COI Expires 01/01/2020 ,..-''"441) OP ID:NF
At �'" CERTIFICATE OF LIABILITY INSURANCE DATE(AIId1DWYY)YY
12126118 ._
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 pollcy((es)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 endorsoment(s).
PRODUCER 305-294.6677 NAME:
The Fullers,Inc 305-292-4641 PHONE
mit,EAU lkik
Nor
1432 Kennedy Drive
Key West,FL 33040 ADCMPR HORNW-1
Norman Fuller cueTOMERIei.
INSURED William P Horn Architect PA INSURER(S)AFFORDINGCOVEtAGE NAME
First Insurance Company
Bill Ham INSURER 9:
915 Eaton St. H1suRERc:
Key West,FL 33040
INSURER 0
INSURER E:
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,
WSR ADG��SUER°_-' _ a r
p-TR I TYPE OF INSURANCE I1FISa l l'^l : POLICY NUMBER I{'pr,ww IL IDNYYy], uurTs
GENERAL L1AINl1TY EACH OCCURRENCE _ $
COMMERCIAL GENERAL LIABILITY 1' ? lF�[4GE�RLIRttt
_
j r — I PREMISES(tn o .i?i..._ $
CLAIMS MADE Li OCCUR i NED EXP(Any an ee'aon) S
:_--I PERSONAL&ADV INJURY {3
I I I
L-- } GENERAL AGGREGATE g S
GEML AGGREGATE� PROS 1- LIMIT APPLIES PER PRODUCTS-COMP/OP AGG i
I POLICY? ( I LOG - S
AUTOMOBILE LIABILITY 3 I COMBINED SINGLE LIMIT $
f(Ea soOdeM)
ANY Aura R 6q,RISK I BODLY INJURY{Pr person) 3
ALL OWNED AUTOS ®Y r P. .
BODILY INJURY(Per accident} S ���
)_�SCHEDULED AUTOS PROPERTY DAMAGE
[I i HIRED AUTOS DA •`' (Pr acddenl) r
I
1 NON-OWNED AUTOS Oe�p-- rWAIVEq1
9
UMBREI LA LIAR i OCCUR I EACH OCCURRENCE S
EXCESS UA9 i i CLAIMS AAADE ' AGGREGATE $
E____
DEDUCTIBLE
S
RETENTION S -.� f $
WORKERS COMPENSATION 8_ STATU- X l OTH-
AND EMPLOYERS'UAEILTTY S2iY Ll4U1$ f _
A CFYICERAdEM EREXRCLUDED?EC VE Y�Y NIA �20-40146 01I01119 01/01/20 EL EACH ACCIDENT I r 1,000,000
(Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE]$ 1,000,000 •
Myyea,descibo under ..- x.
DESCRIPTION OF OPERATIONS below I - EL DISEASE-POLICY LIMIT{i 1,000,000
C I I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddMlonai Remarta echadua,it mon spies I.required)
CERTIFICATE HOLDER CANCELLATION
MONBOCC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Monroe County BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN
ACCORDANCE WITH THE POLICY PRO SIONS.
Risk Management
1100 Simonton SL AUTHORISED REPRESENTA •
Key West,FL 33040 Norman Fuller
I
®19 - 9 A :-D CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks AC•r•D