Backup Documents 07/28/2009 Item #10G
lOG
MEMORANDUM
Date: September 21, 2009
To: Kelly Green, Administrative Assistant
Tourism Department
From: Teresa Polaski, Deputy Clerk
Minutes and Records Department
Re: TDC Category B Multi-Cultural Festival Grant
Agreement
Attached please find one (I) original agreement, referenced above (Agenda
Item #10G) adopted by the Board of County Commissioners on Tuesday,
July 28,2009.
If you should have any questions, you may contact me at 252-8411.
Thank you,
Attachments (3)
VlAJ "if 9
ITEM NO.: DATE RECEIVJ,:O G
FILE NO.: fY1 "1'1X.., (JX5~9 "})~ q II \
ROUTED TO: M~ -/Do,.ltf.lfj
DO NOT WRITE ABOVE THIS LINE
.--....-
".- "\
I
REQUEST FOR LEGAL SERVICES C.J
Date: August 4, 2009 jJ j ---i
Colleen Greene ~ ~ '0 ~ \{f -("' ~
To: -...J
Office of the County Attorney
From: Kelly Green, Tourism Department q . I Lj. DC(
CfVl&-
Re: TDC Category B Multi-Cultural Festival Grant Agreement pl'5.clo9Z-
BACKGROUND OF REQUEST:
~ This contract was approved by the BCC on July 28, 2009, Agenda /
~ ~ltem10G ~
" '0 c\O This item has not been previously submitted.
\~(prl
ACTION REQUESTED:
Contract review and signature.
OTHER COMMENTS:
Please forward to BCC for signature after approval. If there are any
questions concerning the document, please contact me. Purchasing would
appreciate notification when the documents exit your office. Thank you.
I ..' t: (
~V u:ut ~j
31 L~ { 0 ,-
RLS# IJ~- Tb~ - (J()t)3cr
CHECKLIST FOR REVIEWING CONTRACTS
Entity Name: If €.bLAfJ'bS {J/U!a-rnfN N ,(Jh.Av-r /l-S504" I~t!, lOG ':';,:1.
Entity name correct on contract? ~Yes - No
Entity registered with FL See. of State? ~Yes No
-
Insurance
Insurance Certificate attached? ~Yes - No
Insured registered in Florida? ~Yes - No
Contract # &/or Project referenced on Certificate? - Yes V"' No
Certificate Holder name correct (BCC)? ~Yes No
Commercial General Liability Exp, Date 3/( 1"2."'0
General Aggregate Required $ - Provided $ 3IMlL
Products/Compl/Op Required $ - Provided $ IN 1!.L.\C.btb Exp, Date ~ ,
Personal & Advert Required $ 3HJ, fJO() Provided $ lM.lL Exp. Date \. I
Each Occurrence Required $ .;H}__, Provided $ \~ Exp. Date i I
Fire/Prop Damage Required $ ~aJ)~D Provided $ 3tJ~)'~O Exp. Date , I
Automobile Liability Provided $4-
Bodily Inj & Prop Required $ N \ {:).. Exp Date _
Workers Compensation \
Each accident Required $ .5 T4\-1". Provided $ S't)) ()#O Exp Date 8ft"l 'U'LD
Disease Aggregate Required $ j..\M ,1" Provided $ , , Exp Date
Disease Each Empl Required $ " Provided $ II Exp Date
Umbrella Liability Exp Date ~
Each Occurrence Provided $ t M\L
Aggregate Provided $ II Exp Date I'
Does Umbrella sufficiently cover any underinsured portion? ./'" Yes No
Professional Liability
Each Occurrence Required $ Provided $ Exp. Date
Per Aggregate Required $ Provided $ Exp. Date
Other Insurance Required $~ Exp Date 3/1 /UID
Each Occur Type: .511,.tbf.N"1 Provided $ 1 "" l L
County required to be named as additional insured? V' Yes - No
County named as additional insured? ~es No
-
Indemnification
Does indemnification meet County standards? _~Yes No
Is County indemnifying other party? - Yes ~o
Performance Bond
Bond requirement referenced in contract? - Yes V"No
If attached, expiration date of bond
Does dollar amount match contract? Yes No
- -
Agent registered in Florida? - Yes No
Signature Blocks
Correct executor name in signature block? ~Yes No
Correct title of executor? ~Yes No
Executor authorized to sign for entity? ~Yes - No
Proper number of witnesses/notary? ~Yes - No
Authorization for executor to sign, if necessary: ~~
Chairman's signature block? ~Yes No
Clerk's attestation signature block? ~Yes - No
County Attorney's signature block? ~Yes - No
Attachments /Yes
Are all required attachments included? No k
ReVIewer Imtials: , 't;
Date: '!( ri ~
04-COA- 10 /222
www.sunbiz.org - Department of State Page 1 of3
lOG
Home Contact Us E-Filing Services Document Searches Forms Help
p rElY i()lJ~() nl,is t NEl~t() nl,l~t REltlJJ!1TQ!"j~t Officer/RA Name Search
I;yents No Name History I Submit ]
Detail by Officer/Registered Agent Name
Florida Non Profit Corporation
REDLANDS CHRISTIAN MIGRANT ASSOCIATION, INC.
