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1579 *Lake Monroe Harbour, IncCity Of Sanford/Lake Monroe Harbour, Inc. Letter Of Agreement Extending Memorandum Of Agreement This Letter Of Agreement Extending Memorandum Of Agreement is entered into this day of 12014, by and between the CITY OF SANFORD, a Q U Florida municipality (hereinafter referred to as the "City"), whose address is City of Sanford City Hall, 300 North Park Avenue, Sanford, Florida 32771 and LAKE MONROE HARBOUR, INC., a Florida corporation (hereinafter referred to as "Monroe Harbour"), whose address is c/o Charles J. Volk, President, 531 North Palmetto Avenue, Sanford, Florida 32771. The City and Lake Monroe Harbour, Inc. are referred to herein as the "parties" in implementation of the year-to-year agreement of the parties. Whereas, the Fourth of July Fireworks Celebration (hereinafter referred to as the "Celebration") has been historically held yearly on the lakefront of Lake Monroe in Sanford, Florida; and Whereas, the Celebration has included an annual fireworks display; and Whereas, the launch site for the proposed 2014 Fireworks Display is identified in the attached map Exhibit "A"; and Whereas, Exhibit "A" also identifies an area in which preparation, precautions and public safety efforts are necessary pursuant to City, State and Federal regulations for the protection of life and property; and Whereas, Lake Monroe Harbour, Inc., is a tenant operating a Marina dockside, dry storage and boat basin operation within the area described in Exhibit "A"; and Whereas, the City desires to ensure that the premises, property and personnel of the tenant, Lake Monroe Harbour, Inc., are reasonably protected against any and all personal injury and property damage exposure resulting from the Celebration planned to be conducted on the lakefront in Sanford from the launch site identified in Exhibit "A "; and Whereas, the City Staff including the Event Coordinator Supervisor of Special Events, and Manager, City Attorney, Police Sergeant, Fire Department Lieutenant and Risk Management Director have conferred and will, as necessary, confer with the officers, directors, manager and operator of the Lake Monroe Harbour, Inc. in an attempt to identify and consider all of the concerns of the City and the Tenant germane to the Celebration; and Whereas, the parties have concluded after their several discussions to memorializing their several commitments, agreements, covenants and stipulations in the best interests of the parties; and further, for the public good and the protection of life and property in and about the area identified in Exhibit "A" and along the waterfront area of Lake Monroe within the City of Sanford. Now, Therefore, the parties agree and understand as follows with regard to the July 4, 2014 Celebration: 1. The above recitals are true and correct. 2. Lake Monroe Harbour, Inc. agrees as follows: a. To cooperate with the City in consenting to continue the annual planned Fireworks Celebration to be staged, performed and scheduled within the area described in the attached Exhibit "A" for launch of fireworks; and b. To facilitate the relocation and movement of Lake Monroe Harbour, Inc. property located outside the dry storage area to the parking area west of the dry Page 2 of 7 storage facility; and C. To assist with the designation of the security area west of the dry storage facility so as to coordinate twenty -four (24) hour security and surveillance by the City Police Department commencing at 5PM on July 3, 2014 and continuing until 7:00 a.m. on July 5, 2014; and d. To assist with the designation of exposure areas in and about the Exhibit "A" premises for continuous survey, surveillance and extinguishment control activities of the City's Fire Department; and e. To make available to designated representatives of the City's Park's Department, Special Events Supervisor, Fire Department and Police Department keys and authorization to enter upon the floating docks in the eastern basin for purposes of preparation, protection and clean up of said areas prior to, during and following the Fireworks Display event; and f. Tender to the City's Risk Management Director a copy of the current Fire, Windstorm Extended Coverage and General Liability Insurance Policy insuring the properties of Lake Monroe Harbour, Inc. against incidents of damage and calamity to persons and property (a copy of Lake Monroe Harbour, Inc. policy shall be attached hereto as Exhibit "B" for ready reference by the parties). 