Certificates of Insurance
.... -
Client#: 319793
HIPPIND
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY)
10/14/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wachovia Insurance Service ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 25277 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FI 33622
813-681-5664 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nautilus Insurance Company 17370
H.I.P.P. Industries, Inc. INSURER B: ACE Property & Casualty Insurance Co 20699
Hospitality Instit. Public Preservation INSURER c: Mapfre Insurance Company of FL
1386 5th Street INSURER D:
Sarasota, FL 34236 INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L TR N R TYPE OF INSURANCE POLICY NUMBER POl"{CY EFFECTIVE LIMITS
A
GENERAL LIABILITY NC7869137
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~ OCCUR
03/13/09
C
GEN'L AGGREGATE LIMIT APPLIES PER:
PR8,: LOC
AUTOMOBILE LIABILITY 4150090002489
03/13/09
03/13/10
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
-'.
GARAGE LIABILITY
ANY AUTO
EXCESSIUMBRELLA LIABILITY
OCCUR D CLAIMS MADE
DEDUCTIBLE
RETENTION $
B WORKERS COMPENSATION AND
EMPLOYERS'LlABILlTY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
C45755150
03/30/09
03/30/10
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is additional insured as required by written contract.
CERTIFICATE HOLDER
CANCELLATION
EACH OCCURRENCE
DAMAGE TO RENTED
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COM PlOP AGG
Deductible
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
AUTO ONLY - EA ACCIDENT $
$
$
$
$
$
$
$
OTHER THAN
AUTO ONLY:
EACH OCCURRENCE
AGGREGATE
$1 000 000
$50 000
$5 000
$1 000000
$1 000 000
$1 000000
$1 000
$1,000,000
EA ACC
AGG
X
E.L. EACH ACCIDENT $1 000 000
E.L. DISEASE - EA EMPLOYEE $1 000 000
E.L. DISEASE - POLICY LIMIT $1 000 000
Monroe County Board of
County Commissioners
1100 Simonton Street
Key West, FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL --3Q..... DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2
#S1521348/M1471466
CSC02
@ ACORD CORPORATION 1988
IMPORT ANT
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
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 25-5 (2001/08) 2 of 2
#S1521348/M1471466