Filing Information
Document Number 709687
FEI/EIN Number 591221966
Date Filed 10/01/1965
State FL
Status ACTIVE
Last Event AMENDED AND RESTATED ARTICLES
Event Date Filed 07/03/2003
Event Effective Date NONE
Principal Address
402 W MAIN STREET
IMMOLAKEE FL 34142-3933 US
Changed 01/17/1997
Mailing Address
402 W MAIN STREET
IMMOLAKEE FL 34142-3933 US
Changed 01/09/2002
Registered Agent Name & Address
MAINSTER, BARBARA
402 W MAIN STREET
IMMOKALEE FL 34142-3933 US
Name Changed: 01/09/2002
Address Changed: 01/15/2004
Officer/Director Detail
Name & Address
Title VD
KROME, MEDORA
P,O, BOX 900596
HOMESTEAD FL 33090 US
TitleVD
THOMAS, FRED
1205 ORCHID AVE
IMMOKALEE FL 34142 US
http:/ /ccfcorp.dos.state.f1. us/scripts/cordet.exe?action=DETFIL&inCL doc _ number=709687... 9/4/2009
www.sunbiz.org - Department of State Page 2 of3
1 G
Title TD
GALVAN, EDUARDO
750 S 5TH ST
IMMOKALEE FL 34142 US
Title D
MAINSTER, BARBARA
402 W MAIN STREET
IMMOKALEE FL 34142 US
Title SD
PRINGLE, RICHARD
2125 FIRST STREET
FORT MYERS FL 33901 US
Title PD
STUART, MICHAEL
P.O. BOX 948153
MAITLAND FL 32794 US
Annual Reports
Report Year Filed Date
2007 01/05/2007
2008 01/02/2008
2009 01/07/2009
Document Images
01/07/2009 -- ANNUAL REPORT [ View image in PDF format ]
01/02/2008 ---ANNUALREPOfU [ Vi.ewimage in PDF format ]
01/05/2007 -- ANNUAL REPORT [ View image in PDF format ]
01/04/2006 -- ANNUAL REPORT [ View image in PDF format ]
01/06/2005 -- ANNUAL REPORT [ View image in PDF format ]
01/15/2004 -- ANNUAL REPORT [ View image in PDF format ]
07/0;3/2Q03 Arnendedc:lndBe.~tClJe(jArtiQe$ [ View image in .PDF fqrmat ]
02/12/2003 -: ANNUAL REPORT [ View image in PDf fqrmat ]
01/09/2002 -- ANNUAL REPORT [ View im(lge in PDF fqrmat. ]
01/22/2001 -- ANNUAL REPORT [ View image in PDF format ]
02/15/2000 -- ANNUAL REPORT [ View image in PDF format ]
11/10/1999 -- Amendment [ View image in PDFformat ]
02/22/1999 n ANNUAL REPORT [ View image in PDF format ]
01/20/1998 ANNUAL REPORT [ View image in PDF format ]
01/17/1997 -- ANNUAL REPORT [ View image in PDF format ]
01/26/1996 -- ANNUAL REPORT [ View image in PDF format ]
02/01/1995 -- ANNUAL REPORT [ View image in PDF format ]
Note: This is not official record, See documents if question or conflict.
previQ~~IL.!",ist Next on List R~turnToJ,.i~t Officer/RA Name Search
http://ccfcorp.dos.state.fl. us/scripts/cordet.exe?action=D ETFIL&inCL. doc _ number=709687... 9/4/2009
lOG
MEMORANDUM
TO: Ray Carter
Risk Management Department
FROM: Kelly Green, Tourism Department
DATE: August 3, 2009
RE: Review Insurance for TDC Category B Tourism Agreement for
Multi-Cultural Festival
This Contract was approved by the BCC on July 28, 2009, Agenda Item 10G
Please review the Insurance Certificates for the above referenced contract. If
everything is acceptable, please forward to the County Attorney for further
review and approval. Also, will you advise me when it has been forwarded.
Thank you. If you have any questions, please contact me at extension 2384.
O~TE. RECEl'J.EO
t..U(J , 1 2009 q( It O~
Rl~
mausen_Q 1JlE..
From: RaymondCarter
Sent: Tuesday, September 01, 2009 2:34 PM
To: PhillippiPenny; GreenKelly
Cc: mausen_g; WertJack
Subject: FW: FW: Insurance Certificate for Multi-Cultural Event
Attachments: coi rcma collier-pdf
All, I have approved the revised certificate of insurance received for the TDC Tourism Agreement with Redlands Christian
Migrant Association (RCMA) and attached same to the agreement. The contract will now be forwarded to the County
Attorney's Office for their review.
Thank you,
Ray
From: Phillippipenny
Sent: Monday, August 31, 20093:09 PM
To: RaymondCarter
Subject: FW: FW: Insurance Certificate for Multi-Cultural Event
As requested
IMMOKALEE eRA
iThe p/<1ce to C<1// home/
Penny Phillippi, Executive Director
Immokalee Community Redevelopment Agency
310 Alachua Street
Immokalee, FL 34142
239.2522310 *** Fax 239252.3970
Cell: 239285.7635
PennyPhillippi~Colliergov ,net
www.colliercra.com
From: Gilbert Flores [mailto:gilbert@rcma.org]
Sent: Friday, August 21, 2009 1:18 PM
To: Phillippi Penny; Monica Fish
Cc: MuckelBradley; BetancourtChristie
Subject: RE: FW: Insurance Certificate for Multi-Cultural Event
Penney,
Attached is the COL Let me know if you need any additional information,
GF
From: Phillippipenny [mailto:PennyPhillippi@colliergov.net]
Sent: Tuesday, August 18, 2009 4: 11 PM
To: Monica Fish; Gilbert Flores
Cc: MuckelBradley; BetancourtChristie
Subject: RE: FW: Insurance Certificate for Multi-Cultural Event
1
lOG
Gilbert,
Please clarify for me exactly what we need to do or how to contact Dana, We want to move this grant forward.
Thanks,
Penny
IMMOKALEE eRA
iThe p/;Jce to (4// home.!
Penny Phillippi, Executive Director
Immokalee Community Redevelopment Agency
310 Alachua Street
Immokalee, FL 34142
239.252.2310 *** Fax 239.252.3970
Cell: 239.285,7635
PennvPhilliooi(aJ,Colliergov,net
www.colliercra.com
From: Monica Fish [mailto:fish34142@yahoo.com]
Sent: Saturday, August 15, 20097:36 PM
To: Gilbert Flores
Cc: Phillippipenny; MuckelBradley; BetancourtChristie
Subject: Re: FW: Insurance Certificate for Multi-Cultural Event
Hi Gilbert,
See attachment: I thought I sent this to you when I sent it to Gloria and the others. It delineates RCMAs role and
the timeline as best as possible. This is a reimbursement grant. Penny is working on getting money from the
county to put into your Celebration of Cultures account because we do not have enough sponsorship, so that we
can pay our expenses. I assumed you would be writing the checks to the advertisers that the grant approved for
us to use. I also assumed that Gloria and I would put together the grant monies reimbursement requests. This
is in the grant that was submitted which was cced to you at one time. Would you and Gloria have time to meet
with Penny and me to go over all of this?
In regards to the questions below, I suppose the additional insured may be the CRA. What is Dana's phone
number. Can you also email us her email. The CRA will have to talk with her to take care of this --that would
be Penny and Brad. Penny's number is 239.252.2310.
I am sorry that I cannot be more helpful, Thank you!! ! ! !
