HomeMy WebLinkAbout2001 01 24 - Agreement RecordsAGREEMENT RECORDS
Project Name: CkLLlp , �\o cde< �t K awCbeC S - S Pof �S
Cohn�'eX
Department of Origin:
Agreement with: C0 C on S+ f U_C\- �'vn
Date Agreement Awarded: 1 - a '-/- aoo \
*Completion/Termination Date of Project:
Retention/Destruction Date:
Comments:
(check one below)
Agreements: Capital Improvement (15yrs)
Agreements: Non -Capital Improvement (5fyrs)
Upon Completion of Project pull original Bid File (no bid file if this is a Grant) and put with
original Agreement File for retention.
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ACOR 1. CERTIFICATE OF LIABILITY INSURANCE os;�,;z o
PRODUCER (561)567-1188 (561)778-1416 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
SCHLITT INSURANCE SERVICES INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1717 INDIAN RIVER BLVD ALTER THE COVERAGE AFFORDED BY THE POLJCIES BELOW.
SUITE 300
VERO BEACH, FL 32960 INSURERS AFFORDING COVERAGE
INSURED Camco Services, Inc. INSURERA: Evanston Insurance Co
4445 North AlA INSURERS:
Vero Beach, FL 32963 INSURER
INSURER U
INSURERE:
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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.
LPOLICY TR
TYPE OF INSURANCE
POUCYNUMBER
PDATE MMAD
DATE MM,DD O
LIMITS
A1A
GENERAL UABIUTY
MG803313
03/31/2000
03/31/2001
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (My .0 fle) $
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
X COMMERaALGENERALUABILITY
CLAIMSMADEFRI OCCUR
MED EXP (My ane Persm) $
PERSONAL B ADV INJURY $ 1,000,000
A
X Professional LTab.
GENERAL AGGREGATE $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/CP AGO $ 1,000,000
POLICY SEPT. Fl LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
aa
(Ea idrnp E
BCUILYINJURY $
For pwIxrt)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILYINJURY $
Pa acdc!W)
HIREDAUTOS
NON OWNED AUTOS
PROPERTY DAMAGE $
Per wdder$)
GARAGELIABILITY
AUTO ONLY -EA ACCIDENT S
OTHER THAN EAACC S
ANY AUTO
AUTO ONLY: AGO $
EXCESS LIABILITY
EACH OCCURRENCE $
AGGREGATE $
OCCUR F� CLAIMS MADE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS CONP+ENSATIONAND
-
TORY U
LIMITS ER
E.L. EACH ACCIDENT $
EMPLOYERS' LIASIUTY
E.L. DISEASE - EA EMPLOYEE S
E.L DISEASE -POLICY LIMIT $
OTHER
nFRrAI0
VM OF OPPRATIONS&WATIONMEHICLES/EXCLUSIONS
ADDED BY ENDORSEMENTISPECIAL
PROVISIONS
CERTIFICATE HOLDER
ADDITIC14AL INSURED; INSURER LETTER:
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
Camco Services,
Inc.
EXPIRATI ON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
4445 North
A1A
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE LEFT,
Vero Beach,
FL 32963
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
LOCAT I ON: Sch I i tt Services RX TIME 08/17 '00 13:45
WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01A
Original Printing Issued May 1, 1988 Standard
INFORMATION PAGE
RISK ID
Insurer: Zenith Insurance Company
1-800-226-2324
NCCI Carrier Code No. 13145
1. The Insured: CAMCO SERVICES INC
4445 HWY AlA #150
VERO BEACH, FL 32963
Individual _ Partnership
Mailing Address: 4445 HWY AIA #150
VERO BEACH, FL 32963
Other workplaces not shown above:
FEIN 65-0672716
P O L I C Y N O.
35450
X Corporation
2. The policy period is from January 15, 2000, 12:01 AM Standard Time to January 15,
2001, 12:00 AM Standard Time at the insured's mailing address. The Anniversary Rating Date
is January 15, 2000.
3. A. Workers' Compensation Insurance: Part One of the policy applies to the Workers'
Compensation Law of the states listed here: FLORIDA
B. Employers Liability Insurance: Part Two of the policy applies to work in each
state listed in Item 3.A. The limits of our liability under Part Two are:
Bodily Injury by Accident $100,000 each accident
Bodily Injury by Disease $500,000 policy limit
Bodily Injury by Disease $100,000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any,
listed here: All states except states listed in item 3A and North Dakota, Ohio,
Washington, West Virginia, Wyoming
D. This policy includes these endorsements and schedules: WC 09 06 06
WC 00 04 14 WC 00 03 08
4. The premium for this policy will be determined by our Manuals of Rules,
Classifications, Rates and Rating Plans. All information required below is subject to
verification and change by audit.
Classifications Code Premium Basis Rate Per Estimated
No. Total Estimated $100 of Annual
Annual Remuneration Remuneration Premium
SEE ATTACHED
Total Estimated Annual Premium $
Minimum Premium $705.0 Exp se C ant $
Countersigned by: v
ARDEN X.FtLTEN INSURANCE, 'V$RO- 1. M
jlc l January 6, 2000
O
3.987 National Council on Compensation Insurance Inc. info.mrg
ARLSON
AW/ U U .J J I J i 6IHI L Ut- t-L-uHIUN
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONST INDUSTRY LICENSING BOARD
11,111 LICENSE NBR
101II/2000 00009857 CB -0012032,'
timed heli;L-DI
IS-C`ERTI FI ED CTOR
Under the provisions of Chapter 489
Expirationdate: AUG 31, 2002
PROCTORS DERRICK A
CAMCO SERVICES INC
5135 N US 1
VERO BEACH FL 32967
JEB BUSH KIM BINKLEY—SEYER
GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY
1. Bip Depietro — Electric
2. All Star Plumbing —Plumbing
3. Modern Roofing systems — Roofing
4. Gator Lumber - Trusses
HUGH WILLIAMS, PROJECT MANAGER
BAREFOOT BAY RECREATIONAL DISTRICT
BAREFOOT BAY BOULEVARD
BAREFOOT BAY, FLORIDA
(561)664-3141
$180,000.00 Construction of boat Dock, Building, Electric, Etc.
HARRY CRIST, MANAGING AGENT
(561)473-3364
INDIAN TRAILS CLUB, INC.
Construction of Guardhouse and Security Gates
EDUARDO GANDOLFO, GENERAL CONTRACTOR
MICHELLO, INC.
1450 BRICKELL BAY DRIVE, #808
MIAMI, FLORIDA 33131
(561)473-1979
PROJECT: Blue Cypress Lake Fishing Access — $400,000.00 — General Contracting, Site Work,
Concrete Forming, Pilings, Clearing, Curbing, Landscaping, Facilities, Etc.
DEBBIE LAYTON
(561) 713-0028
General Contracting and Construction of a Custom 3800 Sq. Foot CBS Home with Site Work.