COI Expires 04/01/2014 ACC)R0 CERTIFICATE OF LIABILITY INSURANCE 03/23/20
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 CONTACT
NAME;
L LLC PHONE 888 -553 -9002 FAX
Lockton Affinity, _ jAa' Nn Fxt)" (A/C. Net;
P.O. Box 410679 A
ADDDRDR
ESS:
Kansas City, MO 64141 INSURER(S) AFFORDING COVERAGE NAICM
INSURER q; Ace American Insurance Co. 22667
INSURED INSURER B :
Habitat for Humanity of Key West
and Lower Florida Keys, Inc. INSURERC:
PO Box 5873
INSURER D :
Key West, FL 33045
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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR VD POLICY NUMBER (MMIDD/YYYY) (MN/DO/WWI
A GENERAL LIABILITY X GL1064565 -13 04/01/2013 04/01/2014' EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1,0 0 0, 000
PREMISES (Ea occurrence) $
CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 0
PERSONAL & AOV INJURY _ $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
I POLICY I ,P 'j 8 LOC $ :
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
APPR V i B RI • AGEMENT (Ea accident) J U
ANY AUTO BY i A . BODILY INJURY (Per person) $
ALL OWNED SCHEDULED DA . 11:11/4,��v .. BODILY INJURY (Per accident) $
AUTOS AUTOS v- • - V `! -� s`^' ( ent )
NON -OWNED W • /A ,c, PROPERTY DAMAGE $
HIRED AUTOS _ AUTOS / CC. �1 I-, (Per accident)
$
UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS -MADE AGGREGATE $ _
DED RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY YIN TORY IIMITS ER
ANY PROPRIETORIPARTNER/EXECUTI
OFFICER /MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $
(Mandatory In NH) E.L. DISEASE - EA EMPLOYI
If yes, describe under
DESCRIPTION OF OPERATIONS below ' E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Certificate Holder is listed as Additional Insured as respects to Landlord
Location Address: 5530 3rd Ave., Stock Island, FL
CERTIFICATE HOLDER CANCELLATION
County Administrator
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Monroe County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS.
Key West, FL 33040
AUTHORIZ • REPRESENTATIVE
I AL.
198: 2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) / The ACORD name and logo are registered marks of ACORD
11138047 L' C,• ■1064565