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PANTHEON LLC 3 OF 5
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RFP No. 22-09-01 Restaurant Lease and Operations at 18050 Collins Ave
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PANTHEON LLC
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PANTHEON LLC 3 OF 5
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Last modified
10/20/2022 11:32:08 AM
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10/20/2022 11:31:54 AM
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DATE (MMIDD/YYYY) <br />AC RL> CERTIFICATE F LIABILITY INSURANCE 10/17/2022 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. III I III MCI III I III= <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsemensss <br />t s). <br />CONT <br />PRODUCER <br />NAMEACT Olga Chavez <br />PHONE Ext); (305) 228-1533 FAX No : (305) 228-1525 <br />Citinsurance Agency Corp <br />E-MAIL titins Cltl InS.COm <br />8390 West Hagler St Suite 213 ADDRESS: <br />INSURERS AFFORDING COVERAGE NAIC # <br />Miami FL 33144 INSURER A: WESTERN WORLD INS COM <br />INSURED INSURER B : <br />RDF CONSTRUCTION & SERVICES INSURER C: <br />5941 NW 193RD ST INSURER D: <br />HIALEAH FL 33015 INSURER F <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSRADDL SUBR POLICY EFF POLICY EXP LIMITS <br />LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MMIDDIYYYY <br />X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 ,000,000 <br />$ <br />DAMAGE TO RENTED 500,000 <br />CLAIMS -MADE OCCUR PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ 5,000 <br />A NPP1588089 02/03/2022 02/03/2023 PERSONAL & ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2100011000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />❑ PRO- El LOC $ <br />POLICY JECT <br />OTHER: COMBINED SINGLE LIMIT $ <br />AUTOMOBILE LIABILITY Ea accident <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />OWNED SCHEDULED BODILY INJURY (Per accident) $ <br />AUTOS ONLY AUTOS PROPERTY DAMAGE $ <br />HIRED NON -OWNED Per accident <br />AUTOS ONLY AUTOS ONLY $ <br />EACH OCCURRENCE $ <br />UMBRELLA LIAB OCCUR <br />AGGREGATE $ <br />EXCESS LIAB CLAIMS -MADE <br />$ <br />DED RETENTION $ PER OTH- <br />WORKERS COMPENSATION STATUTE ER _. <br />AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENTANY <br />$ <br />OFFICER/MEMBER EXCLUDED? PROPRIETOPJPARTNERIEXECUTIVE ❑ N I A <br />E.L. DISEASE - EA EMPLOYE $ <br />(Mandatory in NH) <br />If yes, describe under E.L. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />A NPP1588089 02/03/2022 02/03/2023 DEDUCTIBLE $500 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />GENERAL CONTRACTOR <br />�l MINE MINI IIII Will <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />CITY SUNNY ISLES BEACH 11 MEN MEN I <br />AUTHORIZED REPRESENTATIVE <br />18070 COLLINS AVENUE cz D <br />SUNNY ISLES BEACH FL 33160 <br />MEN © 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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