HomeMy WebLinkAboutQuentin L. Hampton COL 3-29-16Client#: 1051678 QUENTLI
DATE (MMIDDIYYYY)
ACORD. CERTIFICAT E OF LIABILITY INSURANCE 03/29/20 6
. . ..........
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.
holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. It 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 Go CT
NAME:
USI Insurance Services, LIC PHONE _ . .. . .............. . ... . . . . . . . . . . . . ................................................
A'C
1715 N. Westshore Blvd. Suite 700 E-MAIL
Tann FUDRESS.
51SILRED
Quentin L. Hampton Associates, Inc,
PO Drawer 290247
4401 Eastport Pkwy
Port Orange, FL 32127-0247
INSURER(S) AFFORDING COVERAGE
NAIC #
. ..... . ....................................................... . I—- . ....... . ....... . . . ....
INSURER A � XL Specialty Insurance Company
... ....... .. . .............. . . . . . . .... . .. .. . ...................... . . . . . ......
-r..=-_N
7885
- ------------------ — ----------
INSURER B
!NSk!RER C e
----- --
INSURER D:
INSURER E
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS is 'ro CER'rIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED -NAWD—ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTI i0l DOCUMENT wrm RESPECT TO WHICH TI, IIS
CERTIFICATE MAY BE ISSUED OR MAY P01TAK THE INSURANCE AFFORDE15 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIWTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
�] CLAIMS -MADE D OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
I
J POLICY 0 PRO. JT LOC
OTI-IER:
AUTOMOBILE LIABILITY
LIMITS
EACI-I OCCURRENCE $
DAUMT-0 P ENTED
FREt
A_Ij `...VES
A
MED EXP (Any one person� $
-.r. ......... ...... .......... . . ................ —
PERSONAL & ADV INJURY S
GENERAL AGGREGATE
PRODUCTS
- COM11110P AC.'Ca
_i$
ANY AUTO
BODILYIKILIRY(Per imson) $
ALU. OWNED
SCFIEDULED
..... .. . ..... — '__ ' ___
130 DILY hUUIRY (Per accident) $
AUTOS
AUTOS
NON -OWNED
PROPERTY DAMAG
$
HIRIED AUTOS
AUTOS
�Paracdd -
.............. . .
$
UMBRELLA LIAR_JkJq
CUIR _EACIA OCCURRENCE Or
EXCESS LIAR rl A11-MAnF ArrPPrATP
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
Lola.0,.1 �#�
Professional Liability coverage is written on a claims -made basis.
El. DISEASE - POLICY LIMIT I
1 0000001 1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City ®} Cape Canaveral THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P. 0. Box 326 ACCORDANCE WITH THE POLICY PROVISIONS.
Cape Canaveral, FL 32920
AUTHORIZED REPRESENTATIVE
V—X�P "K 06—W- A011
0 1988-2014 .-.CO PO', .rights reserved.
ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S17531999/MI7531991 KEBEW