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Certificates of Insurance Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/17/2019 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: Gallagher Charter Lakes ttAlC..No.Ext): 616-975-3500 (A/C,No):Fax616-975-0670 3940 Peninsular Drive SE Suite 100 E-MAIL ADDRESS: Grand Rapids, Ml 49546-6107 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:XL Specialty Insurance Company INSURED INSURER B: Pump Out USA INSURERC: 1150 Highway 83 North INSURERD: INSURER E Defuniak Springs FL 32433 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 ADDL SUER POLICY EFF POLICY EXPINK) W LIMITS LTR INK) POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A COMMERCIAL GENERAL LIABILITY UM00046315MA18A 12/18/201812/18/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1 00 000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 A POLICY JECT PRO LOC XLM00000217 12/18/201812/18/2019 PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:POLLUTION LIAB. POLLUTION $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY API VED Y ISKQ PNAGEMENT (Per accident) EY UMBRELLA LIAB OCCUR r1 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE DAM, f 'J[' - AGGREGATE $ DED RETENTION$ WAIVER N/@1Lm YES__ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ __ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under • DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) LIABILITY COVERAGE IS EXTENDED TO INCLUDE CREW LIABILITY(JONES ACT)AT A LIMIT OF$1,000,000 SUBJECT TO A$5,000 DEDUCTIBLE • CERTIFICATE HOLDER CANCELLATION Additional Insureds: Monroe County Board of Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1100 Simonton St., Rm 2268, Key West, FL 33040 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. State of Florida, Dept of EPA 3900 Commonwealth Blvd.Tallahassee, FL 32399 AUTHORIZED REPRESENTATIVE i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD -.--`-' /a(�[[�� ��aa/���p ry (�/�r� p p�Q q (�� p {per �a(� . IiCQ`L'�®® 6dL�U`ATFBYdlr� V ®F Lr�I16ri1t�OL�9 d tl O0F7��J91�/r1��b15 DATE(MNllOD1YYY1) C:(D 01/17/2019 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 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 dogs not confer rights to the certincete holder in lieu of such endorsement(s). PRODUCER CONTACT Charlie NAME Branch Branch Ins PE Branch o,Extl:q(14 2� _S g7 I FAX 12443 San Jose Blvd E-MAILDSS: (A/C,No): Jacksonville, Fl 32223 INSURER(S)AFFORDING COVERAGE I NAIC# INSURED INSURER A: Mercury Ins 103526 PumpOut USA INSURERS: • 1150 State Highway 83 INSURER C: I Defuniak Springs, Fl 32433 INSURER I INSURERR E: I COVERAGES INSURER F: I CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST HD 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 ADDL SUER LTR • TYPE OF INSURANCE I I I POLICY EFF POLICY EXP INSp INVp POLICY NUMBER (MM/DDIYYYY)I LIMITS I COMMERCIAL GF_NEr A , A.MUTY - (hRrWODfYYYYj EACH OCCURRENCE S — I CLAIMS PAADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) S MED EXP(Any one person) S PERSONAL 3 ADV INJURY $ GEN'L AGGREGATE UMIT APPLIES PER: IPOUCYI IJECT LOC GENERAL AGGREGATE S OTHER: PRODUCTS-COMP/OP AGG`S -S AUTOMOBILE LIABILITY - —'---' ---- — COIN61identI SINGLE LIMIT IX ANYAUTO (Ea accident) $ 1,000,000 A ALL OWNED i _-- BODILY tDIJAY(Per person) �S 1,000,000 AUTOS SCHEDULED , AUTOS A BA09000011766 02/28/18 02/28/19 BODILY INJURY(Per accident)I$ 1,000,000 ( HIRED AUTOS AUTOS PROPERTY DAMAGE s I,007,000 (Per