3. The City agrees as follows: a. To provide Lake Monroe Harbour, Inc. with a current and valid and enforceable Certificate of Coverage from its Liability carrier providing the maximum coverage available to the City giving consideration to the needs of Monroe Harbour (copy Page 3 of 7 of the Certificate of Coverage is attached hereto as Exhibit "C" for ready reference by the parties); and b. To provide Lake Monroe Harbour, Inc. with a current, valid and enforceable Certificate of Issuance from, Zambelli Fireworks Manufacturing, Co. or such other provider of fireworks display services as may be engaged by the City from time -to- time, establishing Limits of Coverage providing for coverage to which the City is entitled and providing that Monroe Harbour shall be declared an additional insured on said policy as respects commercial, general liability insurance pertaining to the operations of Zambelli Fireworks Manufacturing Co., or other provider, at the Celebration within the City of Sanford, Florida; and C. Assist Monroe Harbour in designating the security parameters west of the dry storage facility and coordinate to the satisfaction of the needs of Lake Monroe Harbour, Inc. and its properties twenty -four (24) hour security and surveillance under the direction of the Sanford Police Department commencing at 5PM on July 3, 2014 and continuing until 7:00 a.m. on July 5, 2014; and d. Assist Lake Monroe Harbour, Inc. in designating potential extinguishment control areas for management by the City's Fire Department including, but not limited to, the following: 1. dry storage exteriors; and ii. dry storage roof which shall be hosed prior to, during and post event for the protection of the dry storage roof and related facilities; and iii. floating docks zone south of the dry storage facility within the Page 4 of 7 eastern harbor area; and iv. all premises leased to Lake Monroe Harbour, Inc. by the City; and V. all boats, trailers, canopies, vehicles, equipment and personal property in and about the premises of Monroe Harbour shall be protected against exposure to damage by reason of the fireworks used in the Celebration; and vi. perform dud management services as required during and after the Celebration to ensure the safety of persons and property. e. Coordinate and implement clean up to the satisfaction of the parties in areas including, but not limited to, the following: I. dry storage roof and exterior; ii. floating docks and the eastern basin; iii. island area; iv. lake front zone; and V. streets, alleys and travel ways on the island and within to lake front areas. f. Coordinate and implement the restoration of premises and properties to the satisfaction of the parties in areas and zones including, but not limited to, the following: i. south dry storage exterior; ii. additional dry storage areas as needed and identified; iii. all parking areas on the island; iv. boat ramps; Page 5 of 7 V. floating docks in the eastern and western basins; vi. harbor docks; vii. lake front zones; and viii. such other areas as shall be impacted by the event, if any. h. Establish and maintain constant communication between and to the satisfaction of the parties so as to implement control and fulfill their respective responsibilities to each other as described herein; and i. The City shall have full authority and opportunity to abort the event for the protection of life, property and the safety, health and welfare of Monroe Harbour and the citizens of the City of Sanford. 4. Attached hereto for ready reference by the parties, are the below listed maps, photos, policies and renderings, to wit: Exhibit "A" - Launch Zone Identification Photo Exhibit "B" - Lake Monroe Harbour, Inc. Coverage and General Liability Insurance Policy Exhibit "C" - Zambelli Fireworks Manufacturing, Co. Certificate of Insurance Exhibit "D" - Lake Monroe Harbour, Inc. Certificate of Coverage issued by the City Exhibit "E" - Marina Isle Lease /Easement Map Page 6 of 7 5. All other terms and conditions of the underlying agreement between the parties are hereby ratified and affirmed. Attest: Barbara Arthur Secretary Attest: CyntlNia Porter, City Clerk For use and reliance of the Sanford City Commission c Lake Monroe Ha Charles J. V President City Of San Jeff Triplett, Ma Page 7 of 7 ur, Inc. LAKEM -1 OP ID: CSJ .Q am LIABILITY DATE (MMIDDNYYY) 06/27/14 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 INSURER(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 407- 898 -1776 NAMEACT Chris St John, AIAM, AAi, CIC Hugh Cotton Insurance 2315 Curry Ford Road 407 - 8950918 Orlando, FL 32806 PHONE 407 -895 -0918 A/c No Exti :407- 898 -1776 aC ae ADDRESS- cstjohn hughcotton.com Tom Sutton INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers 40282 $ INSURED Lake Monroe Harbour, Inc. Barbara Arthur 531 North Palmetto Avenue INSURER B : Atlantic Specialty Insurance PERSONAL & ADV INJURY INSURER C: INSURER D: GENERALAGGREGATE Sanford, FL 32771 INSURER E PRODUCTS - COMPIOPAGG S 2,000,000 INSURER F: S A !`l1vFRA('�FC CFRTIFICATF NI IMBFR- 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. -IN- TRR TYPE OF INSURANCE I POLICY NUMBER MM DDYIYYYY MM1DDYIYYYY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR )( ZOL14S3052413 07/25/13 07/25/14 EACH OCCURRENCE $ 1,000,000 PREMISES a occurr -ELATE ence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY - S 1,000,000 GENERALAGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- T LOC POLICY PRODUCTS - COMPIOPAGG S 2,000,000 S A AUTOMOBILE LIABILITY J'ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X BAOC82202A 07/25113 07/25/14 Ea accideDtSWGLE LIMIT S 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S — — PROPERTY DAMAGE Per accident - S S A UMBRELLA LIAB EXCESS LIAR X I OCCUR OB14S3054813 07/25/13 07/25/14 EACH OCCURRENCE S 2,000,000 X L_tCLAIMS-MADE AGGREGATE S 2,000,000 DED X RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE ❑ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) if yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT S _ E.L. DISEASE - EA EMPLOYE $ Fs E.L. DISEASE - POLICY LIMIT _ B Excess Liability B5JH25364 07/25113 07/25/14 Exc Liab 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HULUEK tsN1V /'GLEN I IVI`! CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Sanford ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 1788 Sanford, FL 32772 AUTHORIZED REPRESENTATIVE —;?�4 0� V "1 yiil3 -LUTV HI,VRU �.vrcrvrv+l lulu. nn nynw Icac,.�... ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF COVERAGE Certificate Holder Administrator Issue Date 06/17/2014 LK MONROE HARBOUR MARINA, INC Florida League of Cities, Inc. 531 N. PALMETTO AVE Department of Insurance and Financial Services P.O. Box 530065 SANFORD, FL 32771 Orlando, Florida 32853 -0065 COVERAGES THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO THE DESIGNATED MEMBER FOR THE COVERAGE 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT, COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FMrr 0529 I COVERAGE PERIOD: FROM 10/1/13 1 COVERAGE PERIOD: TO 10/1/1412:01 AM STANDARD TIME TYPE OF COVERAGE - LIABILITY TYPE OF COVERAGE - PROPERTY General Liability ® Buildings ® Miscellaneous ® Comprehensive General Liability, Bodily Injury, Property Damage and ❑ Basic Form ® Inland Marine Personal Injury ® Special Form ® Electronic Data Processing ® Errors and Omissions Liability ® Personal Property ® Bond ® Supplemental Employment Practice ❑ Basic Form ❑ ® Employee Benefits Program Administration Liability ® Special Form ® Medical Attendants'/Medical Directors' Malpractice Liability ® Agreed Amount ® Broad Form Property Damage ® Deductible $25,000 ® Law Enforcement Liability ❑ Coinsurance N/A ® Underground, Explosion & Collapse Hazard ® Blanket ❑ Specific Limits of Liability ® Replacement Cost " Combined Single Limit ❑ Actual Cash Value Deductible Stoploss $25,000 Limits of Liability on File with Administrator Automobile Liability TYPE OF COVERAGE - WORKERS' COMPENSATION ® All owned Autos (Private Passenger) ® All owned Autos (Other than Private Passenger) ® Hired Autos ® Statutory Workers' Compensation ® Non -Owned Autos ® Employers Liability $1,000,000 Each Accident $1,000,000 By Disease $1,000,000 Aggregate By Disease Limits of Liability `Combined Single Limit ❑ Deductible N/A Deductible Stoploss $25,000 ® Self Insured Retention $200,000 Automobile/Equipment — Deductible ® Physical Damage Per Schedule - Comprehensive - Auto Per Schedule - Collision - Auto Per Schedule - Miscellaneous Equipment Other The limit of liability is $200,000 Bodily Injury and/or Property Damage per person or $300,000 Bodily Injury and/or Property Damage per occurrence. These specific limits of liability are increased to $3,000,000 for General Liability and $2,000,000 for Automobile Liability (combined single limit) per occurrence, solely for any liability resulting from entry of a claims bill pursuant to Section 768.28 (5) Florida Statutes or liability /settlement for which no claims bill has been filed or liability imposed pursuant to Federal Law or actions outside the State of Florida. Description of Operations /Locations/Vehicles/Special Items Re: Insurance verification for July 41 Festival & Fireworks. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE AGREEMENT ABOVE DESIGNATED MEMBER CANCELLATIONS SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROGRAM, ITS AGENTS OR REPRESENTATIVES. CITY OF SANFORD PO BOX 1788 SANFORD FL 32772 1788 AUTHORIZED REPRESENTATIVE FMIT -CERT (10/96) AC"R " CERTIFICATE OF LIABILITY INSURANCE DA 6/2/2014YYY) 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 INSURER(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). PRODUCERAIIied Specialty Insurance, Inc 10451 Gulf Boulevard CONTACT NAME, a"c °NN Ext: A/C No: ADDRESS: Treasure Island, FL 33706 -4814 INSURER (S) AFFORDING COVERAGE NAIC # 1- 800 - 237 -3355 INSURERA: T.H.E. Insurance Company 12866 $ 1,000,000 INSURED Zambelli Fireworks Mfg Co., INSURER B: INSURER C: dba: Zambelli Fireworks Internationale, etal 20 South Mercer Street INSURER D: $ New Castle, PA 16101 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. INSR LTR TYPE OF INSURANCE S POLICY NUMBER MM /DD/YY YY MM/DD/YYYY LIMITS A