COI Expires 04/01/2018DATE (MMIDD/YYYY)
ACORL?® CERTIFICATE OF LIABILITY INSURANCE 03'01120"
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
INSURERS(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
DONTACT
Lockton Affinity, LLC
P.O. Box 873401
HONE
A/C No.Ext): 888-553-9002
AX
vc, No),
-MAIL
DDRESS:
Kansas City, MO 64187-3401
INSURER(S) AFFORDING COVERAGE
NAIC
NSURER-A: ACE American Insurance Co.
22667
INSURED
NSURER-B:
Habitat for Humanity of Key West and Lower Florida Keys, Inc.
PO Box 5873,
Key West, FL 33045
NSURER-C:
NSURER-D:
NSURER-E:
NSURER-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.
IN
SR
LT
R
TYPE OF INSURANCE
ADDL
INSR
SUB
R
NVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY)
POLICY EXP
MM/DD/YYYY)
LIMITS
A
GENERAL LIABILITY
IXCOMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
X
GL1064565-17
04/01/2017
04/01/2018
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 1,000,000
MED EXP (Any oneperson)
$ 0
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
EN'L AGGREGATE LIMIT APPLIES PER
X OLICY
PRODUCTS — COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE LIABILITY
NY AUTO
LL OWNED SCHEDULED
UTOS AUTOS
NON -OWNED
IRED AUTOS AUTOS
CMBI
Ea accc aeDtSINGLE LIMIT
$
BODILY INJURY Per Person
$
BODILY INJURY Per accident
$
PROPERTY DAMAGE
Per accident
$
XCESS LIAB
OCCUR
CLAIMS MADE
EACH OCCURRENCE
$
_IUMBRELLALIAB
AGGREGATE
$
EDI RETENTION $
ORKERS COMPENSATION
ND EMPLOYERS' LIABILITY
NY PROPRIETOR/PARTNER/EXECUTIVE Y/N
C STATU-
CRY LIMITS
TH-
R
FFICER/MEMBER EXCLUDED?
E.L. EACH ACCIDENT
$
MANDATORY IN NH)
f yes, describe under
E.L. DISEASE — EA EMPLOYEE
$
ESCRIPTION OF OPERATIONS below
E.L. DISEASE — POLICY LIMIT
$
ANP
V Y RI G
MEM
Certificate Holder is named Additional Insured as respects to Landlord. DATE a$ .
WAIVER N/ Y T CC
CERTIFICATE HOLDER 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
I AUTHORIZED REPRESENTATIVE I
Monroe County Board of Commissioners
1100 Simonton St.,
Key West, FL 33040
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
1064565