accident) UPABRELLA LIAR I OCCUR PIP 10,000 EACH OCCURRENCE S EXCESS UAB 1CLAIMS-MADE WORIOERSED IOP.IENSA11ON RETENTION S 1 A RISK NAGF MEN' AGGREGATE $ S AND EMPLOYERS'LIABILITY y!N I s ATUTE I I OER +I ANY PROPRIETOR/PARTNER1EXECUTIVc !A S OFFICER/MEMBER EXCLUDED? i TI P A BYEL.F�.CH ACCIDENT S ( - (Mandatory in NH) i EL DISEASE-EA EMPLOYE S If yes,describe under DATE., DESCRIPTION OF OPERATIONS belowEL.DISEASE-POLICY UMIT I S WAIV11 Cam_ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton St Rm 2268 ACCORDANCE IN PBtfGY P P11JVf8I NS. // Key West, Fl 33040 AUTHORIZE REP!NTA -----____o ©1988.:2o- rACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Ac Rye CERTIFICATE OF LIABILITY INSURANCE loiion017 i 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(les) must be endorsed. it SUBROGATION IS WANED, 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). CONTACT Cho,% Branch PRODUCER NAME. ___ —— PHONE —.__--_-_— Branch & Branch ins g04288-8828 -- i P AIC No 12443 San Jose Blvd A_DDRESS`•.- Jacksonvlile, FI 32223 INSURERIS AFFORDING COVERAGE NAIC 1 ---------------------------- — --- -- LHsuRER A: Mercury ins Company i INSURED INSURERS: PumpOut USA MURERC- _-___ — 1150 State Highway 83 INSURER Defuntak Springs. F1 32433 _INSURERE:----_____ INSURER F: OC17rCIr1Sr MI ISIIRFR• IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TH)S INDICATED. NOTITH WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRESPECT TO W4i1Cii TV' CFRTtFICATE 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR ; TYPE OF RISURANCE 1 l 1 POLICY NUYBHr t y E� I POLICY EXP LUdtTS GENERALLMNLITY ( ( (EACH OCCURRENCE Is I j I ( IPREHtSESjEeow+rremxl i5 MERMAL GENERAL LIABILITY _-.__._—____ I CWMS•:.iAD'c L. OCCUR j LSD'r)CP IAny ooe person) S PE.RSONAL SAOV INJURY --yl s _ GENERAL AGGREGATE is GENL AGGREGATE LOAT APPLPcS PER: I PROt DUCTS. -C IOP AGG 5 - II I Policy F—i PRO I I LOC I JECT f + i AUToasoBlLE uABltm' I I I ems WGLE Llulr i s 1,00Q000 191 ANY AUTO _ j 02/2IV201 BODILY 14JURY (Pe, Peen) S 1.000,000 10 /28/20181somywuuRYpwmcidem)IS 1,000,000 utwe+ED SCHEDULED X j BA090000007967 F' f AUTOS `Y! AUTOS ! _ NON -OWNED 1 HIRED AUTOS }ram AUTOS RO DAMA i P PERrY�---` 1,000,000 UMBRELLA Lwe AGGREGATE _..I EXCESS LIAR i j CLAIMS-MADE,I--- ! ! i I s i DaO RETENTION S j wcsLivri ' orH TijY L IT woarEizscolPerlsATroN j f AND EVOLOVERS• LIABILITY YINt I ! ';ANY II E.L EACH ACCIDENT �S PROPRETORtPARINET— ECUUVE 'OFFiCERAIEDBER'cX0.UDEO? ❑jN/AJ i (6landatbry in NH) i EL OL4EncF - FA E14PLOYI—q 5__— I EL DISEASE -POLICY LAST i 5 e dtwyi. Indsr �r�ss : DES6 OF OPERATIONS Dabw DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ANach ACORD 101, AdGUrnai Remarks S&wdvla, N mme space is requqDA VED ENT R N/AY f Monroe County 1111 12th St. Ste 408 Key West, FI 33040 ACORD 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE.. THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY ?ROVIS1ONS. ®1488 2010 ACORD CORPORATION. All rights The ACORD name and logo are reglSterea marNs or sar. GL' I AlCC)R�® `./ CERTIFICATE OF LIABILITY INSURANCE DATE /1f7 10/3030/20172017 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(les) 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 Gallagher Charter Lakes 3455 East Paris Ave SE Grand Rapids, MI 49512 CONTACT NAME: P"�" ; 616-975-3500 FAX No): Fax616-975-0670 E-MAIL RESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: XL Specialty Insurance Company INSURED Pump Out USA 1150 Highway 83 North Defuniak Springs FL 32433 INSURER B INSURER C : INSURERD: INSURER E : INSURERF: 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MWDDY EFF POLICimima IPAY EXP p LIMITS A COMMERCIAL GENERAL LIABILITY UM00046315MA16A 12/18/201612/18/2017 EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR DAMAGE TO RENT10- PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 RPOLICY❑ JECT LOC XLM00000217 12/18/201612/18/2017 PRODUCTS - COMP/OP AGG $ 2,000,000 POLLUTION $ 1,000,000 OTHER: POLLUTION LIAB. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per. accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR 11 EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE BY DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE WAIVER YE6 STATUTE ERH E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) LIABILITY COVERAGE IS EXTENDED TO INCLUDE CREW LIABILITY (JONES ACT) AT A LIMIT OF $1,000,000 SUBJECT TO A $5,000 DEDUCTIBLE Additional Insureds: Monroe County Board of Commissioners 1100 Simonton St., Rm 2268, Key West, FL 33040 State of Florida, Dept of EPA 3900 Commonwealth Blvd. Tallahassee, FL 32399 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DATE (MWDDNYYY) A�coco CERTIFICATE OF LIABILITY INSURANCE 10/12/2016 THIS CERTIFICATE IS ISSUED AS AI ROF NEGATIVELYAMEND, EXTEN 1111::ORMATION ONLY D OR ALTER TIHE GHTS COVERAGE AFFORDED ABY THE POLIC EIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 ; an certainpoliciesSequfEre�an endorsathe (mentn A statemeust be nt on this ertificate dosed. if SUBROG es not ,confer rights ,to the the terms and conditions o policy, certificate holder In lieu of such endorsement s . CONTACT Certificate Team _ NAME: FAX 239-939-7172 PRODUCER PHONE , 239_939-1010 %centria, Inc. >091 Colonial Blvd. -MAIL .coifm@acentria.com :ort Myers FL 33966 NAtC III AFFORDING COVERAGE �9Ann1 PUMPOUT-01 INSURER 8 : INSURED INSURER C : i Pump Out USA, Inc. INSURER D : 1150 Hwy 83 North — De Funiak Springs FL 32433 INSURER E: INSURER F ICY PE COVERAGES ERTIFICATE NUMBER: 1729743615 REVISION NUMBER: THIS iS TO CERTIF NTHAT OTWITHSTANDING ANY ICIES OF REQUIREMENT, INSURANCE TERM I' CO TIONVOFBANY CONTEEN ERACTT OR OTHER DOCUMENT WITH RESPECT TOWHICH RIH S INDICATED. 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 REDUCEDFF PAID CDYEFFIEXP T LIMITS TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY ^! CLAIMS MADE 1l 1 OCCUR "EN'L AGGREGATE LIMIT APPLIES PER: - U LOC POLICY 0 PROJECT OTHER: AUTOMOBILE LIABILITY I ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED I HIRED AUTOS R AUTOS UMBRELLALIAB I OCCUR EXCESS LIAR CLAIMS DED RETENTION E 1p/WC3235896 10I12/2016 11011212017 A WORKERS COMPENSATION Y I f AND EMPLOYERS' LIABILITY Y ! N iANY PROPRIETORIPARTNERIEXECUTIVE N I A OFFICERIMEMBER EXCLUDED? ru-..a.�...v in NHI EXP (Any one TONAL 8 ADV S S �E • � E tEa accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident)' $ Per accident) IE _ EACH OCCURRENCE E E.L. red) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is requl Owners/Officers Excluded from Workers Compensation Benefits: Donald Brown THE WORKERS COMPENSATION INCLUDES A WAIVER OF SUBROGATION, FORM (WC000313) :ERTIFI;Air- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MONROE COUNTY BOARD OF COMMISSIONERS THE ACCORDANCEN DATE THEREOF, NOTIC IWITH THE POLICY PROVISIONSON DATE THEREOF, E WILL BE DELIVERED IN 1100 SIMONTEN STREET KEY WEST FL 33040 AUTHORIZED REPRESENTATIVE LL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD