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FACE PAGE <br />This page is the face of the policy referenced by number below and is a part of the policy. <br />Insured's Name: <br />Policy Number: Policy Dates: From: To: <br />Surplus Lines Agent's Name: Marcia Whisman <br />Surplus Lines Agent's Address: 120 E. Palmetto Park Road, Suite 300 <br />Boca Raton, FL 33432 <br />Surplus Lines Agent's License: # P134922 <br />Producing Agent's Name: <br />Producing Agent's Physical Address: <br />INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA <br />INSURANCE GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE <br />OBLIGAT <br />Policy Premium: Policy Fee: <br />Tax:Service Fee: <br />Surplus Lines Agent's Countersignature: <br />If this policy is a surplus lines, personal lines residential property policy then the following shall apply: <br />-PAY PROVISION THAT MAY RESULT <br />IN HIGH OUT-OF-POCKET <br />If this policy is a surplus lines, personal lines residential property policy which includes the peril of <br />windstorm then the following shall apply: <br />HURRICANE OR WIND LOSSES, WHICH MAY RESULT IN HIGH OUT- <br />OF- <br />Docusign Envelope ID: 9169D06A-D3E7-4D44-8D61-C1792E745D63Docusign Envelope ID: 3D542459-73B4-49E2-B3FC-2D9791862FDF