Monica
--- On Fri, 8/14/09, Gilbert Flores <gilbert@rcma.org> wrote:
From: Gilbert Flores <gilbert@rcma.org>
Subject: FW: Insurance Certificate for Multi-Cultural Event
To: fish34142@yahoo.com
Date: Friday, August 14,2009,9:56 PM
Monica,
2
Please answer Dana's questions below. Thanks. lOG " <1
GF
From: Dana Reeves
Sent: Fri 8/1412009 9: 1 0 PM
To: Gilbert Flores
Subject: RE: Insurance Certificate for Multi-Cultural Event
What is the full name and address for the additional insured? If you have the name of a contract person
and their email address, we can send the COI directly to them with a cc to us. Also what is the time
frame for this grant? What activities involve RCMA?
Thanks!
From: Gilbert Flores
Sent: Friday, August 14, 2009 1:47PM
To: Dana Reeves
Cc: Monica Fish; Gloria Gonzalez
Subject: RE: Insurance Certificate for Multi-Cultural Event
Dana,
Please review the insurance requirements as stated below for this grant and respond accordingly. Hope
you are having a good summer. Thanks.
GF
4. INSURANCE:
(a) GRANTEE shall submit a Certificate of Insurance naming Collier County, and its Board of
County Commissioners and the Tourist Development Council as additional insureds.
(b) The certificate of insurance must be valid for the duration of this Agreement, and be
3
issued by a compauy licensed in the State of Florida, aud provide General Liability Insurauce for nolO G
less than the following amounts:
BODILY INJURY LIABILITY $300,000 each claim per person
PROPERTY DAMAGE LIABILITY $300,000 each claim per person
PERSONAL INJURY LIABILITY $300,000 each claim per person
WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY - Statutory
(c) The Certificate of Insurance must be delivered to the Executive Director of the CVB or his
designee within ten (10) days of the approval of this Agreement by the COUNTY. The GRANTEE
shall not commence activities hereunder which are to be funded pursuant to this Agreement until the
Certificate of Insurance has been received by the COUNTY and the Agreement is fully executed.
From: Monica Fish [mailto:]
Sent: Friday, August 14,2009 12:59 PM
To: Gilbert Flores
Subject: Fw: Insurance Certificate for Multi-Cultural Event
--- On Thu, 8/13/09, Monica Fish <fish34142ClV,yahoo.com> wrote:
From: Monica Fish <fish34142@yahoo.com>
Subject: Fw: Insurance Certificate for Multi-Cultural Event
To: "Gloria Gonzalez" <gloriagClV,rcma.org>
Cc: PennyPhillippiClV,Colliergov.net, ChristieBetancourt@colliergov.net
Date: Thursday, August 13, 2009, 6:07 PM
Hi Gloria,
Can you do this? (You have the contract in another email.)
Thanks,
4
Monica lOG
--- On Thu, 8/13/09, GreenKelly <KellvGreen@colliergov.net> wrote:
From: GreenKelly <KellvGreen@colliergov.net>
Subject: Insurance Certificate for Multi-Cultural Event
To: fish34142@vahoo.com
Cc: "WertJack" <JackWert@colliergov.net>, "RaymondCarter" <ravrnondcarter@colliergov.net>
Date: Thursday, August 13,2009,10:32 AM
Monica,
I have been advised that, pursuant to the grant agreement, RCMA needs to provide the County an
insurance certificate with the limits set forth on p. 3, section B ofthe agreement. If you have any
questions, please contact Ray Carter in the Risk Management department at 252-8839.
Thanks,
Kelly
Kelly Green
Tourist Development Tax Coordinator
Naples, Marco Island, Everglades
Convention & Visitors Bureau
2800 N. Horseshoe Drive
Naples, FL 34104
(239) 252-2384; (239) 252-2404 fax
Kell vGreen@colliergov.net
Discover Florida's Last Paradise
Naples, Marco Island, Everglades City
Do You Yahoo!?
Tired of spam? Yahoo! Mail has the best spam protection around
http://mai1.vahoo.com
5
.1 IJ ,5
~~ CERTIFICATE OF LIABILITY INSURANCE o;1(::~~
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
Marsh ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3031 N, Rocky Point Drive, Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Tampa, FL 33607 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: Erica Connick (813) 207-5121
S18152-WC-CASU-09-10 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Stonington Insurance Company 10340
Redlands Christian Migrant Association __
402 W. Main Street INSURER B: Wausau Underwriters Ins Co 26042
Immokalee, FL 34142 INSURER C: Lexington Insurance Company 19437
INSURER D: Hartford Specialty CO,
INSURER E: Colony Insurance Company 39993
COVERAGES -0
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOlWlTHSTANDING 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,
NS~ ADD'l TYPE OF INSURANCE POLICY NUMBER POUCYEfFECTIVE POUCY EXPIRATION LIMITS
LTR INSRt DATE(MMlDDIYYYY) DATE(MMlDDIYYYY)
A X GENERALLIABlLlTY CCG30002012-04 03/01/2009 03/01/2010 EACH OCCURRENCE 1,QOO.QQQ
r- DAMAGE TO RENTED 300 000
X COMMERCIAL GENERAL LIABILITY PREMISESIEa oCCUlTance' $ ,
~ -:=J CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
IlL E'RnFF~~lnNAI I IAFlIIITY PERSONAL&ADVINJURY $ 1.000,000
GENERAL AGGREGATE $ 3,000,000
GENERALAGGREGAT~hIMIT APPLIES PER PRODUCTS _ COMP/OP AGC $ INCLUDED
II POLICY il JE& n LOC --
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- ANY AUTO (Ea accident) $
= ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS I BODILY INJURY $
- NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
I-- (Per eccident)
GARAGE LIABILITY AUTO ONLY _ EA ACCIDENT $
RANY AUTO i OTHER THAN EA ACC $
AUTO ONLY: AGG $
C EXCESS I UMBRELLA LIABILITY 1000869 03/01/2009 03/01/2010 ~H OCCURRENCE $ 1,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $ 1,000,000
$
Ii DEDUCTIBl.E_ $
Ix1 RETENTION $
B WORKERS COMPENSATION AND WCJZ91423775019 08/16/2009 08/16/2010 X IT"X\;JJATU- I [OJ.1;l-
EMPLOYERS' LIABILITY . i ILlIT!':1
ANY PROPRIETORlPARTNERlEXECUTIVE Y / N ::.L. EACH ACCIDENT $ 1500,000
OFFICERlMEMBER EXCLUDED? ~N .. $ '-00 000
~ .L. DISEASE - EA EMPLOYE, ,) ,
, (Mandatory in NH) W yes, describe under L DISEASE POLICY LIMIT $ '500 000
SPECIAL PROVISIONS below , ,_ , ,
o OTHER Student Accident 20SR137124 06102/2009 03/01/2010 See Page 3
E SML, EBL, PL, GL, EPL AR4460293 03/01/2009 03/01/2010 Excess Liability 1,000,000
DESCRIPTION OF OPERATlONSlLOCATlONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Collier County, A Political Subdivision of the State of Florida and Tourist Development Council is an additional insured per 2009 Tourism Agreement for
General Liability,
CERTIFICATE HOLDER ATL-002036044-02 CANCELLATION
------------
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE.
Collier County, a Political Subdivision EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
of the State of Flo~da , ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Jack Wert, Executive Director Naples, Marco Island, Everglades CVB
2800 N. Horseshoe Drive BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
N I L 341 0 UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
ap as, F 4 AcWI;\~:'s'i,EBU7n~~ENTAT1VE
Erica Connick
ACORD 25 (2009/01) @ 1998-2009 ACORD CORPORATION. All Rights Reserved
The ACORD name and logo are registered marks of ACORD
~ -
lOG t.,--~~
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
Acord 25 (2009/01)
~ ~.."'"
.I. tJ b
--
ADDITIONAL INFORMATION A TL-002036044-02 DA TE (MM 001 \')1
08,21/2009
---- -
PRODUCER
Marsh
3031 N, ROck~ Point Drive, Suite 700
Tampa, FL 3 607
Altn: Erica Connick (813) 207-5121 ---
S18152-WC-CASU-09-10 I
INSURERS AFFORDING COVERAGE NAIl: #
~-~---
INSURED INSURER F:
RedJands Christian Migrant Association ------
INSURER G:
402 W, Main Street 1---.
Immokalee, FL 34142 INSURER H:
~--
INSURER I:
---
TEXT
---
Lexington Insurance Policy #1000869 is an Umbrella policy containing Auto Liabil~, General L1abll~, Employers Liability and Employee Benefits Liahility.
The Auto Liability is excess over the Stonington Insurance Company Policy, The eneral Liability, mployee Benefits Liability and Employers Liabili~' is
excess over the Colony Insurance Company of $2,000,000,
Student Accident:
Accidental Death: $2,000 (Principal Sum)
Accidental Dismembennent: $10,000 (Principal Sum)
Accident Medical Expense: $25,000 (Maximum Benefit)
Maximum Dental Limit: $1,000
CERTIFICATE HOLDER
Collier County, a Political Subdivision
of the State of Florida
Jack Wert, Executive Director Naples, Marco Island, Everglades CVB
2800 N, Horseshoe Drive
Naples, FL 34104
A.wI.\<:S'tEBnpr..~~ENTA TlVE --
Erica Connick
lOG
2009 TOURISM AGREEMENT BETWEEN
COLLIER COUNTY AND REDLANDS CHRISTIAN MIGRANT ASSOCIATION
CATEGORY "B" GRANT FUNDS AGREEMENT
THIS AGREEMENT is made and entered into this 8,C?!- day Of~, 2009, by
and between the Redlands Christian Migrant Association (RCMA), a Florida not-for-profit
corporation ("GRANTEE") and Collier County, a political subdivision of the State of Florida
("GRANTOR" or "COUNTY").
WHEREAS, the COUNTY has adopted a Tourist Development Plan ("Plan") funded by
proceeds from the Tourist Development Tax; and
WHEREAS, the Plan provides that certain of the revenues generated by the Tourist
Development Tax are to be allocated for the promotion of tourism in Collier County nationally
and internationally and for the promotion and advertising of events and activities intended to
bring tourists to Collier County; and
WHEREAS, GRANTEE has applied to the Tourist Development Council and the County
to use Tourist Development Tax funds for the development of a website and the out-of-county
marketing and advertisement of the Irnmokalee Mexican Independence Day Celebration; and
WHEREAS, the Tourist Development Council has recommended funding this request
with Tourist Development Tax proceeds; and
WHEREAS, the Collier County Board of County Commissioners has approved funding
and the Chairman was authorized to execute the Tourism Agreement
NOW, THEREFORE, BASED UPON THE MUTUAL COVENANTS AND PREMISES
PROVIDED HEREIN, AND OTHER VALUABLE CONSIDERATION, IT IS MUTUALLY
AGREED AS FOLLOWS:
1. SCOPE OF WORK:
(a) fu accordance with the authorized expenditures as set forth in the Budget, attached
hereto as Exhibit "A", GRANTEE shall expend the funds to produce a web site and out-of-county
marketing and advertisement of the Irnmokalee Mexican Independence Day Celebration.
2. PAYMENT:
(a) The amount to be paid under this Agreement shall be a total of fourteen thousand
one hundred and twelve dollars ($14,112,00). GRANTEE shall be paid in accordance with fiscal
procedures of the County for the expenditures incurred as described in Paragraph One (1) herein
upon submittal of a request for funds on the form attached hereto as Exhibit "D" and made a part
1
lOG
hereof, and shall submit invoices and proof of payment in the form of cancelled checks or other
documentation to the Executive Director of Naples, Marco Island, Everglades Convention &
Visitors Bureau (CVB) or his designee for review and upon verification by letter from the
GRANTEE that the services or work performed as described in the invoice have been completed
or that the goods have been received and that all vendors have been paid.
(b) The Executive Director of the CVB or his designee shall determine that the
invoice payments are authorized and that the goods or services covered by such invoice[s] have
been provided or performed in accordance with such authorization. The line item budget
attached as Exhibit "A" shall constitute authorization for the expenditure[s] described in the
invoice[s].
(c) All expenditures shall be made in conformity with this Agreement.
(d) The COUNTY shall not pay GRANTEE until the Clerk of the Board of County
Commissioners pre-audits all payment invoices in accordance with law.
(e) GRANTEE shall be paid for its actual costs, not to exceed the total amount for
any line item nor the maximum amount budgeted pursuant to the attached "Exhibit A",
3. ELIGIBLE EXPENDITURES:
(a) Only eligible expenditures described in Paragraph One (1) will be paid by
COUNTY.