GENERAL LIABILITY CPP0103167 -01 2/01/2014 02/01/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occ.n-ence $ 100,000 x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 2,000,000 $ POLICY F_ PRO LOC A AUTOMOBILE LIABILITY CPP0103167 -01 2/01/2014 02/01/2015 Ea acccide_D? SINGLE LIMIT BODILY INJURY (Per person) S }� ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTO S AUTOS X H)C N ON -OWNED lHIREDAUTOS AUTOS PROPERTY DAMAGE Peraccidenl $ A �C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ELP0011081 -01 02/01/2014 02/01/2015 EACH OCCURRENCE $ 9,000,000 AGGREGATE $9,000,000 DED RETENTION S $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE WC144355 2/01/2014 02101 /2015 X WC STATU- OTH- ?Y�'�-JT —S E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N /A E.L. DISEASE - EA EMPLOYE • S 1 ,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 Workers Compensation Cover ige is afford Win the Sta e(s) of: AZ, CO, CT, DE, FL, GA, IL, IN, KY, LA, MD, MI, MN, MO, NC, NE, h J, NM, NV, h Y, OR, PA, S C, SO, TN, TX, UT, VA & WI. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Display Date: July 4, 2014 Rain Date: Location: Lake Monroe Harbour Marina RE: General Liability, the following are named as additional insured in respects to the operations of the named insured only City of Sanford, Wharton Smith, Inc, Waste Pro Inc, CPH Engineers, Monroe Harbour Marina Inc, WFTV/WRDQ, Cox Broadcasting, OSSA - Orlando Sanford International Airport, Roses Southwest, Inc., GAI Consultants Inc, Solo Media Inc, WUCF 89.9 FM, Central Florida All Star Football Inc, Wayne Densch Inc - ATIMA GEK I If-IUA I E HULUEK GANGtLLA I IUN 9584 City of Sanford SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 1788 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sanford, FL 32772 ACCORDANCE WITH THE POLICY PROVISIONS. CERT# 201.96 pRESENTAT r�tia� ©1988 -2010 ACID ,RIJ CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF COVERAGE Certificate Holder Administrator Issue Date 06/17/2014 LK MONROE HARBOUR MARINA, INC Florida League of Cities, Inc. 531 N. PALMETTO AVE Department of Insurance and Financial Services P.O. Box 530065 SANFORD, FL 32771 Orlando, Florida 32853 -0065 COVERAGES THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO THE DESIGNATED MEMBER FOR THE COVERAGE 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT. COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FMIT 0529 1 COVERAGE PERIOD: FROM 1011/13 1 COVERAGE PERIOD: TO 10/1/1412:01 AM STANDARD TIME TYPE OF COVERAGE - LIABILITY TYPE OF COVERAGE - PROPERTY General Liability ® Buildings ® Miscellaneous • Comprehensive General Liability, Bodily Injury, Property Damage and ❑ Basic Form ® Inland Marine Personal Injury ® Special Form ® Electronic Data Processing • Errors and Omissions Liability ® Personal Property ® Bond ® Supplemental Employment Practice ❑ Basic Form ❑ ® Employee Benefits Program Administration Liability I@ Special Form ® Medical Attendants'/Medical Directors' Malpractice Liability ® Agreed Amount ® Broad Form Property Damage ® Deductible $25,000 ® Law Enforcement Liability ❑ Coinsurance N/A ® Underground, Explosion & Collapse Hazard ® Blanket ❑ Specific Limits of Liability (D Replacement Cost ` Combined Single Limit ❑ Actual Cash Value Deductible Stoploss $25,000 Limits of Liability on File with Administrator Automobile Liability TYPE OF COVERAGE - WORKERS' COMPENSATION ® All owned Autos (Private Passenger) ® All owned Autos (Other than Private Passenger) ® Hired Autos ® Statutory Workers' Compensation ® Non -Owned Autos ® Employers Liability $1,000,000 Each Accident $1,000,000 By Disease $1,000,000 Aggregate By Disease Limits of Liability Combined Single Limit ❑ Deductible N/A Deductible Stoploss $25,000 ® Self Insured Retention $200,000 Automobile /Equipment— Deductible ® Physical Damage Per Schedule - Comprehensive - Auto Per Schedule - Collision - Auto Per Schedule - Miscellaneous Equipment Other The limit of liability is $200,000 Bodily Injury and/or Property Damage per person or $300,000 Bodily Injury and/or Property Damage per occurrence. These specific limits of liability are increased to $3,000,000 for General Liability and $2,000,000 for Automobile Liability (combined single limit) per occurrence, solely for any liability resulting from entry of a claims bill pursuant to Section 768.26 (5) Florida Statutes or liabilfty /settlement for which no claims bill has been filed or liability imposed pursuant to Federal Law or actions outside the State of Florida. Description of Operations /Locations/Vehicles/Special Items Re: Insurance verification for July 41 Festival & Fireworks. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE AGREEMENT ABOVE. DESIGNATED MEMBER CANCELLATIONS SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROGRAM, ITS AGENTS OR REPRESENTATIVES. 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EASEMENT MAP SANFORD. FL 32771