Certificates of Insurance •
Client#: 5675 HORNWIL3
ACQRQ.. CERTIFICATE OF LIABILITY INSURANCE OATE(M o;z
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 CONTACT
NAME: _ ._. —.._ _ _
USUSuncoast Tampa PHO14E 813 289 -5200 { (aCt,o) 813 2894561
(MC, No, Ext):
P.O. Box 22668 ADDRESS: -
Tampa, FL 33622-2668 PRObt>MEiF
CUSTOMER ID A: ... - --
813 289 -5200 INSURERS) AFFORDING COVERAGE NAIC
INSURED INSURER A : XL Specialty Insurance Company 37885
William P. Horn, Architect, P.A. INSURERS:
915 Eaton Street INSURER C:
Key West, FL 33040 INSURER O : —
INSURER E : _
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE INDICATED. NOTWITHSTANDING O LISTED REQUIREMENNT, TERM ORCONDIT ABOVE
ION OF NY CONTRACTT OR OT ER DOCUMENTWITH RESPECT POLICY
ECT TO WHICH
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.
NNSR DL SUM rOLICY EFF 'n (MMIDDIYYYY) POLICY EXP LIMITS
).TR TYPE OF INSURANCE NSR WVD POLICY NUMBER MMIDDlYYY I `I
I OENERALUABILITY EACH N 4.
r '
COMMERCIAL GENERAL LIABILITY 1 PREMISES (Ea occurrence) ) --
CLAIMS -MADE I l OCCUR MED EXP (Any one person) S
I PERSONAL 8 AM INJURY $
— ` - { 1 GENERAL AGGREGATE ' $
i GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $
-� — PRO- I — $
POLICY PRO I LOC i
I AUTOMOBILE U ABILITY ^ COMBINED SINGLE LIMIT
1 (Ea accident) 1 S
ANY AUTO BODILY INJURY (Per person) I $
— ._.... ..... ..._. ._
ALL OWNED AUTOS j - . ' BODILY INJURY (Per acddent)
l ' •
• 1 $
SCHEDULED AUTOS i _ PROPERTY DAMAGE S
HIRED AUTOS ! �/ k `
, NON -OWNED AUTOS $ ,
UMBRELLA LIAB ! - EACH OCCURRENCE ' $
—
a OCCUR AGGREGATE '$
EXCESS UAB CLAIMS-MADE '—
, J DEDUCTIBLE —... _...._ —! $ ...__
1 RETENTION $ I $
WORKERS COMPENSATION WC STATU OTH
AND EMPLOYERS' LIABILITY ` — TORY 1 EMITS I FR
Y 1 N ;
•
I ANY PROPRIETOW EL. EACH ACCIDENT ! $ PARTNERJEXECUTIVEI II N/A '
OFFICER:MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $
' ESCRIPTION D OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
A I Professional DPS9702624 8/20/2012 08/20/2013 $1,000,000 per claim
;Liability ( $1,000,000 anni aggr.
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Professional Liability coverage is written on a claims -made and reported basis.
Project: Conch Key, Big Pine & North Key Largo Fire Stations
Annual Contract for Architectural Services
CERTIFICATE HOLDER CANCELLATION
Monroe County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Board of County Commissioners ACCORDANCE WITH THE POUCY PROVISIONS.
Attn: Risk Management 1100
Simonton AUTHORIZED REPRESENTATIVE
Key West, FL 33040 04 ' O-044. 4, --
i
01988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S39877X M398T67 AGB
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