Loading...
COI Expires 04/03/2018INSURANCE CAPITAL 5240 BABCOCK NE 102A PALM BAY, FL 32905 1-561-223-2199 Certificate of Insurance Certificate Holder ................................. Additional Insured MONROE COUNTY BD.CC 1100 SIMONTON S KEY WEST, FL 33040 Insured ................................ ROY K KHANNA 3117 CAROL AVENUE PALM SPRINGS, FL 33461 PR99REll/!/E� COMMERC/AL Policy number: 02121612-4 Underwritten by: PROGRESSIVE EXPRESS INS COMPANY March 16, 2017 Page 1 of 1 Agent ................................. INSURANCE CAPITAL 5240 BABCOCK NE 102A PALM BAY, FL 32905 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. ............................................................................................................................................................................. Policy Effective Date: Apr 3, 2017 Policy Expiration Date: Apr 3, 2018 Insurance coverage(s) Limits ............................................................................................................................................................................. BODILY INJURY/PROPERTY DAMAGE $100,000 COMBINED SINGLE LIMIT ................................................................................................................................................................. I ........... UNINSURED MOTORIST $10,000/$20,000 NON -STACKED ............................................................................................................................................................................. PERSONAL INJURY PROTECTION $10,000 W/$0 DED - NAMED INSURED ONLY Description of LocationNehicles/Special Items Scheduled autos only ............................................................................................................................................................................. 1996 INTL 470 1 HTSLAAM6TH274156 Stated Amount $9,000 COMPREHENSIVE $500 DED COLLISION $500 DED Certificate number 07517NET612 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. QB N VEU �AGIEIVIeNT Form 5241 (10/02) YTE WAIVER N — E royrkhanna@cs.com ACORff CERTIFICATE OF GARAGE INSURANCE `� DATE(MMIDD/YYYY) 03/16/2017 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 Insurance Capital Management LLC 5240 Babcock Street NE Suite 102A Palm Ray FI l2qn-ri CONTACT NAME; Deborah B Howard A124072 (PHONE C, N . 561-223-2199 F^X ac No): 561-429-2375 cm@y SS: icmllcl3@yahoo.com ADDRESS: ADDRE INSURERS AFFORDING COVERAGE NAIC # INSURERA: Catlin Specialty Insurance company 15989 INSURED Roy Khanna 3117 Carol Avenue Palm Springs FL 33461 INSURER B: Progressive Express Insurance Company INSURER C : INSURER D : INSURERE: INSURER F : COVERAGES PROD / CUSTOMER ID: CERTIFICATE 0• 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 LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MM/DD/YYYYl LIMITS AJ'� GARAGE LIABILITY HIRED AUTOS ONLY ANY AUTO NON -OWNED OWNED INUGARAGE D AUTOS ONLY BUSINESS X 0900704079 01/09/2017 01/09/2018 AUTO ONLY (Ea accident) $ 1,000,000- OTHERTHAN EAACCIDENT $ 1,000,000. Sealer Service Liability AUTO ONLY AGGREGATE $ 2,000,000- A GARAGE KEEPERS LIABILITY kLEGAL LIABILITY ECT BASIS 0900704079 01/09/201701/09/2018 COOTC P / LOC SPECIFIED LOC PERILS $ 180,000- $ 1/ COLLISION LOC $ 180,000, PRIMARY EXCESS LOC $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ SA� S AN r DATE S ' EMENT h ' �/ 7t-;` VVV GEN'L AGGREGATE LIMIT APPLIES PER: FIR OTHER: JECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? Y/N (Mandatory in NH) ❑ If yes, describe under N/A E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ REMARKS below B COMMERCIAL AUTO X 02121612-4 04/03/201604/03/2018 100,000 COMBINED BODILY INJURY/PROPERTY SINGLE LIMIT DMG. REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Monroe County Board of County Commissioners is listed as an additional insured as indicated above with an "x" CERTIFICATE Monroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Rick Management THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. Key West FL 33040 AUTHORIZED REPRESENTATIVE monique@monroecounty-fl.gov A124072d�� Fax 305-289-6061 Fax 305-292-4487 © 2010-2015 ACORD CORPORATION. All rights reserved ACORD 30 (2016103) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software. www.FormsBoss.com (c) Impressive Publishing 800.208-1977