(b) COUNTY agrees to pay eligible expenditures incurred between the effective date
and December 31, 2009.
(c) Any expenditures paid by COUNTY which are later deemed to be ineligible
expenditures shall be repaid to COUNTY within thirty (30) days of COUNTY's written request
to repay said funds.
(d) COUNTY may request repayment of funds for a period of up to three (3) years
after termination of this Agreement or any extension or renewal thereof.
4. INSURANCE:
(a) GRANTEE shall submit a Certificate of Insurance naming Collier County, and its
Board of County Commissioners and the Tourist Development Council as additional insureds.
2
lOG
(b) The certificate of insurance must be valid for the duration of this Agreement. and
be issued by a company licensed in the State of Florida, and provide General Liability Insurance
for no less than the following amounts:
BODILY INJURY LIABILITY $300,000 each claim per person
PROPERTY DAMAGE LIABILITY $300,000 each claim per person
PERSONAL INJURY LIABILITY $300,000 each claim per person
WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY - Statutory
(c) The Certificate of Insurance must be delivered to the Executive Director of the
CVB or his designee within ten (10) days of the approval of this Agreement by the COUNTY.
The GRANTEE shall not commence activities hereunder which are to be funded pursuant to this
Agreement until the Certificate of Insurance has been received by the COUNTY and the
Agreement is fully executed.
5. REPORTING REOUIREMENTS:
(a) GRANTEE shall provide to County a quarterly Interim Status Report on the form
attached hereto as Exhibit "B".
(b) GRANTEE shall provide to County a Final Status Report on the form attached
hereto as Exhibit "c' no later than December 31,2009.
(c) The report shall identify the amount spent, the duties performed, the services
provided and the goods delivered since the previous reporting period.
(d) GRANTEE shall take reasonable measures to assure the continued satisfactory
performance of all vendors and subcontractors.
(e) COUNTY may withhold any interim or final payments for failure of GRANTEE
to provide the interim status report or final status report until the County receives the interim
status report or final status report or other report acceptable to the Executive Director of the
CVB.
6. CHOICE OF VENDORS AND FAIR DEALlNG:
(a) GRANTEE may select vendors or subcontractors to provide services as described
in Paragraph One (l).
(b) COUNTY shall not be responsible for paying vendors and shall not be involved in
the selection of subcontractors or vendors.
3
lOG
(c) GRANTEE agrees to disclose any financial or other relationship between
GRANTEE and any subcontractors or vendors, including, but not limited to, similar or related
employees, agents, officers, directors and/or shareholders.
(d) COUNTY may, in its discretion, object to the reasonableness of expenditures and
require payment if invoices have been paid under this Agreement for unreasonable expenditures.
The reasonableness of the expenditures shall be based on industry standards.
7. INDEMNIFICATION:
GRANTEE shall indemnify and hold hannless Collier County, its agents, officers and
employees from any and all liabilities, damages, losses and costs, including, but not limited to,
reasonable attorneys' fees and paralegals' fees, to the extent caused by the negligence,
recklessness, or intentionally wrongful conduct of the GRANTEE or anyone employed or utilized
by the GRANTEE in the performance of this Agreement. This indemnification obligation shall
not be construed to negate, abridge or reduce any other rights or remedies which othelWise may be
available to an indemnified party or person described in this paragraph.
8. NOTICES:
All notices from the COUNTY to the GRANTEE shall be in writing and deemed duly
served if mailed by registered or certified mail to the GRANTEE at the following address:
Barbara Mainster
Executive Director
402 West Main Street
Immokalee, FL 34142
239.658.3560
Fax: 239.658.3571
All notices from the GRANTEE to the COUNTY shall be in writing and deemed duly
served if mailed by registered or certified mail to the COUNTY to:
Jack Wert. Executive Director
Naples, Marco Island, Everglades CVB
2800 N. Horseshoe Drive
Naples, Florida 34104
The GRANTEE and the COUNTY may change the above mailing address at any time
upon giving the other party written notification pursuant to this Section.
4
-
10"
9. NO PAR1NERSHIP: Nothing herein contained shall be construed as creating a
partnership between the COUNTY and the GRANTEE, or its vendors or subcontractors, or to
constitute the GRANTEE, or its vendors or subcontractors, as an agent or employee of the
COUNTY.
10. COOPERATION: GRANTEE shall fully cooperate with the COUNTY in all
matters pertaining to this Agreement and shall provide all information and documentation
requested by the COUNTY from time to time pertaining to the use of any funds provided
hereunder.
II. TERMINATION:
(a) The COUNTY or the GRANTEE may cancel this Agreement with or without cause
by giving thirty (30) days advance written notice of such termination specifying the effective date
of termination.
(b) If the COUNTY terminates this Agreement, the COUNTY will pay the
GRANTEE for all expenditures or contractual obligations incurred by GRANTEE, with
subcontractors and vendors, up to the effective date of the termination so long as such expenses are
eligible.
12. GENERAL ACCOUNTING: GRANTEE is required to maintain complete and
accurate accounting records, All revenue related to the Agreement must be recorded, and all
expenditures must be incurred within the term oitrus Agreement.
13. AVAILABILITY OF RECORDS: GRANTEE shall maintain records, books,
documents, papers and financial information pertaining to work performed under this Agreement
for a period of three (3) years. GRANTEE agrees that the COUNTY, or any of its duly authorized
representatives, shall, until the expiration of three (3) years after final payment under this
Agreement, have access to, and the right to examine and photocopy any pertinent books,
documents, papers, and records of GRANTEE involving any transactions related to this
Agreement.
14. PROHIBITION OF ASSIGNMENT: GRANTEE shall not assign, convey, or
transfer in whole or in part its interest in this Agreement without the prior written consent of the
COUNTY.
15. TERM: This Agreement shall become effective on the latest date signed and shall
remain effective until December 31, 2009. If the project is not completed within the term of this
5
In~
agreement, all unreleased funds shall be retained by the COUNTY. Any extension of this
agreement beyond the one (1) year term in order to complete the Project must be at the express
consent of the Collier County Board of County Commissioners.
16. The GRANTEE must request any extension of this term in writing at least sixty
(60) days prior to the expiration of this Agreement, and the COUNTY may agree by amendment to
this Agreement to extend the term for an additional one (1) year.
