#18-7482 (R & W Enterprises) PROFESSIONAL SERVICE AGREEMENT
# 18-7482
for
Real Estate Appraisal and Consulting Services
THIS AGREEMENT, made and entered into on this,93(C"day of pr( ( . 2019 , by
and between R & W Enterprises. Inc.
authorized to do business in the State of Florida, whose business address is
2186 Coffee Pot Blvd, NE, St. Petersburg, Florida 33704-4650 , (the "Contractor")
and Collier County, a political subdivision of the State of Florida, (the "County"):
WITNESSETH:
1. The Agreement shall be for a three (3 ) year period, commencing 0 upon the
date of Board approval-❑ or on and terminating three ( 3 )
year(s) from that date or until all outstanding Purchase Order(s) issued prior to the
expiration of the Agreement period have been completed or terminated.
The County may, at its discretion and with the consent of the Contractor, renew the
Agreement under all of the terms and conditions contained in this Agreement for two
( 2 ) additional one (1 ) year(s) periods. The County shall give the Contractor
written notice of the County's intention to renew the Agreement term prior to the end of the
Agreement term then in effect.
The County Manager, or his designee, may, at his discretion, extend the Agreement under
all of the terms and conditions contained in this Agreement for up to one hundred and
eighty (180) days. The County Manager, or his designee, shall give the Contractor written
notice of the County's intention to extend the Agreement term prior to the end of the
Agreement term then in effect.
2. COMMENCEMENT OF SERVICES. The Contractor shall commence the work upon
issuance of a 0 Purchase Order ❑ ❑
3. STATEMENT OF WORK. The Contractor shall provide services in accordance with the
terms and conditions 0 Request for Proposal (RFP) ❑ ❑
Other ( ) # 18-7482 , including all
Attachment(s), Exhibit(s) and Addenda and the Contractor's proposal referred to herein
and made an integral part of this Agreement.
❑■ The Contractor shall also provide services in accordance with Exhibit A — Scope of
Services attached hereto.
Page 1 of 14
Professional Service Agreement#2019-011
3.1 This Agreement contains the entire understanding between the parties and any
modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in
compliance with the County's Procurement Ordinance, as amended, and Procurement
Procedures in effect at the time such services are authorized.
3.2 The execution of this Agreement shall not be a commitment to the Contractor to
order any minimum or maximum amount. The County shall order items/services as
required but makes no guarantee as to the quantity, number, type or distribution of
items/services that will be ordered or required by this Agreement.
3.311I The procedure for obtaining Work under this Agreement is outlined in Exhibit A —
Scope of Services attached hereto.
3-4 ❑ __ • _ ❑ Other
Exhibit/Attachment:
35 ❑ - - - - - •- -- --
4. THE AGREEMENT SUM. The County shall pay the Contractor for the performance of this
Agreement based on Work performed pursuant to the quoted price offered by the
Contractor in response to a specific Request for Quotations and pursuant to the Price
Methodology in Section 4.1. Payment will be made upon receipt of a proper invoice and
upon approval by the County's Contract Administrative Agent/Project Manager, and in
compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government
Prompt Payment Act".
4.1 Price Methodology (as selected below):
U Lump Sum (Fixed Price): A firm fixed total price offering for a project; the risks are
transferred from the County to the contractor; and, as a business practice there are no
hourly or material invoices presented, rather, the contractor must perform to the satisfaction
of the County's project manager before payment for the fixed price contract is authorized.
.- - ,, ,,_- .,,,.-a- :„ _ � W_� ,W.,-, _,, e, � „: ..s•„- x-. a . .x- - _
for-t ejecf:
Page 2 of 14
Professional Service Agreement#2019-011
4.2 Any County agency may obtain services under this Agreement, provided sufficient
funds are included in their budget(s).
4.3 Payments will be made for services furnished, delivered, and accepted, upon
receipt and approval of invoices submitted on the date of services or within six (6) months
after completion of the Agreement. Any untimely submission of invoices beyond the
specified deadline period is subject to non-payment under the legal doctrine of"laches" as
untimely submitted. Time shall be deemed of the essence with respect to the timely
submission of invoices under this Agreement.
44 - . _ _ , - _ - -•. -_ _ - - _-
.. -- -- , . - _ ---- - •- _ "-- -=-- Travel expenses shall
reimbursed as per Section 112.061 Fla. Stats.
Mileage ee
8r-ea cfast
Lunch $44,-99
Dinner
Airfare - -- -2 - :
eeaeh-efass-fare
Rental-Gar
hedging Aster cost of lodging at single
Parking
W lk a s+ne
undertaken pursuant to this Agreement.
5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes
associated with the Work or portions thereof, which are applicable during the performance
of the Work. Collier County, Florida as a political subdivision of the State of Florida, is
Page 3 of 14
Professional Service Agreement#2019-011
exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida
Statutes, Certificate of Exemption # 85-8015966531 C.
6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if
mailed or emailed to the Contractor at the following:
Company Name: R & W Enterprises, Inc.
Address: 2186 Coffee Pot Blvd. NE
St. Petersburg, Florida 33704-4650
Authorized Agent: Dan K. Richardson, President
Attention Name & Title:
Telephone: (727) 822-5612
E-Mail(s): danyueh33@aol.com
All Notices from the Contractor to the County shall be deemed duly served if mailed or
emailed to the County to:
Board of County Commissioners for Collier County, Florida
Division Director: Jay Ahmad
Division Name: GMD- Transportation Engineering Division
Address: 2885 S. Horseshoe Drive
Naples, Florida 34104
Administrative Agent/PM: Harry Henderson
Telephone: (239) 252-5847
E-Mail(s): Harry.Henderson@colliercountyfl.gov
The Contractor and the County may change the above mailing address at any time upon
giving the other party written notification. All notices under this Agreement must be in
writing.
7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a
partnership between the County and the Contractor or to constitute the Contractor as an
agent of the County.
8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits
necessary for the prosecution of the Work shall be obtained by the Contractor. The County
will not be obligated to pay for any permits obtained by Subcontractors.
