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HomeMy WebLinkAboutInsurance CertificatesRX Date /Time 0511612013 09,29 P,002 From:Becky Scarfone FaxlD:ltaliano Insurance Page 2 of 2 Date:5/16/2013 10:28 AM Page:2 of 2 SEBAS4 OP ID: BS AIII` CERTIFICATE OF LIABILITY INSURANCE DATE 5116DIYYYY) 05!16!13 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 813 - 877 -7799 NAMEACT ITALIANO INSURANCE SERVICES 813.677 -8877 P. O. Box 18425 Tampa, FL 33679 -8425 Zachary Miller RHONE Ell: FAIL No: ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p INSURER A: Travelers 02974 INSURED Sebastian Airport Storage LLC dba About Storage 415 Live Oak Drive INSURER B: A INSURERC: X INSURER D: 6601574MG02 Vero Beach, FL 32963 INSURER E PREMISES oa -N PREMISEES S Eeoccurrence ) $ 100,000 INSURER F CLAIMS -MADE I OCCUR 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INS WVD POLICY NUMBER POLICY E F MMIDDIYYYY POLIC EX MMIDDIVYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 6601574MG02 01/25/13 01/25/14 PREMISES oa -N PREMISEES S Eeoccurrence ) $ 100,000 CLAIMS -MADE I OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP /OP AGG $ 2,000,000 POLICY j �7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)$ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION WC STAT U- OTH- TRY I AND EMPLOYERS' LIABILITY YIN T ER ANY PROPRIETOR /PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate Holder is included as Additional Insured - Fax: 772 - 581 -0149 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Sebastian ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Jean Tarbell 1225 Main Street AUTHORIZED REPRESENTATIVE Sebastian, FL 32958 ;� . ACORD 25 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RX Date /Time 01121/2013 01121/2013 09:40 Italiano Insurance 09,40 Italiano Insurance P,001 ffAX) P.0011001 SEBAS4 OP ID: BS CERTIFICATE OF LIABILITY INSURANCE D " 011/12211/13 /13 ' THIS CERTIFICATE 18 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polities may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder In lieu of such endorsement(s), PRODUCER 813 - 877 -779 P AO I NO INSURANCE SERVICES 813- 877 -8877 Tempo, FL 93679 -8426 Zachary Miller PHONE c No mss` INSUMR(S ) AFFORDINOCOVSRAGE NAIC0 INSURER A : Travelers 02974 INSURED Sebastian Airport Storage LLC dba About Storage 418 Live Oak Drive Vero Beach, FL 32983 INSURER B: INSURER C: INSURER D: INSURER a S 1,000,00 S 100,00 / 10,00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 18 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. INOR TYPB OP INSURANCE POLICY N MB MMID MMID T E LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 S 100,00 / 10,00 A X COMMERCIAL OENERAL LIABILITY CLAIMS-MADE 191 OCCUR X 68015741111111102 01126113 01125114 MHDEXP(Anyoneperson ) PERSONALSADvINJuRY $ 1,000,00 GENERALAGGREGATE 5 2,000,00 OEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS • COMPIOP A00 I 2,000,00 POLICY iFc LOG S AUTOMOBILE LIABILITY COMBINED $ dent BODILY INJURY (Per person) S ANY AUTO ALL AUTOS AUTOS A�SUIED BODILY INJURY (Per wddent) 6 ^! HIRED AUTOS ALOr(NOOS NED IF pSKIY I I UMBRELLA LUAB OCCUR EACH OCCURRENCE I AGGREGATE I EXCESS LIAR CLAIMS -MADE DIED I I RETENTION I $ WORKERS COMPENSATION WC STATU- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMSER EXCLUDED? ❑ MIA MIT ER El, EACH ACCIDENT I E.L. DISEASE -EA EMPLOYE $ (MandatMInNH) Q "S deeuibe under TIONB