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Home My WebLink AboutCopy of Insurance per Resolution 08-147ld%Su1c 1111 COMMON POLICY DECLARATIONS CLS1340200 Policy Number SCOTTSDALE INSURANCE COMPANiI® CLS1451473 Renewal of Number Home Office: One Nationwide Plaza - Columbus, Ohio 43215 Administrative Office: 8877 North Gainey Center Drive • Scottsdale, Arizona 85258 1-NO-423-7675 A STOCK COMPANY ITEM 1. Named Insured and Mailing Address KEYS WI-FI INC 104 PALMETTO AVENUE Insured Producer Andrew Brown TAVERNIER, FL 33070 Code:109792 BROWN INSURANCE & FINANCIAL 2520 WEST BAY DRIVE Agent Name and Address LARGO, FL 33770 Richard.F. Hull HULL & COMPANY, INC. P.O. BOX 20027 ST. PETERSBURG, FL 33742 Agent No.: 09003 Program No,: None ITEM 2. Policy Period From: February 28, 2008 To: February 28, 2009 Tenn: 1 year 1 day 1201 A.M., Standard Time at your mallIng address. Business Description: Vacant Land In return for the payment of the premium, and subject to all the terns of this policy, we agree with you to provide the insurance as stated in this policy_ This policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown, there is no coverage_ This premium may be subject to adjustment. Coverage Part(s) Premium Commercial General Liability Coverage Part S 1,000.00 Commercial Property Coverage Part Flat Cancellation S Not Covered Commercial Crime Coverage Part Not Permitted S Not Covered Commercial Inland Marine Coverage Part S Not Covered Commercial Auto (Business Auto or Truckers) Coverage Part $ Not covered Commercial Garage Coverage Part S Not Covered Professional Liability Coverage Part $ Not Covered S S Premium S 1.000.00 Policy Fee $ 35.00 u S S J�/ ✓ Surplus Lines Tex 5% FSLSO •Service Fee % $ S 51.75 1.04 �i .1 1 FHCF Fee 1% $ 10.35 Z' O S y/ Total Policy Premium S 1.098.14 Form(s) and Endorsement(s) made a part of this policy at time of issue: See Attached Schedule of Endorsements ST, PETERSBURG, FL 302WO KMtmsh This insurance, is issued pursuant to the Florida surplus tines law. Persons insured by surplus lines carriers do not have the protection of the Florida insurance guaranty act to the extent of any right of recovery for the obligation of an Insolvent unlicensed Insurer. THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S), TOGETHER WITH THE COMMON POLICY CONDITIONS. COVERAGE PART(S), COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY. OPS-D•l (124)0) COMPLETE THE ABOVE NUMBERED POLICY S=SDALE INSURANCE COMPANYm Home Office: One Nationwide Plaza • Columbus, Ohio 43215 Administrative Office: 8877 North Gainey Center Drive • Scottsdale, Arizona 85258 1.80D-423-7675 A STOCK COMPANY In Witness Whereof, the Company has caused this policy to be executed and attested. Secretary President The information contained herein replaces any similar information contained elsewhere in the policy. UT"OVPG.(9-07) SCOTTSDALE INSURANCE COMPANY 4D COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS These Supplemental Declarations form apart of policy number CLS1451473 LIMITS OF INSURANCE General Aggregate Limit (other than Products/Completed Operations) S 2,000,000,00 Products/Completed Operations Aggregate Limit S Excluded Personal and Advertising Injury Limit S 1,000,000.00 any one person or Each Occurrence Limit S 1,000,000.00 organization Damage to Premises Rented to You Limit $ 100,000.00 any one premises Medical Expense Limit S 5,000.00 any one person DESCRIPTIONO F^BUSINESS Form of business: Corporation Business Description: Vacant Land Location of all premises you own, rent or occupy: Sea Form CL170 CLASSIFICATION AND PREMIUM Classification Code No. •Premium Basis Pr/Ops Rate Prod/Comp Advance Premium Pr1Ops Prod/Comp O s O s See Form CL 170 $ S FORMS AND ENDORSEMENTS (other than applicable forms and endorsements shown elsewhere In the policy) Forms and endorsements applying to this Coverage Part and made part of this policy at time of issue: See Attached Schedule of Endorsements •(a) Area, (c) Total Cost, (m) Admission, (p) Payroll, (s) Gross Sales, (u) Units, (o) Other THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIALLIABILITY DECLARATIONS, TOGETHER WITH THE COMMON POLICYCONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THEABOVE NUMBERED POLICY. CLS-SQ l (&Oil COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS Policy Number CLS1451473 LOCATION'OF'PREMISES Location of All Premises You Own, Rent or Occupy; 06950 Won Rd, Pon St Lucie, FL 34987 2) 9901 Range lint, Rd, Pon St Lucie. FL34987 1�r 3) 12003 Martn Hwy, Martin County, Palm Clty. FL. 34990 4) 951 Marsh Ave, Ft Myars, FL 33905 PREMIUM Classification Code. No, Premium Rate Advance Premium Basis Prem[Op PriCo PremfD Pr/Co Vacant Land, 49451 T) 1 5.4500 Excluded 175.00MP Exciuded Vacant Land. 49451 T)1 5.4500 Excluded 175.00MP Excluded Vacant Lund. 49451 T)1 6AS00 Excluded 475.00MP Excluded Vacant Land.. 49,151 T) 1 5AS00 Excluded 17S.00LIP Excluded Extension of Declarations —Total Advance Premium S 1,000,00 Minimum and Deposit CL 170 (6,93)