Payment for all such permits issued by the County shall be processed internally by the
County. All non-County permits necessary for the prosecution of the Work shall be
procured and paid for by the Contractor. The Contractor shall also be solely responsible
for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall
comply with all rules, regulations and laws of Collier County, the State of Florida, or the U.
S. Government now in force or hereafter adopted. The Contractor agrees to comply with
Page 4 of 14
Professional Service Agreement#2019-011
CA()
all laws governing the responsibility of an employer with respect to persons employed by
the Contractor.
9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use
in any manner whatsoever, County facilities for any improper, immoral or offensive purpose,
or for any purpose in violation of any federal, state, county or municipal ordinance, rule,
order or regulation, or of any governmental rule or regulation now in effect or hereafter
enacted or adopted. In the event of such violation by the Contractor or if the County or its
authorized representative shall deem any conduct on the part of the Contractor to be
objectionable or improper, the County shall have the right to suspend the Agreement of the
Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to
the satisfaction of the County within twenty-four (24) hours after receiving notice of such
violation, conduct, or practice, such suspension to continue until the violation is cured. The
Contractor further agrees not to commence operation during the suspension period until
the violation has been corrected to the satisfaction of the County.
10. TERMINATION. Should the Contractor be found to have failed to perform his services in
a manner satisfactory to the County as per this Agreement, the County may terminate said
Agreement for cause; further the County may terminate this Agreement for convenience
with a thirty (30) day written notice. The County shall be the sole judge of non-performance.
In the event that the County terminates this Agreement, Contractor's recovery against the
County shall be limited to that portion of the Agreement Amount earned through the date
of termination. The Contractor shall not be entitled to any other or further recovery against
the County, including, but not limited to, any damages or any anticipated profit on portions
of the services not performed.
11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to
race, sex, color, creed or national origin.
12. INSURANCE. The Contractor shall provide insurance as follows:
A. •■ Commercial General Liability: Coverage shall have minimum limits of
$ 1,000,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability
and Property Damage Liability. This shall include Premises and Operations; Independent
Contractors; Products and Completed Operations and Contractual Liability.
a- Q■ Business Auto ' ia ge shall "lave minimum limits of
$ Per Occurrence, Combined Single Limit for Bodily Injury Liability and
C. ❑■ Workers' Compensation: Insurance covering all employees meeting Statutory
Limits in compliance with the applicable state and federal laws.
The coverage must include Employers' Liability with a minimum limit of$ 1,000,000 for
each accident.
Page 5 of 14
Professional Service Agreement#2019-011
D. 0 Professional Liability: Shall be maintained by the Contractor to ensure its legal
liability for claims arising out of the performance of professional services under this
Agreement. Contractor waives its right of recovery against County as to any claims under
this insurance. Such insurance shall have limits of not less than $ 1,000,000 each claim
and aggregate.
occurrence.
GT
limits of$ per occurrence.
Special Requirements: Collier County Board of County Commissioners, OR, Board of
County Commissioners in Collier County, OR, Collier County Government shall be listed
as the Certificate Holder and included as an "Additional Insured" on the Insurance
Certificate for Commercial General Liability where required. This insurance shall be primary
and non-contributory with respect to any other insurance maintained by, or available for the
benefit of, the Additional Insured and the Contractor's policy shall be endorsed accordingly.
Current, valid insurance policies meeting the requirement herein identified shall be
maintained by Contractor during the duration of this Agreement. The Contractor shall
provide County with certificates of insurance meeting the required insurance provisions.
Renewal certificates shall be sent to the County thirty (30) days prior to any expiration
date. Coverage afforded under the policies will not be canceled or allowed to expire until
the greater of: thirty (30) days prior written notice, or in accordance with policy provisions.
Contractor shall also notify County, in a like manner, within twenty-four (24) hours after
receipt, of any notices of expiration, cancellation, non-renewal or material change in
coverage or limits received by Contractor from its insurer, and nothing contained herein
shall relieve Contractor of this requirement to provide notice.
Contractor shall ensure that all subcontractors comply with the same insurance
requirements that the Contractor is required to meet.
13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall
defend, indemnify and hold harmless Collier County, its officers and employees from any
and all liabilities, damages, losses and costs, including, but not limited to, reasonable
attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this
Agreement by Contractor, any statutory or regulatory violations, or from personal injury,
property damage, direct or consequential damages, or economic loss, to the extent caused
by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or
anyone employed or utilized by the Contractor in the performance of this Agreement. This
indemnification obligation shall not be construed to negate, abridge or reduce any other
Page 6 of 14
Professional Service Agreement#2019-011
CA 0
rights or remedies which otherwise may be available to an indemnified party or person
described in this paragraph.
This section does not pertain to any incident arising from the sole negligence of Collier
County.
13.1 The duty to defend under this Article 13 is independent and separate from the duty to
indemnify, and the duty to defend exists regardless of any ultimate liability of the Contractor,
County and any indemnified party. The duty to defend arises immediately upon presentation
of a claim by any party and written notice of such claim being provided to Contractor.
Contractor's obligation to indemnify and defend under this Article 13 will survive the
expiration or earlier termination of this Agreement until it is determined by final judgment that
an action against the County or an indemnified party for the matter indemnified hereunder is
fully and finally barred by the applicable statute of limitations.
14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the
County by the GMD- Transportation Engineering Division
15. CONFLICT OF INTEREST. Contractor represents that it presently has no interest and shall
acquire no interest, either direct or indirect, which would conflict in any manner with the
performance of services required hereunder. Contractor further represents that no persons
having any such interest shall be employed to perform those services.
16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the following
component parts, all of which are as fully a part of the Agreement as if herein set out
verbatim: Contractor's Proposal, Insurance Certificate(s), El Exhibit A Scope of Services,
Q RFP/❑ ❑Othe -- #18-7482 , including Exhibits,
Attachments and Addenda/Addendum, ❑ subsequent and ❑ Other
17. APPLICABILITY. Sections corresponding to any checked box ( will expressly apply to
the terms of this Agreement.
18. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the
parties herein that this Agreement is subject to appropriation by the Board of County
Commissioners.
19. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall
offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of
value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier
County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure
5311. Violation of this provision may result in one or more of the following consequences:
a. Prohibition by the individual, firm, and/or any employee of the firm from contact with
County staff for a specified period of time; b. Prohibition by the individual and/or firm from
doing business with the County for a specified period of time, including but not limited to:
submitting bids, RFP, and/or quotes; and, c. immediate termination of any Agreement held
by the individual and/or firm for cause.
Page 7 of 14
Professional Service Agreement#2019-011
CAO
20. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the
Contractor is formally acknowledging without exception or stipulation that it agrees to
comply, at its own expense, with all federal, state and local laws, codes, statutes,
ordinances, rules, regulations and requirements applicable to this Agreement, including but
not limited to those dealing with the Immigration Reform and Control Act of 1986 as located
at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended;
taxation, workers' compensation, equal employment and safety including, but not limited
to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records
Law Chapter 119, including specifically those contractual requirements at F.S. §
119.0701(2)(a)-(b) as stated as follows:
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO
THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS
AT:
Communication and Customer Relations Division
3299 Tamiami Trail East, Suite 102
Naples, FL 34112-5746
Telephone: (239) 252-8383
The Contractor must specifically comply with the Florida Public Records Law to:
1. Keep and maintain public records required by the public agency to perform the
service.
2. Upon request from the public agency's custodian of public records, provide the
public agency with a copy of the requested records or allow the records to be
inspected or copied within a reasonable time at a cost that does not exceed the
cost provided in this chapter or as otherwise provided by law.
3. Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law for
the duration of the contract term and following completion of the contract if the
Contractor does not transfer the records to the public agency.
4. Upon completion of the contract, transfer, at no cost, to the public agency all public
records in possession of the Contractor or keep and maintain public records
required by the public agency to perform the service. If the Contractor transfers all
public records to the public agency upon completion of the contract, the Contractor
shall destroy any duplicate public records that are exempt or confidential and
exempt from public records disclosure requirements. If the Contractor keeps and
maintains public records upon completion of the contract, the Contractor shall meet
all applicable requirements for retaining public records. All records stored
electronically must be provided to the public agency, upon request from the public
agency's custodian of public records, in a format that is compatible with the
information technology systems of the public agency.
Page 8 of 14
Professional Service Agreement#2019-011
If Contractor observes that the Contract Documents are at variance therewith, it shall
promptly notify the County in writing. Failure by the Contractor to comply with the laws
referenced herein shall constitute a breach of this Agreement and the County shall have
the discretion to unilaterally terminate this Agreement immediately.
21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages
and agrees to the successful Contractor extending the pricing, terms and conditions of this
solicitation or resultant Agreement to other governmental entities at the discretion of the
successful Contractor.
22. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise
unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in
effect.
23. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this
Agreement in compliance with the Procurement Ordinance, as amended, and Procurement
Procedures.
24. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this
Agreement to resolve disputes between the parties, the parties shall make a good faith effort
to resolve any such disputes by negotiation. The negotiation shall be attended by
representatives of Contractor with full decision-making authority and by County's staff person
who would make the presentation of any settlement reached during negotiations to County for
approval. Failing resolution, and prior to the commencement of depositions in any litigation
between the parties arising out of this Agreement, the parties shall attempt to resolve the
dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State
of Florida. The mediation shall be attended by representatives of Contractor with full decision-
making authority and by County's staff person who would make the presentation of any
settlement reached at mediation to County's board for approval. Should either party fail to
submit to mediation as required hereunder, the other party may obtain a court order requiring
mediation under section 44.102, Fla. Stat.
25. VENUE. Any suit or action brought by either party to this Agreement against the other party
relating to or arising out of this Agreement must be brought in the appropriate federal or state
courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such
matters.
26. ❑ - •
- _
shall not change Key Personnel unless the following conditions are met: (1) Proposed
Page 9 of 14
Professional Service Agreement#2019-011
CAO
0 AGREEMENT STAFFING. The Contractor's personnel and management to be utilized for
this Agreement shall be knowledgeable in their areas of expertise. The County reserves the
right to perform investigations as may be deemed necessary to ensure that competent persons
will be utilized in the performance of the Agreement. The Contractor shall assign as many
people as necessary to complete required services on a timely basis, and each person
assigned shall be available for an amount of time adequate to meet required services.
27. 0 ORDER OF PRECEDENCE. In the event of any conflict between or among the terms of
any of the Contract Documents, the terms of solicitation the Contractor's Proposal, and/or the
County's Board approved Executive Summary, the Contract Documents shall take precedence.
-- - ,... . - a .,- .. .... - -.... .- .2. . ,'.,_. .W,¢ •.
-
Summary, the terms of the Agreement shall take precedence over the terms of all other
.- - _. - . • •.- -. -- -- -•---- ---.
-- -. a -- a -• a- -.e .- ,-- - .
28. ASSIGNMENT. Contractor shall not assign this Agreement or any part thereof, without the prior
consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement,
or any part herein, without the County's consent, shall be void. If Contractor does, with
approval, assign this Agreement or any part thereof, it shall require that its assignee be bound
to it and to assume toward Contractor all of the obligations and responsibilities that Contractor
has assumed toward the County.
29. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as
amended. Background checks are valid for five (5) years and the Contractor shall be
responsible for all associated costs. If required, Contractor shall be responsible for the costs of
providing background checks by the Collier County Facilities Management Division for all
employees that shall provide services to the County under this Agreement. This may include,
but not be limited to, checking federal, state and local law enforcement records, including a
state and FBI fingerprint check, credit reports, education, residence and employment
verifications and other related records. Contractor shall be required to maintain records on
each employee and make them available to the County for at least four (4) years. All of
Contractor's employees and subcontractors must wear Collier County Government
Identification badges at all times while performing services on County facilities and properties.
Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed
each year at no cost to the Contractor during the time period in which their background check
Page 10 of 14
Professional Service Agreement#2019-011
CAO
is valid, as discussed below. All technicians shall have on their shirts the name of the
contractor's business.