beitrN E.L. DISEASE • POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Adaeh ACORD 101, AddlUonal Ramar M Schedule, It room apace Is required) Certificate Holder is included as Additional Insured. Fax: 772 -881 -0149 CERTIFICATE HOLDER CANCELLATION ®1988.2010 ACORD CORPORATION, All rights reserved. ACORD 25 (2010108) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Sebastian ty Attn: Jean Tarbell THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 1225 Main Street Sebastian. FL 32988 AUTHORIZED REPRESENTATIVE ®1988.2010 ACORD CORPORATION, All rights reserved. ACORD 25 (2010108) The ACORD name and logo are registered marks of ACORD RX Date /Time 03/12/2012 15:52 P,001 From:Kathy McKinney FaxlD:ltaliano Insurance Page 1 of 1 Date:3/1212012 04:45 PM Page:1 of 1 OP ID: KM .4COR0" CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 03/12112 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 813 -877 -7799 ITALIANO INSURANCE SERVICES P. O. Box 18425 813- 877 -8877 Tampa, FL 33679-8425 Zachary Miller CONTACT PHONE FAX A/C No Ext : A/c No ADDRESS: PRODUCER SEBAS� CUSTOMERID#F INSURER(S) AFFORDING COVERAGE NAIC # INSURED Sebastian Airport Storage LLC dba About Storage 415 Live Oak Drive Vero Beach, FL 32963 INSURER A: Travelers 02974 INSURER B: INSURER C INSURER D EACH OCCURRENCE INSURER E: AMA I PREMISES Ea occurrence INSURER F A 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 LTR TYPE OF INSURANCE i AUTHORIZED REPRESENTATIVE POLICY NUMBER POLICY EFF MMIDO YYYY POLICY EXP MMADNVYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMA I PREMISES Ea occurrence $ 100,00 A X COMMERCIAL GENERAL LIABILITY X 6601574M602 01/25/12 01/25/13 CLAIMS -MADE 7 OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ee accident) $ ANY AUTO BODILY IN URY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS H IR ED AUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE I OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) 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 Included as Additional Insured. Fax: 772 - 581 -0149 CERTIFICATE HOLDER CANCELLATION ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Sebastian Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Jean Tarbell 1225 Main Street Sebastian, FL 32958 AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD co/RV® CERTIFICATE OF LIABILITY INSURANCE OP ID KM V E�06/16/10 PATE (MM/DDIYY 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 ITALIANO INSURANCE SERVICES P. 0. Box 18425 Tampa FL 33679 -8425 Phone:813 -877 -7799 Fax:813- 877 -8877 NAME: PHONE IFAX A/C, No, Ext : (AIC, No): ADDRESS: PRODUCER CUSTOMER ID #: SEBAS-4 INSURER(S) AFFORDING COVERAGE NAIC# INSURED Sebastian Airport Storage LLC dba About Storage 415 Live Oak Drive Vero Beach FL 32963 INSURERA: Travelers 02974 INSURER B: INSURER C : INSURER D EACH OCCURRENCE INSURER E: PREMISES (Ea occurrence) INSURER F: A 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM POLICY EFF /DD/YYYY) POLICY EXP ( MM /DD/YYYY) LIMITS Sebastian FL 32958 GENERAL LIABILITY EACH OCCURRENCE $ 1000000 PREMISES (Ea occurrence) $ 100,000 A X COMMERCIAL GENERAL LIABILITY KTK6601574M602- IND -10 01/25/10 01/25/11 CLAIMS -MADE a OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENT AGGREGATE LIMIT APPLIES PER'. PRODUCTS - COMP /OP AGG $ 2000000 $ X POLICYF_j PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (Per