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COI Expires 06/29/2018
ACCW �� CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDYYYY) 11/6/2017 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 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 - Isaksen Insurance, Inc 30346 Overseas Highway P.O. BOX 430534 Big Pine Key FL 33043 CONTACT Jason Kirkpatrick NAME: P lc No): (305) 872-1005 AHCrNo Ext : (305) 872-009.7 Fa E-MAILS:Jason@IsaksenInsurance.com ADDRES 1 NSURER(S) AFFORDING COVERAGE NAIC# INSURERA:United States Liability Insurance INSURED Jayne's Cleaning Service, Inc. 171 Aphenien day Tarpon Springs FL 34689 INSURER B : INSURERC: INSURERD: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:CL1571400572 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 SUER POLICY NUMBER MMI�DIYYYY XP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A CLAIMS -MADE X� OCCUR DAMAGE RENTED O PREMISESEa..urr nce $ 100,000 MED EXP (Any one person) $ 5,000 X CL1612146B 06/29/2017 6/29/2018 PERSONAL & ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 500,000 X POLICY ACT LOC PRODUCTS -COMP/OPAGG $ Included $ OTHER: AUTOMOBILE LIABILITY COMEaBINEDnt SINGLE LIMIT accide $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OVANED HIRED AUTOS AUTOS PROPERTY DAMAGE Peracddent $ UMBRELLA LAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N PER STATUTE ERH ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) f yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS [VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) V GEMENTO ATE WAIVE /A -( ;-�`'C� UhKIIHL:A11- HULUtK Lewinski—Monique@monroecou Monroe County BOCC Monique Lewinski 1100 Simonton St Key West, FL 33040 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 ohn Isaksen/BRANDY © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)