COI Expires 01/01/2019OP ID: NF
CERTIFICATE OF LIABILITY INSURANCE
DATE(MWODNYYY)
01/03118
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. 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 endorsemen s .
PRODUCER 305-294-6677
The Fullers, Inc 305-292-4641
1432 Kennedy Drive
Key West, FL 33040
Norman Fuller
ON TACT
NAME:
PHONE FAX
A,c Ext : ArC No
T_
PRODUCER
CUSTOMER ID,: HORNW-1
INSURERS AFFORDING COVERAGE
NAIC N
INSURED William P Horn Architect PA
INSURERA:Retail First Insurance Company
Bill Horn
915 Eaton St.
Key West, FL 33040
INSURER B :
INSURERC:
INSURER D
INSURER E :
INSURER F :
COVERAGES CERTIFICATE Nl1MRER- RFVICInN NI IMAFR-
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.
1�TR
TYPE OF INSURANCE
ADDL
UB
POLICY NUMBER
MM1DDmYY
MMIDDIYYYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
S
UAMAGF TO RENTED—
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL 8 ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
PRODUCTS- COMP/OP AGG
$
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea soddent)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
S
AGGREGATE
$
DEDUCTIBLE
RETENTION S
S
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? �Y
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
520-40146
01/01/18
01/01119
WC STATU- I X OTH-
ITO
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE -EA EMPLOYEE
$ 11000100
E.L. DISEASE • POLICY LIMIT
S 11000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more apace Is required) ^ BY P E Y GEMIENT
WAIVER /AYES._._
MONRCON
Monroe County
1100 Simonton Street
Key West, FL 33040
G C.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TOE POLICY PROVISIONS.
AUTHORIZED REPREI
Norman Fuller
0198811200(A AC04D CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of kCORq