The Contractor shall immediately notify the Collier County Facilities Management Division via
e-mail (DL-FMOPS@colliergov.net) whenever an employee assigned to Collier County
separates from their employment. This notification is critical to ensure the continued security
of Collier County facilities and systems. Failure to notify within four (4) hours of separation may
result in a deduction of$500 per incident.
(Intentionally left blank-signature page to follow)
Page 11 of 14
Professional Service Agreement#2019-011
IN WITNESS WHEREOF, the parties hereto, have each, respectively, by an authorized person
or agent, have executed this Agreement on the date and year first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Crystal Kinzel, Clerk of Courts of the
Circuit Court & Comptroller
aiwuct
lko
By. Wil a' m L. McDaniel Jr. ,Chairman
Dated: 1.
(SEAL) '.:0 `+:
,
signature-only.
Contractor's .Witnesses: R &W Enterprises, Inc.
Contractor
2
By: / ti--
Co ractor's irst Witness Signatur91
D k. a,-4 sp s)//°r6s 1`6-^-4—
+ vQn c,Lehner TType/print signature and titlel'
TTyp�e/pprintt witness nameT
je 44 , •
Contractor's Second Wit,es�
Pack,/ L , 1/q pp
TType/print witness nameT
Ap ed as to Fe a d Legality:
_Cgrnty pttorne A i
Print Name `�
Page 12 of 14
Professional Service Agreement#2019-011
r _�
Exhibit A
Scope of Services
Q■ following this page (pages 1 through 1 )
this exhibit is not applicable
Page 13 of 14
Professional Service Agreement#2019-011
(A()
18'7482 "Real Estate Appraisal and Consulting Services"
SCOPE OF SERVICES
Collier County has ongoing land acquisition efforts for road projects,utility projects, Conservation Collier land
preservation efforts and other governmental needs. One of the most important components of these efforts
involves appraisals and appraisal related activities.
As such, the County established a pool of qualified appraisers who can provide a diverse level of services.
Services shall include, but not limited to;
• valuation of residential and commercial properties
• partial acquisitions
• condemnation appraisals
• cost estimates, and
• expert witness testimony
These appraisers will be available to submit quotes on a not-to-exceed lump-sum basis. Quotes will be
requested from the pool of appraisers selected for this agreement (solicitation #18-7482) and will be awarded
a given assignment based upon a combination of lowest cost and qualifications as to which appraiser is best
suited to provide such service. This will be based upon specific experience with similar properties and/or
appraisal issues, quoted turn-times for completion of the work and potential litigation related factors associated
with a given assignment. Once qualified, County staff will obtain a minimum of three quotes for each
assignment.
For work requiring unique experience or knowledge the County's Contract Administrative Agent may select a
specific appraiser using the direct select method. When direct select is deemed necessary, a letter must be
attached to the purchase order with sufficient detail to justify the need for a direct select. Such justification
should identify the individual making the request, description of requirement and address why the requirement
can only be fulfilled by the identified appraiser.
The types of services typically required by the County range from short form comparable sales valuations of
vacant parcels, to complex estimates of compensation due property owners arising from partial takings of
property by the County,as well as estimates of any severance damages resulting there from. While some of the
appraisals required by the County will be typical estimates of the market value of"whole" properties, the
majority of the assignments will involve property owner compensation estimates as a result of partial takings
from larger parent tracts.
All appraisals must be submitted first to the County's Real Estate Services Department or TECM/ROW
Department(depending on which department ordered the appraisal)electronically in DRAFT. Once the County
has reviewed and approved the appraisal, the appraiser will be asked to electronically submit a final signed
copy of the appraisal. Once the final signed version of the appraisal is sent, the appraiser may also submit an
invoice to be reviewed/approved and processed for payment.
Page l of l
CA()
Other Exhibit/Attachment
Description:
❑ following this page (pages through )
❑■ this exhibit is not applicable
Page 14 of 14
Professional Service Agreement#2019-011
CAO
„.1.4.4
05-26-2011
„EF,` AlViAT"'. STATE OF FLORIDA
CMEF FINANCIAL OFFICER DEPARTMENT Of FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
NON-CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 05/26/2011 EXPIRATION DATE: N/A
PERSON: RICHARDSON DAN K
FEIN: 591097321
BUSINESS NAME AND ADDRESS:
A S V ENTERPRISES INC
2186 COFFEE POT BLVD NE
ST PETERSBURG FL 33704
SCOPES OF BUSINESS OR TRADE:
1- SALES 1- APPRAISAL
3- REAL ESTATE / PROPERTY MOMT
45I 0373.At 1rrl.a31 It IAaelr. 443 04114+ I,.'. n 3113,.of 1 ., ..3. :a.a,.. Ir 1,4aa r ..r.r.,M. ai,,,....,.ar.1...
.... ... 111ar
n .
s,.0a.try r. _
a1 . 33;73. A F i r 0434 a»t
'e.4! err O f .is c51.4, 04 1a.,.1.. 13, ,I• ivr 4i../.,443 6Y! M.,. N
I! 4 ..0 a .
,y sal 4 sl.0 ,`F.1
.13110 a 9.a., r.l .
rr4 ,.. s154.1 a.,,
I, an a r301.,v =1 3.3.33...31+,.,cl , ,ri133,N tn( a
l..r 1I4,
1. ,, all.rsri..
•••••,1 e.1.. e.1.3,e.1.3, 1,3.,Y,A, ,ar,.s..M .. ..t...
CUEST73MS7 145CU 413 'e04
(11/.17.'257 CERTIFICATE C4 tLEC77Ck 10 BE EXE&0P? 1Ee1SE0 01-7:
PLEASE CUT OUT THE CARD BELOW AND RETASN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF F030$ciAl SERVICES „ y., f IMPORTANT
O1ViS5OTr OF WORKERS”COMPENSATION 1PPurmset :0 C:.np:,, 44905(141. FS,.Al ofllcer of a Co,pofat.at*1'
NON-CONSTRUCTION INDUSTRY �S,� O Noels e.tm0ta4 ±ram 1K.4 tha0ttt by filing a nert,t.eate o! elect,,•
CERTsPiCATE OF ELECTION TO SE EXEMPT FROM FLORIDA +�• L 4,3,41,,, 84, oo"on Ray no:',mi.(B,,o,(t5 01 Ca#Weneehee unde• th,,
WORKERS'COMPENSATIONLAW 1111 D Cnyter.