17. EVALUATION OF TOURISM IMPACT: GRANTEE shall monitor and evaluate
the tourism impact of the Project, explaining how the tourism impact was evaluated, providing a
written report to the Executive Director of the CVB or his designee, along with a final budget
analysis by December 31,2009.
18. REQUIRED NOTATION: All promotional literature and media advertising must
prominently list and/or identify the Collier County Tourist Development Council and the
Convention and Visitors Bureau (CVB) as event sponsors.
19. AMENDMENTS: This Agreement may only be amended by mutual written
agreement of the parties, after review by the Collier County Tourist Development Council if
warranted.
IN WITNESS WHEREOF, the GRANTEE and COUNTY have respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first above
written.
. ,
l."
~TIEST:' '. BOARD OF C
"C'" " '" h+
. 'DWIGHT :B.BR:DCK, Clerk COLLIER C
"~" rl k-
H . By:
i. ,$) : s.
. t~st:f,"..1I;..,tO-~o. t',...,.. .
tt....t~ :.., .
. ',' \ ~ 1 - \ ,\ ~
Approved as to fonn and
al sufficiency
~ M~
Colleen M. Greene
Assistant County Attorney Item# ~
~:da ~oA
Dilte q&,L~
R '
6 14
WITNESSES: GRANTEE: lOG
(l~~ bmp0rf REDLANDS CHRISTIAN MIGRANT
ASSOCIATION
Cy\DriQ GDYI('Q It'L
Printed/Typed Name ~ ~ .
~. ~-
BY: ( ~~1;---<-~ ~l-.-..-.<-_\-/L.-__
(2) l~~ J.tJ, ~ bCl\-b:Jro (Y'Q ins1cr
printed/T~ame ~ ' J-o
Jtu//~ lA/3rt II EA-r(1 u-(J . I ~C1--
Printed/Typed Name Printed/Typed Title
7
lOG . t'-1t
EXHIBIT "A"
Redlands Christian Migrant Association
Project Budget
Fundine (Not to Exceed) $14.112.00
Out of County 11,312.00
Advertisin and Marketin
Website Design and 2,800,00
hn lementation
Total $14,112.00
8
lOG
EXHIBIT "B"
Collier County Tourist Development Council
Interim Status Report
EVENT NAME:
REPORT DATE:
ORGANIZATION:
CO NT ACT PERSON: TITLE:
ADDRESS:
PHONE: FAX:
-------------------------------------------------------------------
-------------------------------------------------------------------
On an attached sheet. answer the followina Questions to identify the status of the
IJroiect. Submit this reIJort at least Quarter Iv.
INTERIM - These questions will identify the current status of the project. After the TDC
staff reviews this I nterim Status Report, if they feel you are behind schedule on the
planning stages, they will make recommendations to help get the project stay on schedule.
Has the planning of this project started?
At what point are you at with the planning stage for this project?
(Percent of completion)
Will any hotels/motels be utilized to support this project?
If so, how many hotel room nights will be utilized?
What is the total dollar amount to date of matching contributions?
What is the status of the advertising and promotion for this project?
Have your submitted any advertisements or printed pieces to the TDG staff for approval?
Please supply a sample and indicate the ad schedule.
How has the public interest for this project been up to this point?
9
lOG
EXHIBIT ue"
Collier County Tourist Development Council
Final Status Report
EVENT NAME:
REPORT DATE:
ORGANIZATION:
CONTACT PERSON: TITLE:
ADDRESS:
PHONE: FAX:
===================================================================
On an attached sheet. answer the following Questions for each element in vour
scooe of work.
Final - These questions should be answered for your final status report.
Was this a first time project? If not, how many times has this event taken place?
What hotels/motels were utilized to support the project and how many?
What is the total revenue generated for this event?
Total expenses. (Have all vendors been paid?)
List the vendors that have been paid, if not, what invoices are still outstanding and why?
What is the number of participants that visited the project?
What is the percentage of the total partiCipants from out of Collier County?
What problems occurred if any during the project event?
List any out-of-county- advertising, marketing, and/or public relations that was used to
support the project and attach samples.
How could the project been improved or expanded?
10
lOG
EXHIBIT "0"
REQUEST FOR FUNDS
COLLIER COUNTY TOURIST DEVELOPMENT COUNCil
EVENT NAME
ORGANIZATION
ADDRESS
CONTACT PERSON TELEPHONE ( )
REQUEST PERIOD FROM TO
REQUEST#
( ) INTERIM REPORT ( ) FINAL REPORT
TOTAL CONTRACT AMOUNT $
EXPENSE BUDGET REIMBURSEMENT REQUESTED
TOTALS
NOTE: Reimbursement of funds must stay within the confines of the Project Expenses outlined in
your application. Copies of paid invoices, cancelled checks, tear sheets, printed samples or other
backup information to substantiate payment must accompany request for funds. The following
will not be accepted for payments: statements in place of Invoices; checks or invoices not dated;
tear sheets without date, company or organizations name. A tear sheet is required for each ad for
each day or month of publication. A proof of an ad will not be accepted.
Each additional request for payment subsequent to the first request, Grantee Is required to submit
verification in writing that all subcontractors and vendors have been paid for work and materJals
previously performed or received prior to receipt of any further payments.
If project budget has specific categories with set dollar limits, the Grantee is required to include a
spreadsheet to show which category each invoice is being paid from and total of category before
payment can be made to Grantee. Organizations receiving funding should take into consideration
that it will take a maximum of 45 days for the County to process a check.
Furnishing false information may constitute a violation of applicable State and Federal laws.
CERTIFICATION OF FINANCIAL OFFICER: I certify that the above information is correct based on
our official accounting system and records, consistently applied and maintained and that the cost
shown have been made for the purpose of and in accordance with, the terms of the contract. The
funds requested are for reimbursement of actual cost made during this time period.
SIGNATURE TITLE
11
1 OG
.
