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SURPLUS LINES DISCLOSURE <br />At my direction, Starbright Insurance Agency Corp has placed my coverage in the <br />surplus lines market. <br />As required by Florida Statute 626.916, 1 have agreed to this placement. I <br />understand that superior coverage may be available in the <br />admitted market and at a lesser cost and that persons insured by surplus lines <br />carriers are not protected by the Florida Insurance Guaranty Association with <br />respect to any right of recovery for the obligation of an insolvent unlicensed <br />insurer. <br />I further understand that policy forms, conditions, premiums and deductible <br />used by surplus lines insurers may be different from those found in policies <br />used in the admitted market. I have been advised to carefully read the entire policy. <br />NUNEZ CONSTRUCTION, INC <br />Named Insured <br />BY: <br />Signature of Named Insured Date <br />Print Name and Title of person signing <br />Name of Excess and Surplus Lines Carrier <br />General Liability - Commercial <br />Type of Insurance <br />7/1/2024 <br />Effective Date of Coverage <br />01/01/20221 Florida Surplus Lines Service Office <br />