EIFECTIVE. 05/26/2011 EXPIRATION DATE: N/A
PERSON DAN K RICNARtsSON H Pnss:rnt to Mama/ t.:(1951171, F.S.Can,bcates at Net ho0 4e
,333rD:., rOnly w:11,-,w:11,-,int SCOP Or UTbasun S4 at Axle "52nd 0:,
Fl... 591097331 R cm me ,m7Ice 01 e:e .on oe taemot
Bu5i.4.E55 'NAME AND ADDRESS E Putsuani to Coaotel 44005(131.F.S.Neoces of decnon ro be exemo!
and Cert.'.:es 4't cotton to be.0044bt 0141 At subltCl:b 550010414*
,I, at ay ams afier mt •o.c Of 0`e 401.0;Y the'SSwnce e1 73c
Ctt1,7,313e.353 010534'named 0n int 30hee Y 00,hi,4310 *0 longer m0010
:4'e repaottne,t5 of 5100 0505+00 Is, ,0004n0t of a oett'f,tote. tat
-*_tea'!r.en,5.°S'real.,a certti state n any t:me i0, fa.turr of Pe scoot OF BUSINESS OR RACE 00.1.name"c. ;1e certrl,eate to meet t1333rtpmrtment.St r-.4
».s Mt Van
OtE0TIONS, 111501 013 111.14
CUT HERE
e Carry bottom portion on the job, keep upper portion for your records.
OYl.: 243 CERTI/IC.4RE OF ELECTION 10 8E EXEMPT RtV:SED C1.11
Lams
iii'l
un
Z
O =
W cuEQ
o
ccv
cc
N ` W N
t
LLI v)
0 !— __
IN
Q m Dom, x o
-4 '
_ ,� x
O .:t ~` i irk �. N y
crs
ain7 .......cdoli,.,,, ,...4..7,69..,11 I:1i Lii:.'.‘,..:,,,,,i',.:1;L„,..,1 ir..,,,,,::::,:i....:i.,::z.:,..:3;:'14.1i,kal,''':::.:,:::,••••':ib;...,.'44 i.L'es,..„.,11: '''''t'.",...4.-1114117;:: ' ' -4 . ."—L.L.: C co
f C
(� sr ,ter k,, -, r 3 t 't .O -L
Fa) CO
t/ ; ►-�
cf) til.., , - '.'7_,..,,,,_..:, a, :.: i 1 1.$,-,,te L':i.'-‘,1444::::7''' ; -1-f .: g fu ....., „
_., g„4, ff,,,,,,,.,..,,,,,::,:,,,,-.,:.,,,,,,...,..,-, #-_, 0 4-
0 CV
U. �/ a X c
W ca
zF— w > .�. ¢ ai
w Z " p
W ce a
O w =
U
o W >>'
i
Y a ~ 0
WL)
WIc-
2 Q
rt Ti-,..,,,..
.- iii:+ilivdril
,;.L, �. ,' .t rod ., ��,'.
r� ' ir2:::0. 1
1
eSouthern-Owners Page 1
Issued 05-30-2018
INSURANCE COMPANY TAILORED PROTECTION POLICY DECLARATIONS
6101 ANACAPRI BLVD.,LANSING,MI 48917-3999
AGENCY WEST COAST INSURANCE GROUP Renewal Effective 08-01-2018
12-0298-00 MKT TERR 052 727-344-5500 POLICY NUMBER 982312-20087915-18
INSURED R&W ENTERPRISES INC Company Use 20-23-FL-9808
Company Policy Term
ADDRESS 2186 COFFEE POT BLVD NE Bill 12:01 a.m. 12:01 a.m.
ST PETERSBURG FL 33704-4650 08 01-2018 to 08-01-2019
In consideration of payment of the premium shown below,this policy is renewed. Please attach this Declarations and attachments to your policy. If you
have any questions,please consult with your agent.
55039(11-87)
COMMON POLICY INFORMATION
Business Description: Appraiser
Entity: Corporation
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PART(S): PREMIUM
COMMERCIAL GENERAL LIABILITY COVERAGE $365.00
MINIMUM PREMIUM ADJUSTMENT(GL) $35.00
TOTAL $400.00
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
Premium shown above for commercial general liability coverage is an advanced premium deposit and may be subject to audit.
Forms that apply to all coverage part(s)shown above(except garage liability,dealer's blanket,commercial automobile,if applicable):
55156 (07-12) 55056 (07-87)
A 08%Cumulative Multi-Policy Discount applies. Supporting policies are marked with an(X):
Comm Umb() Comm Auto(X) WC() Life() Personal() Farm().
Countersigned By: WEST COAST INSURANCE GROUP
cSouthern-Owners Page 1
Issued 05-22-2018
INSURANCE COMPANY TAILORED PROTECTION POLICY DECLARATIONS
6101 ANACAPRI BLVD.,LANSING,MI 48917-3999
AGENCY WEST COAST INSURANCE GROUP Change Endorsement Effective 05-10-2018
12-0298-00 MKT TERR 052 727-344-5500 POLICY NUMBER 982312-20087915-17
INSURED R&W ENTERPRISES INC Company Use 20-23-FL-9808
Company Policy Term
ADDRESS 2186 COFFEE POT BLVD NE Bill 12:01 a.m. 12:01 a.m.
ST PETERSBURG FL 33704-4650 08-01-2017 to 08-01-2018
Description of Change
ADDED
55205 ADDITIONAL INSURED
NAME OF PERSON OR ORGANIZATION:
ADD: LEE COUNTY BOARD OF COUNTY COMMISSIONERS
Transaction Number: 002
Endorsement Premium: $0.00
NO CHANGE
Owners 58974 (1-17)
Issued 07-10-2018
INSURANCE COMPANY COMMERCIAL AUTO POLICY DECLARATIONS
6101 ANACAPRI BLVD.,LANSING.MI 48917-3999 PREFERRED PROGRAM
AGENCY WEST COAST INSURANCE GROUP Renewal Effective 08-25-2018
12-0298-00 MKT TERR 052 (727)344-5500 POLICY NUMBER 49-253-926-00
NAMED INSURED R&W ENTERPRISES INC Company Use 20-04-FL-1208
Company POLICY TERM
ADDRESS 2186 COFFEE POT BLVD NE Bill 12:01 a.m. 12:01 a.m.