Ii
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP lOSE I .....~
COLLI-2 06/16/09
- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
tn.1a"ance and Ri.k ~t ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Serv.i~s , Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
8950 Fontana Del Sol Way .200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Naple. FL 34109-4374
Phone: 239-649-1444 Fax: 239-649-7933 INSURERS AFFORDING COVERAGE HAlC ,
- -.. Pr.inceto~ Exces. &; Surp1u. 10786
N6URER 8: lIU.*-1; ~ ea.a1'ti1' OIl 23612
Collier County Go~t ........c
Ri.k NaAaoa-nt Department
3301 ~am.iam.i ~ra.i1 Ea.t, 'D INSURER D:
Naples FL 34112 -----
INSUMR e"
COVERAGES
THE POUc.lES OF IN8UfUt,NCE US11!:D BELOW",,-\IE BEEN lSSUED TO me INSUftED NAMED A8O\lIE FOR THE POUCV ~D INDtCA'TED. NOlWTtf$TANDING
AllY REQUlIWIIfNT, TERM OR ctN)ffi()H Of Atl'( CONTMCT OR OTtER 00CtIIiIENT WT1f RESPECT TO WItCH n1IS CERTlflCATE MAY BE ISSUED OR
JlMY PERTAIN. THE IN8lIIMNCE AfFORDED BY lNI PCUCIES OESCRI8ED HEREIJrt.. sua,lECT TO AI.L TIE TEAMS. EXCLUSIONSAHD CCWOfTlOtrlS Of SUCH
PClU::IEI. AGlGREGATE UMJT8 SHCMIIII MAY HAVE IE:IEN fI!OUCEO 8Y PAID CLAMS.
- = -=-..:=.= -_.-
LlK nNOO_ -..:y- ':::::::: .....
_.-nv EACH 0CClJI0REHCE 11,000,000
L- DMMQE TOAENTED
A X ~ CCMEIlCW. GENERAlllA8k.rrY 64A3J:X00000150S 10/01/08 10/01/09 ~EllllES(&~ I Inc1uc:lacl
- D' Cl.AM&WoDE [X] OCCUR MEO EXP """ OM.......) 11,000
... $200,000 ~ PER8ONAL& I4l1V ItUJRY I Included
.0 $100,000 .. ..... GENERAl. AGGREGATE 11,000,000
QiH'L!tQQReGrAn:l....T APPLES PER; PRODUCTS. COMPfOP AQG I 1,000,000
~~~Y --n: nLOC
-.UAKIIY COIIIIlHEO """"-E LMIT
- 11,000,000
A ~ ....AUTO 64A3J:X000001S05 10/01/08 10/01/09 lEo_
~ ALL OWNED IWTOS IlOIlILV.......
I
SCHEDULED AUT06 au: 1200,000 ~ I (ow_I
- I
~ HIRED AUTOS .xa hOC ,000 .... ___ IlOIlIL V ......
I
~ ~'UTOI "..,-
L------~- ~----_.-
-- --.- ~- ~ """""""'- .
11""-
~UAKIIY AUTO ONLY . fA ACCIOENf .
""" AlJTO """'.""'" .. ACe I
AVTOOLY: "'" I
r-.-.J.~1JIlItLIIY EACH 0CClJI0REHCE 11,000,000
A ~ OCCUR D CLAOM~ 64A3llTOOOO01103 10/01/08 10/01/09 AOGREGAlE 11,000,000
R=: Excess I
I Ge_ral .
. L.iab.i1.itov s
WClNlZItI ~1IDN AND xl~= I 10:
_UMUlY 64A3J:X00000150S 10/01/08
A ..... .1I0..IETOIIII,.,m'."".":UTl\IE 10/01/09 E.L fACH ACCU.NT I 600,000
0fFJC&IItNEMIIE EXCLUDlD? SIll $500,000 EJ.. DISEASE - EA fMP\.O"tIE. . 600,000
If............... --
--- E.L D6IiAIE POUCY UMIT I 600,000
0_
B Exce.s Worker. nc008020 10/01/08 10/01/09 Work COIIIp Statutory
ation SIll $600,000 E.L. 3,000,000
~CW~~'LOCAnoNa/VBICLB/~MiDED.YBlDOMBlBfT'U'eClN.PIllIl:MIIOIra
The certificate holder is a1so ..-cI. a. an aclcl.itional in.ured a. reapecta to
the veneral liab11ty coverage.
Se1f In.ured R8tention inc1uded w.ithin limite of liability. As a110_d by
Florida Statute 768.28.
CERTIFICATE HOLDER CANCELLATION
S'1'A'1'J'13 attOULDMlYOI' TttI! A8CM! ~POIJCIII; _CANCI!I..lBt ~ 1MI DNIA1DiI
DAl1!1MIlIIeOF.1III! ___...... smu._1O MAL ~ ""...-
State of Florida D.p~ N01lCE 10 lIE CBnWICATE ~NAIIED 10" LBtT,IMIf FAIL.WR 1'0 DO ao ~
of '1'ranaporta tion
1074 Highway 90 East ..-c.e NOoaJI'MlION OR UA8LJTYOf AlfYKIND UPON.......-. In IlaBCftOR
Chipley FL 32428
ACORD 25 (2001/08) @ACORD CORPORATION 1988
~,
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the poIicy(ies) must be endorsed, A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
If SUBROGATION IS WAIVED, subject to the tenns and conditions of the policy, certain policies may
require an endorsement, A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s),
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend. extend or alter the coverage afforded by the policies listed thereon,
ACORD 2S (2001108)
lOG
.
ACORD. CERTIFICATE OF LIABILITY INSURANCE OPIDsE I "'TI!~
OOLLI-2 06/16/09
- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Inaurance and Riak Mana~t ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Servi.ae. , Inc. HOLDER. THIS CEImFICATE DOES NOT AMEND, EXTEND OR
8950 Fontana Del Sol Way '200 ALTER THE COVERAGE AFFORDED BY THE POUQES BELOW.
Naple. Y.L 34109-4374
Phone: 239-649-1444 rllll:: 239-649-7933 INSURERS AFFORDING COVERAGE HAIC.
