Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
O-2019-21 CHER
CITY OF CLERMONT
Choice ofChampso,„ ORDINANCE NO. 2019-21
AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF
CLERMONT, LAKE COUNTY, FLORIDA, UNDER THE CODE
OF ORDINANCES OF THE CITY OF CLERMONT, GRANTING A
GARBAGE COLLECTION FRANCHISE TO JJ'S WASTE &
RECYCLING, LLC PROVIDING FOR THE TERM OF THE
FRANCHISE AND FOR OTHER PURPOSES CONNECTED WITH
A FRANCHISE FOR THE COLLECTION OF GARBAGE WITHIN
THE CITY OF CLERMONT.
NOW THEREFORE, BE IT ORDAINED by the City Council of the City of
Clermont, Lake County, Florida as follows:
SECTION 1.
The City, acting by and through its City Council, hereby grants unto JJ's Waste &
Recycling, LLC, its successors and assigns, a non-exclusive right and privilege to operate
a refuse collection system in, upon, over and across the present and future streets, alleys,
bridges, easements and other public places of the City, for the purpose of collecting
commercial refuse, subject to certain limitations hereinafter set forth.
SECTION 2.
The rights granted herein shall specifically not include:
1. the collection and disposal of all residential refuse;
2. the collection and disposal of all commercial refuse generated by
establishments which:
(a) utilize 12 or less refuse cans per pick up each with a capacity not
exceeding 30 gallons and/or
(b) require service two or less times per week.
SECTION 3.
The City hereby grants a non-exclusive franchise to JJ's Waste & Recycling, LLC and
JJ's Waste & Recycling, LLC will agree to collect and dispose of commercial refuse other
than that described in Section 2 of this Ordinance under the conditions set forth in this
Ordinance and in the Franchise Agreement attached hereto and incorporated herein as
Exhibit "A".
1
6
CLER NT
CITY OF CLERMONT
,,CORDINANCE NO. 2019-21
SECTION 4.
JJ's Waste & Recycling, LLC shall be an independent contractor and shall enter into a
contract with City that provides, among other things, that JJ's Waste & Recycling, LLC
shall covenant to hold harmless and indemnify and indemnify the City for any and all
damages, including attorney fees, arising out of directly or indirectly and/or by virtue of
any claim, whether actual or threatened, of whatsoever nature resulting from the activities
of JJ's Waste & Recycling, LLC, its agents, servants or employees, within or without the
city limits. JJ's Waste & Recycling, LLC will, within five (5) days from the adoption of
this Ordinance, cause to be written a policy of general liability insurance, insuring it and
the City against all claims made by any person or persons for personal injuries or property
damage incurred in connection with the performance by JJ's Waste& Recycling, LLC, its
servants, agents, and employees, of the services required under this Ordinance and the
Franchise hereby granted, which said policy shall be written within limits of$1,000,000
per person and $3,000,000 per occurrence, and for not less than $100,000 for damages to
property per occurrence.
SECTION 5.
JJ's Waste & Recycling, LLC shall post with the City a surety bond or letter of credit in
the amount of $100,000 guaranteeing the faithful performance by it of all of its
obligations and covenants under said Contract.
SECTION 6.
This Franchise and the Contract between the City and JJ's Waste & Recycling, LLC shall
be in full force and effect until JJ's Waste & Recycling, LLC, commencing immediately;
and this Franchise and Contract shall thereafter be automatically renewed from year to
year unless terminated by either party upon not less than sixty(60) days written notice.
SECTION 7.
JJ's Waste & Recycling, LLC shall pay monthly to the City a franchise fee established by
separate resolution of the City of Clermont.
SECTION 8.
This Ordinance and the Franchise granted thereby are applicable to all lands lying within
the corporate limits of the City and shall be applicable with equal force to any additional
lands hereinafter included within the corporate limits of the City, and no such addition of
lands or to be excluded from the corporate limits as the same presently exist, shall
invalidate this Ordinance or the Franchise granted hereunder, or constitute a basis for any
adjustment to or claim under any contract which may be executed under the authority of
this Ordinance.
2
cc
CLERMONT CITY OF CLERMONT
Owtce ORDINANCE NO. 2019-21
SECTION 9.
All ordinances and/or parts of ordinances which are in conflict with this Ordinance are
hereby repealed and same shall be of no further force and effect.
SECTION 10.
