEASE - POLICY LIMIT $
EACH OCCURRENCE
AGGREGATE
WC2954897 01/22/2008
01/22/2009 X IT~~J:~,~~I IO"~-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICL.ES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
T~ u".. n~o
,r AT'"''
LIMITS
$
$
$
$
$
$
EA ACC $
$
$
$
$
$
$
AGG
100 , 000
100,000
500,000
Monore County Board of
County Conwnissioners
HOO Simonton St:
1-1213
Key West, FL 33040
SHOUL.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL.ED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WIL.L ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE L.EFT,
BUT FAlL.URE TO MAlL. SUCH NOTICE SHALL. IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~ .4// ./
Steve Goddard/KATHY 7-- ~
ACORD 25,f2001/Qa)
c.G:~
@ACORDCORPORATION 1988