08-25-2018 to 08-25-2019
SAINT PETERSBURG FL 33704-4650
In consideration of payment of the premium shown below,this policy is renewed. Please attach this Declarations and attachments to your policy. If you
have any questions,please consult with your agent.
000085 /000086
Scheduled Drivers List
Listed below are drivers currently scheduled on this policy. Please compare the list with your current records and contact your agent
with any changes that need to be made. We will update the list accordingly for the next renewal.
Name: Date of Birth
Last First Age MM-DD-CCYY State
RICHARDSON DAN 67 05-07-1951 FL
RICHARDSON YUEH * 58 09-07-1959 FL
* DRIVER ASSIGNED TO PRIVATE PASSENGER VEHICLE FOR RATING PURPOSES.
Owners Page 1 58974 (1-17)
Issued 07-10-2018
INSURANCE COMPANY COMMERCIAL AUTO POLICY DECLARATIONS
6101 ANACAPRI BLVD..LANSING.MI 48917-3999 PREFERRED PROGRAM
AGENCY WEST COAST INSURANCE GROUP Renewal Effective 08-25-2018
12-0298-00 MKT TERR 052 (727)344-5500 POLICY NUMBER 49-253-926-00
ITEM ONE Company Use 20-04-FL-1208
NAMED INSURED R&W ENTERPRISES INC
Company POLICY TERM
ADDRESS 2186 COFFEE POT BLVD NE Bill 12:01 a.m. 12:01 a.m.
08-25-2018 to 08-25-2019
SAINT PETERSBURG FL 33704-4650
Entity: Corporation
IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY,WE AGREE WITH
YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
ITEM TWO-SCHEDULE OF COVERED AUTOS AND COVERAGES
This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply
only to those autos shown as covered autos. Autos are shown as covered autos for a particular coverage by the entry of one or more
of the symbols from the COVERED AUTOS section of the Commercial Auto Policy next to the name of the coverage.
COVERAGES COVERED AUTOS LIMIT OF INSURANCE PREMIUM
SYMBOLS FOR ANY ONE ACCIDENT OR LOSS
Bodily Injury 7.19 $1 Million each person/$1 Million each accident $1,433.13
Property Damage 7,19 $1 Million each accident $360.29
Uninsured Motorist 7 $100,000 each person/$300.000 each accident
Coverage (Non-stacked Uninsured Motorist Coverage selected.) $422.73
Medical and Disability-$10,000 each person
Personal Injury Protection 7 Medical limited to$2,500 non-emergency $193.29
Death Benefits-$5,000 each person
Medical Payments No Coverage
Comprehensive 7 $250 deductible applies for each covered auto unless a $116.98
deductible appears in ITEM THREE.
E Collision 7 $500 deductible applies for each covered auto unless a $401.98
deductible appears in ITEM THREE.
H Road Trouble Service
> No Coverage
a.
Additional Expense 7 See ITEM THREE for the limit applicable for each
covered auto. $33.33
Premium for Endorsements
ESTIMATED TOTAL PREMIUM* $2,961.73
*This policy may be subject to final audit.
Includes copyrighted material of Insurance Services Office,Inc.,with its permission.
Page 2 58974 (1-17)
OWNERS INS.CO. Issued 07-10-2018
AGENCY WEST COAST INSURANCE GROUP Company POLICY NUMBER 49-253-926-00
12-0298-00 MKT TERR 052 Bill Company Use 20-04-FL-1208
NAMED INSURED R&W ENTERPRISES INC Term 08-25-2018 to 08-25-2019
ITEM TWO(Continued)
Endorsements That Apply To All Items: 58001 (01-15) 58800 (04-18) 58000 (01-15) 58200 (01-15) 58550 (01-17) 58706 (01-17)
58524 (01-15) 58555 (01-16) 58558 (03-16)
QUICK REFERENCE FOR COVERED AUTO DESIGNATION SYMBOLS
Refer to the Commercial Auto Policy 58001 Section I for a complete description of COVERED AUTOS and policy provisions
that may apply.
1 =Any Auto 6=Owned Autos Subject To A Compulsory Uninsured
2=Owned Autos Only Motorists Law
7=Scheduled Autos Only
3=Owned Private Passenger Autos Only
8=Hired Autos Only
4=Owned Autos Other Than Private Passenger Autos
Only 9=Non-owned Autos Only
5=Owned Autos Subject to No-fault 19=Mobile Equipment Subject To Compulsory Or
Financial Responsibility Or Other Motor Vehicle
Insurance Law Only
Includes copyrighted material of Insurance Services Office,Inc.,with its permission.
Owners Page 3 58974 (1-17)
Issued 07-10-2018
INSURANCE COMPANY COMMERCIAL AUTO POLICY DECLARATIONS
6101 ANACAPRI BLVD..LANSING,MI 48917-3999 PREFERRED PROGRAM
AGENCY WEST COAST INSURANCE GROUP Renewal Effective 08-25-2018
12-0298-00 MKT TERR 052 (727)344-5500 POLICY NUMBER 49-253-926-00
NAMED INSURED R&W ENTERPRISES INC Company Use 20-04-FL-1208
Company POLICY TERM
ADDRESS 2186 COFFEE POT BLVD NE Bill 12:01 a.m. 12:01 a.m.
SAINT PETERSBURG FL 33704-4650 08-25-2018 to 08-25-2019
In consideration of payment of the premium shown below,this policy is renewed. Please attach this Declarations and attachments to your policy. If you
have any questions,please consult with your agent.