- INSUREAA: Princeton Excea. & Suzplu. 10786
__u_~____
IHSUIlt~R B- ~~~~Co 23612
Collier County Go~nt JHSURER c:
Riak Mana~t o.partment
3301 Taaiami Trail Eaat, 'D IHSURER 0:
Naple. Y.L 34112
IrtalMER E:
COVERAGES
THE POUCIES OF INSURANCE LISTED IlELOWHA,VE BEEN JSSUED TO THE WSURED NAMED AIIO\E fOR THE POUCy PERtOD INIJeCItTED. NOTWIniSTANDING
Af'rfREQUlREMENT, TERMOR CONDITION Of ItN'fCONTftACTOfiaTHER OOClAlEHTVlITM RESPECT '1'0 WHICH THtS CER1IF'1CAlE MAY E IS8UEO OR
liMY PERTAIN. THE tflBUMNCE MFORDEDlIYlHE POtJaE$DESCRI8ED HEREIH ISSUBJECTTOAU. nE TEAMS, EXCl.USIONSAND CONOI1lON8 0# SUQi
POUC&fS. AGGREGATE UMI1'I StlCMtI MAY HA\IE BEEN REDUCED BY PAl) ClAM!I
- c: '="~ ~,.:~
LlII nftOf_ -- UMm
............ tACH 0<lClJRllENCE .1,000,000
'-- DAtMGf. TO "ENTED
A ~ 5=::"''-fu OC~ 64A3ZXOOOO01S0S 10/01/08 10/01/09 PREIiUU l&I 00CllftI*) . IncJ.udecl
MED 9P 'I'nI ant.......) . 1,000
r--
an uoo. 000 0CCIl--=:I. PEIt8CtW. & NN IH.IURY . Includecl
r--
mil ttoo,ooo ...._ I GEJlEfW. N'Jl)ftEQA TE .1,000,000
~-
GEItL_"",. Fl'...L,...... PRODIJCTI. COfJItIOf' AQG . 1,000,000
;r PCMJCY :: n LOC
-.....". COMIINED 8lNOLE LIMIT
-- .1,000,000
A X ANY AUTO 64A3EXOOOO01S0S 10/01/08 10/01/09 lEo_
-
AlL CM'NED AUTOS 80Dn.VINJlJRV
~-- .
SC>EWLED AU105 rmt f2tll),OOO ~ ....._l
-
X HIRED AUTO& ara t1oo,ooo ... ..... 8OOIl.YINJUlty
r-- .
~ N<lN-<l'MED AlITO& .....-
f-- """""'""- .
(Pw_
I _.-rrv AUTO ONLY -EAACaOENT .
R-~ OTHER 1l1AH EAACe .
AUTO ONLY: """ .
.-.......... EACH OCCURRENCE . 1,000,000
A 8~UR D ~MADE 64A3liTOOOOO1103 10/01/08 10/01/09 """""""TE . 1,000,000
Exceaa .
R ~~nmz General .
RETEN110N . Liabi.lity .
WDI8CI!RI~1IDNMD X I':': I I":
_.-rrv 6U3EXOOOO01SOS 10/01/08 10/01/0~ . 600,000
A ILL EACHAOCIDENT
Ntf~CtJlM
OfFICEfWEMBER EXCWDlED1 SIR $500,000 n. DtSEA8E - EA u.I..OYEE .600,000
If,..,............... .600,000
_ PIlO\/\8ION8_ E.L OIIEAIE. POUCY LIMIT
"'-
B Exceaa Worker. 1!:WIC008020 10/01/08 10/01/09 Work CoIlIp Statutory
C_aation SIR $600,000 ILL. 3,000,000
DI!!8CIW1IDIfOflONM.....'I.oOCA'TIDN&'-.ca.s,~ADD!D.,.~,IPBML~
Selr Inaured Retention included. within limita or liability. As allowecl by
Florida Statute 768,28.
CERTIFICATE HOLDER CANCELLATION
CCHGUl:4 aIIOlUMY OF ne A80ft ~POucII!II_CANCa.LI!D -... ne: DNlAlIDN
DAtt lMEREOF. 1HE_ --.:VlaJ..I!MJEAVaIl1O....... ~ ......-
frI01'Jc. 10 lIE CllmFlCATI: ttOl.IIER"""'lO.,.. LEFT,"" fM.WiIE lO DO 10.......
c-ru.ty ~os-nt ~ MIOII! NOoawu.......OR UULln'O#NlYGlIDWQNn.-~,,*~OR
310 Alachua Str_t
X-Okal_ I'L 34142 _AlML
t' ~
- -\
ACORD 25 (2001/08) @ACORDCORPORAnON1~
I lOG
I .
I
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the poIicy(IeS) must be endorsed, A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policieS may
require an endorsement. A statement on this certificate does not comer rights to the certificate
holder in lieu of such endorsement(s),
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract betv.<een
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend. extend or alter the coverage afforded by the policies listed thereon,
ACORD 25 (2001108)
lOG
f-...J
<(LL
o -
a:(f)
<(~
(f)Oo..
!:!:!t:D<( 0:
!:::wz <(
> I - :I:
i=f-:::! 0
00<(
<(f-a: w
0::,c':: :I:
.. za:~ I-
0: -w<( >
W >-l_ -l
a:l !l)o~ z
:!E ~w<( 0
::) -lII-
Z >-f-f- en
ZI(f) en
:!E <(f-<( w
w -w 0:
.... ~~,- c
0a:O c
<C zWC') <(
C -f-C') 0
Z o (f) _
W <(-0 l-
e" 00Z w
ZW_
<( Wa:O 0:
--l <(
W(f)5
.. a:a:t:D C
0: ~~a: Z
w <(
:I: wOw
0: .... !l)U5Z en
- (f) a: ....
> <C 0 -l-:J Z
...J 0 <i~1- w
0: a:l I~Z :!E
<C
w W (f)00 :!E
...J :I: (f)O~ 0
0 .... f->-a: 0
.... ~ (f)f-<( 0:
>=ZI
z CJ) !l):J . ::)
ii: <C !l)0s: 0
a. C go _ >-
W W -lLLa: 0:
~ :I: -l00 0
.... <(00 LL
w LL f-a:-l en
...J 0 <(<(LL W
a. I O~ ....
lL 1-t:D-.:;t ::)
w (f) W 1-- Z
...J WIZ :IE
~I-W
W :J0~ _
...J OZf- C")
a:l W-a: _
<C a:(f)<( w
.... -.:;t(f)o.. w
w C\IWW 0:
:I: I a:O :I:
.... t;8(f) f-
z . <( 0 0
o -a: f-
zOO C
1-0
wow w
OW(( !::
Z!:::O :!E
~~Z -
--<( ...J
O-l
a:1-(f) W
.. OOW 0:
W Zf- <(
...J .. >-I-:J ::)
.... e" f-:J~ 0
t= z ~!l)~ >-
:!E ~ o - 0
W z O~a:
.!::: w a:-<(
CJ) woO
<C w ::::i:Jm
c 0:
a. -low
Z W OZI
W
e" 0:: Oc-f-
<(