This Ordinance shall be published as provided by law, and it shall become law and take
effect upon its second reading and Final passage.
3
S
CLER NT
CITY OF CLERMONT
Chace of Champcns ORDINANCE NO. 2019-21
PASSED AND ADOPTED by the City Council of the City of Clermont, Lake County,
Florida on this 9th day of April, 2019.
�.$s�GA jr,eCITY OF CLERMONT
looJ f:'4!r,.Ii, / ." / /
Ili h.N1111
Gail L. Ash, ayor
ATTEST:
/�4
Tracy Ackr• 4 Howe, City Clerk
Approved a •: _. d -:- '
gal %-041 _
Dame-1 . •antzaris, City Attorney
EXHIBIT "A"
CITY OF CLERMONT
• NON-EXCLUSIVE COMMERCIAL ROLL-OFF SOLID WASTE CONTAINER
COLLECTION AND DISPOSAL AGREEMENT
THIS AGREEMENT is made and entered into this 8th day of May, 2018,by and
between the City of Clermont, Florida ("City"), and JJ's Waste & Recycling, LLC, whose
address is 3905 El Rey Road, Orlando, FL 32808 ("Grantee").
RECITALS:
WHEREAS, City as a municipal corporation of the State of Florida has the
authority and right to regulate the use of public right-of-way and related facilities in
conjunction with the commercial activity of the collection and disposal of commercial
waste; and
WHEREAS, Grantee has requested the City grant to it a non-exclusive franchise
right to operate within the incorporated municipal limits of the City of Clermont; and
NOW THEREFORE the parties do hereby agree as follows:
SECTION 1. Definitions. Definitions of terms used in this Ordinance:
(A) "Refuse" includes all garbage and other trash generated by citizens of the
City and businesses within the City.
(B) "Residential Refuse"is that refuse generated by residents of the City.
(C) "Commercial Refuse" is that refuse generated by commercial and industrial
establishments presently operating in the City and any such establishment
which may begin operative during the term of the Contract contemplated
herein. Multi-family residential may be considered commercial use.
SECTION 2. Grant of Franchise.
Pursuant to City of Clermont Ordinance No. 2019-21, the City hereby grants to Grantee,
and the Grantee hereby accepts, a non-exclusive right and privilege to operate a refuse
collection system in, upon, over and across the present and future streets, alleys, bridges,
easements and other public places of the City, for the purpose of collecting commercial
refuse, subject to certain limitations hereinafter set forth.
SECTION 3. Incorporation of the Ordinance.
The Franchise granted hereunder is issued pursuant to and subject to the provisions of the
Ordinance No. 2019-21 as passed on April 9, 2019, hereinafter "the Ordinance".
1
Grantee agrees to comply with all provisions of the Ordinance, as amended from time to
time by the City in the lawful exercise of its Police Powers.
SECTION 4. Compliance with other Federal, State, and Local requirements.
The Grantee agrees to comply with all applicable federal and state laws, rules and
regulations. Failure on the part of the Grantee to comply with material requirements of
this Agreement, the Ordinance or/and any other local, state or federal law, ordinance, or
rule or regulation relating to the collection and disposal of solid waste will result in the
cancellation of this Franchise.
SECTION 5. Insurance, Indemnification, Hold Harmless and Duty to Defend.
(a) Grantee shall, within five (5) days from the adoption of this Ordinance, cause
to be written a policy of general liability insurance, insuring it and the City
against all claims made by any person or persons for personal injuries or
property damage incurred in connection with the performance by Grantee, its
servants, agents, and employees, of the services required under this
Ordinance and the Franchise hereby granted, which said policy shall be
written within limits of $1,000,000 per person and $3,000,000 per
occurrence, and for not less than $100,000 for damages to property per
occurrence. In the event that said policy is ever canceled or terminated,
Grantee shall notify City immediately with the name and proof of the
replacement insurance carrier and policy.
(b) Grantee does hereby agree to indemnify, hold harmless and defend City from
any and all causes of actions or claims of any kind for damages of any kind,
including attorney fees, whether actual or threatened, and related in any
matter, directly or indirectly to the Grantee's exercise of any rights
granted hereunder, either within or without the City limits.
(c) Nothing herein shall be construed or act as a waiver of any sovereign
immunity the City may enjoy in accordance with applicable law, the
protection of which the City expressly reserves.
SECTION 6. Limitation of Grant of Franchise.