ITEM THREE-SCHEDULE OF COVERED AUTOS,ADDITIONAL COVERAGES AND ENDORSEMENTS
TERRITORY CLASS
1. 2007 HOND ODYSSEY TOURING 004
VIN;SFNRL388176109296 Pinellas County,FL
COVERAGES LIMITS PREMIUM
Bodily Injury $1 Million each person/$1 Million each accident $722.71
Property Damage $1 Million each accident 181.66
Uninsured Motorist $100,000 each person/$300,000 each accident 196.67
Personal Injury Protection Medical and Disability-$10,000 each person 88.96
Medical limited to$2,500 non-emergency
Death Benefits-$5,000 each person
Comprehensive ACV-$2,000 deductible 43.32
Collision ACV-$2,000 deductible 136.73
Additional Expense $40 per day/$1,200 per loss 15.51
TOTAL $1,385.56
Interested Parties: None
Additional Endorsements For This Item: 58455 (01-17) 58308 (01-17) 58537 (08-15) 58548 (01-15)
ITEM DETAILS: Auto driven for pleasure use by a 58 year old operator.
Cost Symbol: 13-8B-13-8B-62.
Broadened Coverage for Named Individuals-Drive Other Cars endorsement applies for YUEH&DAN RICHARDSON
10%Anti-Theft Device Discount applies to Comprehensive premium.
Vehicle Count Factor Applies.
5%ABS Discount applies to 131,PD,Coll,and PIP premiums.
Multi-Car Discount applies.
Premier Credit applies.
35%Air Bag Discount applies to PIP and/or MP premiums.
Non-stacked Uninsured Motorist Coverage selected.
Rate Effective Date 06-08-2018
150 0803
Page 4 58974 (1-17)
OWNERS INS.CO. Issued 07-10-2018
AGENCY WEST COAST INSURANCE GROUP Company POLICY NUMBER 49-253-926-00
12-0298-00 MKT TERR 052 Bill Company Use 20-04-FL-1208
NAMED INSURED R&W ENTERPRISES INC Term 08-25-2018 to 08-25-2019
TERRITORY CLASS
•
2. 2016 MERZ CLA 250 004
VIN: WDDSJ4EB1GN342860 Pinellas County, FL
COVERAGES LIMITS PREMIUM
Bodily Injury $1 Million each person/$1 Million each accident $710.42
Property Damage $1 Million each accident 178,63
Uninsured Motorist $ 100,000 each person/$300,000 each accident 226.06
Personal Injury Protection Medical and Disability-$10,000 each person 104.33
Medical limited to$2,500 non-emergency
Death Benefits-$5,000 each person
Comprehensive ACV-$2,000 deductible 73.66
Collision ACV-$2,000 deductible 265.25
Additional Expense $40 per day/$1,200 per loss 17,82
TOTAL $1,576.17
Interested Parties:
Lessor(Additional Insured and Loss Payee):MERCEDES-BENZ OF TAMPA.4400 N DALE MABRY HWY.TAMPA.FL 33614-7021
Additional Endorsements For This Item: 58455 (01-17) 58308 (01-17) 58537 (08-15) 58591 (04-15)
ITEM DETAILS: Auto driven for pleasure use by a 67 year old operator.
Cost Symbol: 41-8A-47-JA-00.
10%Anti-Theft Device Discount applies to Comprehensive premium.
Vehicle Count Factor Applies.
5%ABS Discount applies to BI,PD,Coll,and PIP premiums.
Multi-Car Discount applies.
Premier Credit applies.
Leased Auto
35%Air Bag Discount applies to PIP and/or MP premiums.
Non-stacked Uninsured Motorist Coverage selected.
Rate Effective Date 06-08-2018
150 0803
TERM
ESTIMATED TOTAL PREMIUM $2,961.73
PAID IN FULL DISCOUNT -345.42
ESTIMATED TOTAL PREMIUM IF PAID IN FULL $2,616.31
The Paid In Full Discount does not apply to fixed fees or statutory charges.
Policy Rate Code 0002
A 10%Cumulative Multi-Policy Discount applies. Supporting policies are marked with an(X): Comm Umb()
Comm Prop/Comm Liab(X) WC() Life() Personal() Farm().
00803
00960
Countersigned By:WEST COAST INSURANCE GROUP
ACcte CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY)
02/08/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.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 Ileu of such endorsement(s).
PRODUCER
CONTACT
NAME
PROFESSIONAL LIABILITY SERVICES PHONE
(NC,
1250 S.HIGHWAY 17-9217-92
LAKE CENTER SUITE 110 ADDRESS:
PRODUCER (NC,No).
LONGWOOD,FL 32750 CUSTOMER ID:
INSURER(S)AFFORDING COVERAGE NAIC
INSURED INSURER A C.N.A.Insurance Company 20443
R&W ENTERPRISES,INC INSURERS:
2186 COFFEE POT BLVD NE INSURER C:
ST PETERSBURG,FL 33704
INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THis IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INa TYPE OF INSURANCE AODL e�R POLICY EFF POLICY EXP
LEP IAIaR tyyp POLICY NUMBER
GENERAL LIABILITY AMM/00/Yr/Y) (MMR)DNYYY), LIMITS
EACH OCCURRENCE $
❑ COMMERICAL GENERAL LIABILITY DAMAGE TO RENTED
CLAIMS•MADE ❑OCCUR
PREMISES(Ea occurrence)
❑ MED EXP(Any one person) S
PERSONAL IL ADV INJURY $
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
t'
CI POLICY❑PROJECT❑LOC PRODUCTS-COMP/OP AGG S
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
CIANY AUTO (Each Occurrence)
BODILY INJURY $
12)ALL OWNED AUTOS (Per person)
❑SCHEDULED AUTOS BODILY INJURY
(Per accident) $
0 HIRED AUTOS (PReOPE DAMAGE _
r accident)
❑NON-OWNED AUTOS
❑ S
f
❑ UMBRELLA LIAB❑OCCUR
EACH OCCURRENCE $
❑EXCESS LIAR ❑CLAIMS-MADE AGGREGATE s
❑DEDUCTIBLE $
❑RETENTION S i
WORKERS COMPENSATION YIN WC STATU- 0TH-
AND EMPLOYERS'LIABILITY ❑TORY LIMITS ❑ ER
ANY PROPRIETORIPARTNERiEXECUTNE N/A E.L.EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S
B yes,describe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $
OTHER
REAL ESTATE PROFESSIONALS LIMITS: PER CLAIM $1,000,000
A
PROFESSIONAL LIABILITY
onsInsINSURANCE
RFB 25413422218 08/01/18 08/01/19 AGGREGATE $1,000,000
Errors&Omissions Insurance
DEDUCTIBLE: $5,000
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED OLICIES BE CANCELLED BEFORE THE
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS EXPIRATION DATE THEREOF,NOTICE BE DELI - • IN ACCORDANCE WITH
3295 TAMIAMI TRAIL E. THE POLICY PROVISIONS.
NAPLES,FL 34112 AUTHORIZED REPRESENTATIVE
ACORD 25(2009109) 1 •'• ACORD CORPORATION.All rights reserved.
