Annual Policy Total: $787.50

Retail Producer Indication No. 202463011
Total Amount Due: $727.50

Commercial General Liability Coverage
Classification: 63011 Dwellings 2-Family Tenant Occupied - Lessors Risk Only 
Premium Basis: 1 Location
Location Address: per submission

Limits of Insurance: 
$2,000,000 General Aggregate 
"INCLUDED" Prod/Completed Operations
$1,000,000 Personal and Advertising Injury 
$1,000,000 Each Occurrence
$100,000 Damage to Premises Rented to You 
$5,000 Medical Payments

$500 Deductible BI/PD

IMPORTANT: THE FOLLOWING ITEMS ARE REQUIRED TO REQUEST BINDING
BINDING REQUIREMENTS MUST BE COMPLETED SIGNED AND DATED

Requirements to Bind:
1. Satisfactory ACORD 125 126 Application
2. TRIA Disclosure Notice
3. Surplus Lines Disclosure Notice
4. Satisfactory Supplemental Application
5. Email Binding Requirements to quotes@firestoneagency.com

Satisfactory binding requirements must be received in our office prior to the desired effective date subject to the above terms and conditions. Backdating is NOT permitted. Terms are subject to no prior losses, acceptable underwriting information. Please review carefully and advise if any questions, concerns or changes desired. Copies of all forms and endorsements available. 

PAYMENT REQUIRED WITHIN 20 DAYS TO AVOID CANCELLATION
Coverage is not bound until confirmed by Firestone Agency of Florida, Inc.