The URL can be used to link to this page

05 Contract Renewal #2 -Nason Yeager AFFIDAVIT OF NON-COERCION FOR LABOR AND SERVICES (FLORIDA STATUTES SECTION 787.06(13)) State of Florida ) )ss. County of Palm Beach ) Personally appeared before me,the undersigned authority Stephen L. Conteaguero ("Affiant"), who being first duly sworn,deposes and says on oath and under penalty of perjury as follows: I. That they are of legal age, have personal knowledge of the facts herein stated, and are duly authorized to make this affidavit(the"Affidavit")as Authorized Signer on behalf of City of Okeechobee ("the Entity"). II. That to the best of Affiant's knowledge,the Entity does not engage in any of the following activities as part of its employment practices: 1. Using or threatening to use physical force against any person; 2. Restraining,isolating,or confining or threatening to restrain,isolate,or confine any person without lawful authority and against her or his will; 3. Using lending or other credit methods to establish a debt by any person when labor or services are pledged as a security for the debt, if the value of the labor or services as reasonably assessed is not applied toward the liquidation of the debt, the length and nature of the labor or services are not respectively limited and defined; 4. Destroying, concealing, removing, confiscating, withholding, or possessing any actual or purported passport, visa, or other immigration document, or any other actual or purported government identification document,of any person; 5. Causing or threatening to cause financial harm to any person; 6. Enticing or luring any person by fraud or deceit;or 7. Providing a controlled substance to any person for the purpose of exploitation of that person. III. That this Affidavit is being given to evidence compliance with the law. FURTHER AFF ANT SAYETH NOT. j' Signature The foregoing instrument was sworn to and subscribed before me by means of[physical presence or LI online notarization, this //J t day of September , 20_, by Stephen L. Conteaguero , as flu ru,1t2 ) 241.4., ld ATlvt' of dLt (ti'l 9F 041- (K41m-- ,on its behalf,who [N4iiss personally known to me or[j has produced a driver's license as identification. [Notary Seal] Notary PublicL... 11)"' itt j """"' MELISSA DINATALE ,qY PUB,' Printed Name: Melissa DiNatale 4t `, Notary Public-State of Florida �� •,�, Commission M HH 50044 %?pF� ;o' My Commission Expires My Commission Expires: 12/11/2024 December 11, 2024 ACC)RE�" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/15/2024 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 have ADDITIONAL INSURED provisions or 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 Anchorage Insurance Solutions NAMEACT JC Sola 3801 PGA Blvd (A/CNo.Ext):561-594-0194 FN,Ne).561-422-4099 Suite 600-5941 �DRss:jcsola@anchorageinsurances.com Palm Beach Gardens FL 33410 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:MAIN STREET AMERICA PROTECTION INSURED Nason,Yeager,Gerson, Harris&Fumero,PA INSURER B:OLD DOMINION INSURANCE COMPANY 3001 PGA Blvd#305 INSURER C:Technology Insurance Company Palm Beach Gardens FL 33410 INSURERD:Federal Insurance Company 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE JNS-D'�WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMBS A ✓ COMMERCIAL GENERAL LIABILITY 1✓I I BPG8001Y 10/1/2024 10/1/2025 EACH OCCURRENCE $1,000,000 �� L�✓1 DAMAGE TO RENTED .:_AIMS.