The ACORD name and logo are registered marks of Acord
ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY)
PRODUCER 02113/2019
Phone:(727)344-5500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
West Coast Group,LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
5665 Central Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Saint Petersburg,FL 33710 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License#:L097546
INSURERS AFFORDING COVERAGE NAIL#
INSURED
INSURER A Southern-Owners Insurnace Company 10190
R&W Enterprises Inc c/o Dan Richardson INSURER B: Owners Insurance Co. 32700__
2186 Coffee Pot Blvd NE INSURERC:
Saint Petersburg,FL 33704-4650 INSURER D:
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 ADD•L POLICY EFFECTIVE POLICY EXPIRATION!LTR INSRD TYPF OF INSURANC.F POLICY NUMBER OATF mummy) JATE/MM/OD TY1 LIMITS
GENERAL LIABILITY 20087915 08/01/2018 08/01/2019 I EACH OCCURRENCE S 1,000,000
A Y X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES(Ea occurenca) $ 50,000
CLAIMS MADE I X OCCUR ; MED EXP(Any one person) S 5.000
PERSONAL&ADV INJURY $ 1.000.000
(( I_GENERAL AGGREGATE $ 2_,00(1,000
GEM!AGGREGATE LIMIT APPLIES PER 1 F PRODUCTS-COMP/OP AGG $ 1.000.000
PRO
X POLICY 1 JFCT i 1 LOC •
� I
B AUTOMOBILE LIABILITY 4925392600 08/25/2018 08/25/2019
ANY AUTO ,COMBINED SINGLE LIMIT
(Ea accident) S
ALL OWNED AUTOS
X SCHEDULED AUTOS BODILY INJURY
HIRED AUTOS !(Per person) 1,000,000—
NON-OWNED AUTOS ( BODILY INJURY $
(Per aaident) 1,000,000
— j t PROPERTY DAMAGE
(Peraaident) 1,000,000
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
ANY AUTO I $
--
OTHER THAN EA ACC S
AUTO ONLY: AGG S
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR ICLAIMS MADE
! f AGGREGATE $
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
WC STATU- OTM-
EMPLOYERS•LIABILITY TORY LIMITS ER
ANY PROPWETORIPARTNERIEXECUiNE E.L.EEACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
If yea describe under E.I.DISEASE-EA EMPLOYE-E
SPECIAL PROVISIONS below I E.L.DISEASE-POLICY LIMIT S
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
For any work performed on behalf of Collier County.
Collier County Board of County Commissioners is listed as an additional insured under the captioned Commercial General
Liability on a primary and non-contributory basis If and to the extent required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
Collier County Board of County Commissioners NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
3295 Tamiami Trail E. MPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
Naples,FL 34112
REPRESENTATIVES.
A D REPRESENTATIyE
Le
ACORD 25(2001/08) (RLS)
®ACORD CORPORATION 1988
Printed by RLS on February 13,2019 at 10:01AM
ACC:PRO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
02/08/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER CONTACT
NAME:
PROFESSIONAL LIABILITY SERVICES PHONE
(NC,No):
1250 S. HIGHWAY 17-92 EMAIL FAX
LAKE CENTER SUITE 110 ADDRESS: (NC,No):
PRODUCER
LONGWOOD, FL 32750 CUSTOMER ID:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A C.N.A. Insurance Company 20443
R&W ENTERPRISES, INC INSURER B:
2186 COFFEE POT BLVD NE INSURER C:
ST PETERSBURG, FL 33704
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LETF INSR WVD POLICY NUMBER LIMITS
(MM/DD/YYYY) (MM/DD/YYYY)
GENERAL LIABILITY EACH OCCURRENCE $
❑ COMMERICAL GENERAL LIABILITY DAMAGE TO RENTED
❑❑CLAIMS-MADE El OCCUR
PREMISES(Ea occurrence) $
❑ MED EXP(Any one person) $
❑ PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
El POLICY El PROJECT❑ LOC PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
❑ANY AUTO (Each Occurrence)
BODILY INJURY
❑ALL OWNED AUTOS (Per person)
BODILY INJURY
SCHEDULED AUTOS (Per accident) $
El HIRED AUTOS PROPERTY DAMAGE $
(Per accident)
NON-OWNED AUTOS
❑ $
❑ UMBRELLA LIAB ❑OCCUR $
EACH OCCURRENCE $
❑EXCESS LIAB ❑ CLAIMS-MADE
AGGREGATE $
❑DEDUCTIBLE $
❑ RETENTION$ $
WORKERS COMPENSATION Y/N WC STATU- 0TH-
AND EMPLOYERS'LIABILITY ❑ ❑TORY LIMITS ❑ ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
OTHER
REAL ESTATE PROFESSIONALS LIMITS: PER CLAIM $1,000,000
PROFEA Errors& NAL LIABILITY
Insurance RFB 25413422218 08/01/18 08/01/19 AGGREGATE $1,000,000
Errors Omissions& Insurance
DEDUCTIBLE: $5,000
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED OLICIES BE CANCELLED BEFORE THE
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS EXPIRATION DATE THEREOF,NOTICE BE DELIV --. IN ACCORDANCE WITH
3295 TAMIAMI TRAIL E. THE POLICY PROVISIONS.
NAPLES, FL 34112
AUTHORIZED REPRESENTATIVE
1-':'. 09 ACORD CORPORATION.All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of Acord