The non-exclusive franchise right granted herein is limited by the Ordinance and shall
specifically not include the following to the following:
(a) the collection and disposal of all residential refuse;
(b) the collection and disposal of all commercial refuse generated by
establishments which:
2
(1) utilize twelve (12) or less refuse cans per pick up each, with a capacity
not exceeding thirty(30) gallons and/or
(2) require service two or less times per week
SECTION 7. Service Requirements.
Any and all services to be provided hereunder by Grantee shall be performed in
accordance with applicable professional standards, this Agreement, the Ordinance, and all
Local, State and Federal Laws. In addition thereto, Grantee shall act as follows:
(a) All commercial waste to be picked up by Grantee will be stored in standard
manufactured, mechanically serviced containers approved by the City.
Grantee will supply such containers as needed by customers. Location of
containers is subject to City approval.
(b) Size of containers and frequency of service will be agreed upon by Grantee
and each customer. Minimum container size shall be two cubic feet.
Containers will be disinfected a minimum of once per week to remove all
noxious and/or obnoxious odors.
(c) The rates for each individual customer are to be negotiated between Grantee
and each customer it serves. The City and each customer shall be notified of
any proposed rate change at least sixty (60) days prior to the effective date of
the rate change.
(d) Grantee, its agents, servants or employees shall collect refuse collected
hereunder in enclosed, standard, packer-type vehicles approved by the City,
and shall perform their obligations hereunder in a courteous, workmanlike
manner so as not to create a nuisance for any of the residents of the City.
All such commercial refuse collected hereunder shall be disposed in a
lawful manner.
(e) Grantee shall have the sole responsibility for the billing and collection of
charges provided hereunder. Billings shall be monthly and payable on or
before the 15th day of the succeeding month. In the event bills are not paid
within this time, Grantee shall have the right to discontinue service for non-
payment. Nothing herein shall be construed or act as an acknowledgement
or guarantee by City of any fees or billings owed to Grantee.
(f) Collection shall be made during hours as set forth in a schedule approved by
the City. All collection will be made as quietly as possible.
SECTION 8. Payment of Franchise Fee.
Grantee shall pay monthly to the City a franchise fee established by separate resolution of
the City of Clermont. Grantee shall provide an annual audit report to the City showing
3
gross annual billings and receipts, if requested by the City. Fees to be assessed
commencing with the first billing of any customer. In the event services have been
provided prior to this agreement, all past due fees calculated from the first billing shall be
paid within thirty(30)days of this Agreement.
SECTION 9. Posting of Performance Bond.
Within thirty (30) days of the execution of this Agreement, Grantee shall provide to the
City, and at all times thereafter shall maintain in full force and effect for the term of this
Franchise or any renewal thereof, at Grantee's sole expense, a performance bond or letter
of credit with a company or financial institution and in a form approved by the City in its
sole discretion, in the amount of one hundred thousand dollars ($100,000), consistent
with the requirements of the Ordinance and this Agreement.
SECTION 10. Term,Termination and Assignment.
This Franchise and this Agreement shall be in full force and effect until April 9, 2020,
commencing immediately; and this Franchise and Contract shall thereafter by
automatically renewed from year to year unless terminated by either party upon not less
than sixty(60) days written notice sent via U.S. registered or certified mail, return receipt
requested, to the other party. This Franchise and the Contract between the City and
Grantee may be assignable to an affiliated company by Grantee after it has first obtained
the consent of the City for such assignment. In the event of default of any of the terms of
the Ordinance of this Agreement, City may terminate this agreement after providing to
Grantee thirty(30)days written notice and an opportunity to cure.
SECTION 11. Notice,Proper Form. -
Any notices required or allowed to be delivered hereunder or under the Ordinance shall
be in writing and be deemed to be delivered when (1) hand delivered to the official
hereinafter designated or(2)upon mailing of such notice when deposited in United States
Mail, postage prepaid, certified mail, return receipt requested, Federal Express or courier,
addressed to a party at the address set forth opposite of the party's name below, or such
other address as the party shall specify by written notice to the other party delivered in
accordance herewith:
City: City of Clermont
Attention: City Clerk
685 W. Montrose Street
Clermont, FL 34711
Grantee: JJ's Waste&Recycling, LLC
Attention: Darrell Corbett
3905 El Rey Road
Orlando, FL 32808
4
SECTION 12. Disclaimer of Third Party Beneficiaries.