\ADE I V I OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $5,000 — PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:P 00O 000 RO- GENERAL AGGREGATE $ + , POLICY I—I ECT I-1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: EBL $1,000,000 A AUTOMOBILE LIABILITY Liu BPG8001Y 10/1/2024 10/1/2025 COME(Eaaccident)ciNeUINGLELIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURYaccident) AUTOS ONLY AUTOS (Per $ ✓ HIRED ✓ NON-OWNED PROPERTY DAMAGE — AUTOS ONLY _ AUTOS ONLY (Per accident) $ $ D I</ UMBRELLA LIAB — ✓ OCCUR l IIn EACH OCCURRENCE $I CUG8001Y 10/1/2024 10/1/2025 4,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ C WORKERS COMPENSATION LJ AND EMPLOYERS'LIABILITY Y/N C4491 7 99 10/1/2024 10/1/2025 I✓I STATUTE I I OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) 1E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 t� B Crime I I( 1 8264-5004 10/1/2024 10/1/2025 8500,000(see schedule) B Fiduciary Liability DE 8264-5004 10/1/2024 10/1/2025 $1,000,000 uu DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Insured Locations:3001 PGA Blvd STE 305,Palm Beach Gardens FL 33410,750 Park of Commerce Blvd STE 210 Boca Raton FL 33487, 200 South Andrews Ave STE 901 Fort Lauderdale FL 33301 Certificate Holder,as Manager or Lessor of Premises,is an Additional Insured as respects to General Liability subject to the terms, conditions and exclusions of the policy. CERTIFICATE HOLDER CANCELLATION City of Okeechobee 55 S.E. 3rd Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Okeechobee, FL 34974 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD BPG8001Y AC� DATE(MM/DD/YYYY) EVIDENCE OF COMMERCIAL PROPERTY INSURANCE 10/17/2024 THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW.THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST. PRODUCER NAME, PHONE 561-594-0194 COMPANY NAME AND ADDRESS NAIC NO: CONTACT PERSON AND ADDRESS (A/C.No Ext);._. —. Anchorage Insurance Solutions 3801 PGA Blvd MAIN STREET AMERICA PROTECTION INRANCE COMPANY Suite 600-5941 Lloyds of London Palm Beach Gardens FL 33410 FAX Nol.561-422-4099 ADDRESS:jcsoIa@anchorageinsurances.com IF MULTIPLE COMPANIES,COMPLETE SEPARATE FORM FOR EACH CODE: _ SUB CODE: POLICY TYPE AGENCY BOP CUSTOMER ID#: NAMED INSURED AND ADDRESS Nason,Yeager,Gerson,Harris&Fumero,PA LOAN NUMBER POLICY NUMBER 3001 PGA Blvd#305 BPG8001Y Palm Beach Gardens FL 33410 EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL 10/1/2024 10/1/2025 ❑TERMINATED IF CHECKED ADDITIONAL NAMED INSURED(S) THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION (ACORD 101 may be attached if more space is required) U BUILDING ORLI BUSINESS PERSONAL PROPERTY LOCATION/DESCRIPTION 3001 PGA Blvd STE 305,Palm Beach Gardens FL 33410,750 Park of Commerce Blvd STE 210 Boca Raton FL 33487, 700 Smith Andrewc Ave STF 9ni Fnrt I auderdale Fl 494n1 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 EVIDENCE OF PROPERTY INSURANCE 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. COVERAGE INFORMATION PERILS INSURED BASIC I I BROAD V I SPECIAL COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: $472,800 DED: 2,500 YES NO HA V BUSINESS INCOME n RENTAL VALUE ✓ EYES,LIMIT: n Actual Loss Sustained;#of months: BLANKET COVERAGE ✓ If YES,indicate value(s)reported on property identified above:$ TERRORISM COVERAGE Attach Disclosure Notice/DEC IS THERE A TERRORISM-SPECIFIC EXCLUSION? IS DOMESTIC TERRORISM EXCLUDED? V V LIMITED FUNGUS COVERAGE If YES,LIMIT: DED: FUNGUS EXCLUSION(If"YES",specify organization's form used) V REPLACEMENT COST V AGREED VALUE COINSURANCE ✓ If YES, EQUIPMENT BREAKDOWN(If Applicable) ✓ If YES,LIMIT: DED: ORDINANCE OR LAW -Coverage for loss to undamaged portion of bldg If YES,LIMIT: DED: -Demolition Costs If YES,LIMIT: DED: -Incr.Cost of Construction If YES,LIMIT: DED: EARTH MOVEMENT(If Applicable) ✓ If YES,LIMIT: DED: FLOOD(If Applicable) V If YES,LIMIT: DED: WIND/HAIL INCL V YES NO Subject to Different Provisions: ✓ If YES,LIMIT: DED: NAMED STORM INCL YES ✓ NO Subject to Different Provisions: ✓ If YES,LIMIT: DED:5% PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE ✓ HOLDER PRIOR TO LOSS CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST CONTRACT OF SALE H LENDER'S LOSS PAYABLE I I LOSS PAYEE LENDER SERVICING AGENT NAME AND ADDRESS MORTGAGEE NAME AND ADDRESS City of Okeechobee 55 S.E.3rd Avenue Okeechobee,FL 34974 AUTHORIZED REPRESENTATIVE ©2003-2015 ACORD CORPORATION. All rights reserved. ACORD 28(2016/03) The ACORD name and logo are registered marks of ACORD