accident) $ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE[] OFFICER /MEMBER EXCLUDED? u /A WC STATU- TH- TORY LIMITS I I ER E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E . DISEASE - POLICY LIMIT $ F7- � 7 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is included as Additional Insured. Fax: 772 - 581 -9010 CERTIFICATE HOLDER CANCELLATION o ©1988 =2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Sebastian Donna Cyr AUTHORIZED REPRESENTATIVE 1225 Main Street Sebastian FL 32958 o ©1988 =2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD CHANGE EFFECTIVE DATE: 06 -16 -10 CHANGE ENDORSEMENT NUMBER: 0001 Aftk TRAVELERS J One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT Named Insured: ABOUT STORAGE, SEBASTIAN AIRPORT STORAGE LLC DBA Policy Number: KTK- 660- 1574M602- IND -10 Policy Effective Date: 01/25/10 Issue Date: 07/01/10 Premium $ 0 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY Effective from 06/16/10 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: ADDITIONAL INSURED - DESIGNATED PERSON /ORGANIZATION, CG D4 11 04 08, IS ADDED: CITY OF SEBASTIAN, DONNA CYR 1225 MAIN STREET SEBASTIAN, FL 32958 NAME AND ADDRESS OF AGENT OR BROKER: A J GALLAGHER RMS (BP905) PO BOX 3142 TULSA, OK 74119 IL TO 07 09 87 PAGE 1 OF 1 OFFICE: HOP SC HARTFORD COUNTERSIGNED BY: Aocset, Authorized Representative DATE: 07 -01 -10 TRAVELERS CHANGE EFFECTIVE DATE: 06 -16 -10 CHANGE ENDORSEMENT NUMBER: 0001 POLICY NUMBER: KTK- 660- 1574M602- IND -10 EFFECTIVE DATE: 01 -25 -10 ISSUE DATE: 07 -01 -10 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 07 09 87 CHANGE ENDORSEMENT IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS COMMERCIAL GENERAL LIABILITY CG D4 11 04 08 ADDL INSD -DESIG PERSON OR ORGANIZATION IL T8 01 10 93 PAGE: 1 OF 1 POLICY NUMBER: KTK- 660- 1574M602- IND -10 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 07 -01 -10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): CITY OF SEBASTIAN DONNA CYR 1225 MAIN STREET SEBASTIAN, FL 32958 Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage ", "personal injury" or "advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG D4 11 04 08 © 2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. CHANGE EFFECTIVE DATE: 06 -16 -10 CHANGE ENDORSEMENT NUMBER: 0001 OVERPRINT /CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: RTR- 660- 1574M602- IND -10 RATER: NM47 ISSUE DATE: 07/01/10 STORAGE FIRST PROGRAM EFFECTIVE DATE: 01/25/10 EXPIRATION DATE: 01/25/11 CHANGE EFFECTIVE DATE: 06/16/10 INSUREDS NAME: ABOUT STORAGE, SEBASTIAN AIRPORT STORAGE LLC DBA PRORATA FACTOR: 0.611 SHORT RATE FACTOR: 0.611 NEW /RENEWAL: R PAYMODE: P SOLICITOR CODE: AUDIT FREQUENCY: N SAI: 6543T7126 RESPONSIBILITY: R MSI: WATCH FILE: 0 RATING MODE: G SURVEY CODE: 2 SPECIAL CODE: REINSURANCE: N PROGRAM CODE: L25 AUTO FILINGS: FEDERAL TAX ID: PREMIUM SUMMARY ACCOUNT EFF. NON S.B. MONTH DATE PREMIUM PREMIUM TOTAL 0610 06/16/10 0.00 0.00 0.00 TOTAL: 0.00 0.00 0.00 OFFICE: HOP SC HARTFORD 02S PRODUCER NAME: A J GALLAGHER RMS BP905 TRAVELERS J� ACCOUNT EFFECTIVE MONTH DATE 0610 06/16/10 COMM ITEM .2500 PREM PREMIUM 0 CHANGE EFFECTIVE DATE: 06 -16 -10 CHANGE ENDORSEMENT NUMBER: 0001 PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: KTK- 660- 1574M602- IND -10 RATER: NM47 ISSUE DATE: 07/01/10 COMM ITEM PREMIUM COMM ITEM PREMIUM OFFICE: HOP SC HARTFORD 02S PRODUCER NAME: A J GALLAGHER RMS BP905 COMM ITEM PREMIUM