This agreement is solely for the benefit of and shall be binding upon the parties hereto
and their respective successors in interest. No right or cause of action shall accrue upon,
or by reason hereof, to or for the benefit of any person not a party to this Agreement or a
successor in interest.
SECTION 13. Severability.
This Agreement is declared by the parties to be severable.
SECTION 14. Applicable Law and Venue.
This Agreement shall be construed, controlled, and interpreted according to the laws of
the State of Florida. Venue for any cause of action hereunder shall be exclusively in Lake
County, Florida.
SECTION 15. Entire Agreement; Modification.
This Agreement constitutes the entire agreement between the parties and supersedes all
previous discussions, understandings and agreements. Modifications to and waivers of
the provisions herein may be only by the parties hereto and only in writing.
5
IN WITNESS WHEREOF, the parties hereto have hereunder executed this Agreement
on the j day of April, 2019.
CITY OF CLERMONT, FLORIDA
1 /
<,11F/
' A /
By:
i I. /L
Y
Gail L. Ash, M.yor
ATTEST:
Tracy Ackroyd Howe, City Clerk
Appr y-_: as too •• and legality:
w�
:!� u . . - , • orney
GRANTEE:
JJ'S WAST . & R;•YCLING, LLC
By:
Darrell Corbett l I�,,
Title: 1C4 ?a,f..5%bc-N-K" Celt LQAcA;
ATTEST: J 4� .6 •
Miche'T• S. Cham s ers
Title: C.orrlPtc:at ^�t:,^(Z_
•
•
Bond No E380742
BOND FOR Refuse Collection Contractor CONTRACTOR
(Type of Contractor)
KNOW ALL MEN BY THESE PRESENTS.
That we, JJ'S WASTE & RECYCLING LLC
of the 3905 EL REY ROAD, ORLANDO, FL ,State of FLORIDA ,,as Principal,and
Great American a corporation duly licensed to do surety business in the State of Florida ,
Niretr arecheld a°nglpir n
y, Wund unto the City of Clermont ,as Obligee,in
the penal sum of One Hundred Thousand&No/100 ),DOLLARS($ 100,000 00
lawful money of the United States,to be paid to the Obligee,for which payment well and truly to be made,we bind
ourselves and our legal representatives,firmly by these presnets
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH,That the above bonded Principal has been authorized to
Haul Refuse as per City of Clermont Ordinance No 2011-09-M by the Obligee
NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply with the laws and
ordinances,then this obligation to be void,otherwise to remain in full force and effect until Januar_y 31
2 0 2 0 ,unless renewed by Continuation Certificate
This bond may be terminated at any time by the Surety upon sending notice in writing to the Obligee and to the
Prinicpal at the address last known to the Surety,and at the expiration of sixty(60)days from the mailing of said notice,
this bond shall ipso faxto terminate and the Surety shall thereupon be relieved from any liability for any acts or
omissions of the Principal subsequent to the said date Regardless of the number of eyars this bond shall continue in
force,the number of claims made against this bond,and the number of premiums which shall be payable or paid,the
Surety's total limit of liability shall not be cumulative from year to year or period to period,and in no event shall the
Surety's total liability for all claims exceed the amount set forth above.Any revision of the bond amount shall not be
cumulative
DATED THIS 1st DAY OF February , 2019 .
JJ ' S ASTE & RE YCLING LLC
Princ. pal
DA4Z/2 Cog&11 11?. ria&PrvAmeilAcit
Name & Title (Print)
GREAT AMERICAN INSURANCE COMPANY
,4e„,:,„th_
Joline L. Binette
Attorney-In-Fact
•
GREAT AMERICAN INSURANCE COMPANY
Administrative Office: 301 E 4TH STREET • CINCINNATI,OHIO 45202 • 513-369-5000 • FAX 513-723-2740
The number of persons authorized by
this power of attorney is not more than one
Bond No. E380742
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:That the GREAT AMERICAN INSURANCE COMPANY,a corporation organized and existing under
and by virtue of the laws of the State of Ohio,does hereby nominate,constitute and appoint the person or persons named below its true and lawful attorney-in-
fact,for it and in its name,place and stead to execute on behalf of the said Company,as surety,the specific bond,undertaking or contract of suretyship referenced
herein:provided that the liability of the said Company on any such bond.undertaking or contract of suretyship executed under this authority shall not exceed
the limit stated below.The bond number on this Power of Attorney must match the bond number on the bond to which it is attached or it is invalid.
Name Address Limit of Power
Joline L.Binette 103 Park Street,PO Box 481 $100000—
Lewiston,ME 04243
IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 4th day of February 2019 •
Mies! GREAT AMERICAN INSURANCE COMPANY
e 3 Zetaid ie4 4:4
. • .
Assistac.t Secretary Divisional Senior Vice President
STATE OF OHIO,COUN'iY OF HAMILTON-ss: DAVID C.KRCHIN(877-377-2406)
On this 4th day of February ,2019 ,before me personally appeared DAVID C. KITCHiN,to me
known,being duly sworn,deposes and says that he resides in Cincinnati,Ohio,that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company,the Company described in and which executed the above instrument:that he knows the seal of the said Company:that the seal
affixed to the said instrument is such corporate seal;that it was so affixed by authority of his office under the By-Laws of said Company,and that he signed his
name thereto by like authority.
lkookKohard
!loft Pille,111adtth 9,24.4.4a.0- a
This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company
by unanimous written consent dated June 9,2008.
RESOLVED: That the Divisional President,the several Divisional Senior Vice Presidents,Divisional Vice Presidents and Divisonal Assistant Vice
Presidents,or any one of them,be and hereby is authorized,from time to time,to appoint one or more Attorneys-in-Fact to execute on behalf of the Company.
as surety,any and all bonds,undertakings and contracts ofsuretyship,or other written obligations in the nature thereof to prescribe their respective duties and
the respective limits of their authority;and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the
Company may be affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond.undertaking,contract of suretyship.
or other written obligation in the nature thereof such signature and seal when so used being hereby adopted by the Company as the original signature of such
officer and the original seal ojthe Company.to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I.STEPHEN C.BERAHA,Assistant Secretary of Great American insurance Company,do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of June 9,2008 have not been revoked and are now in full force and effect.
Signed and sealed this 1 s t day of February 2019
M
tjot,,, e 3
t
•
Assistant Secretary
S 1194C(5/15)
DATE(MM/DD/YYYY)
AMR") CERTIFICATE OF LIABILITY INSURANCE
`i 02/01/2019
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 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 CONTACT
NAME:
East Coast Global Insurance LLC ON n Fr,l.(603)842-5968 � ���f.(603)842-5971
340 Central Avenue A@illc.com
ADDRESS: marcweCgDR
Suite 204 -_ INSURER(S)AFFORDING COVERAGE , NAIC K
Dover NH 03820 INSURER A: Crum&Forster Insurance Company
INSURED INSURER B; National Casualty Insurance Company
JJ's Waste&Recycling LLC INSURER C: _
PO Box 585458 INSURER D:
Orlando FL 32858 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 TYPE OF INSURANCE ADDLSUER POLICY EFF POLICY EXP
LTR IVSD MO POLICY NUMBER ,f JIVDD/YYYY) IMM/DDJYYYY) UNITS
x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000
A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 50000
PREMISES IFa nrrunr:e ,
rre
) $ _,
x Hired Non Owned Auto x x EPK 121738 03/15/2018 03/15/2019 MED EXP(Any one person) $5,000
x Pollution PERSONAL&ADV INJURY _ $1,000,000
GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY JECT LOC PRODUCTS-COMP/OP AGG, $2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Fa accident!
B ANY AUTO BODILY INJURY(Per person) $
I OWNEDSCHEDULED
AUTOS ONLY X AUTOS CAO 7769601 05/31/2018 05/31/2019 BODILY INJURY(Per accident) $
HIRED NON-OWNED
AUTOS ONLY PROPERTY DAMAGE
!Per accident) $
AUTOS ONLY _
5
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000 _
A EXCESS LIAB CLAIMS-MADE X x EFX 110239 03/15/2018 03/15/2019 AGGREGATE s 5,000,000
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE FR -
ANY PROPRIETOR/PARTNER/EXECUT'VE(� EL.EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED? I I N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
1 yes.describe under
DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $
1
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
City of Clermont SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
685 W.Montrose Street ACCORDANCE WITH THE POLICY PROVISIONS.
Clermont,FL 34711
AUTHORIZED REPRESENTATIVE <MW>
e4.11<54111
I Attn: City Clerk
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
li