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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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CERTIFICATE OF LIABILITY INSURANCE <br />i f r♦' <br />DATE (MMIDDIYY <br />10/17/2022 <br />THIS -CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE <br />DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF <br />INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE <br />CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy lies) must have ADDITIONAL INSURED provisions or be endorsed. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate <br />does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT NAME: <br />rankCrum Insurance Agency, Inc. <br />FAX: (727)797-0704 <br />00 South Missouri Avenue <br />;Iearwater. FL 33756 <br />IkCrum L/CIF RDF Construction &Services Corp. <br />South Missouri Avenue <br />rwater, FL 33756 <br />rn�rconr_cc <br />277-1620 X 4800 <br />:-MAIL ADDRESS: <br />INSURERS(S) AFFORDING COVERAGE � NAIC# <br />INSURER A: Frank Winston Crum Insurance Company-[— <br />ompany 11600 <br />NSURER 8: <br />NSURER C: <br />NSURER D: <br />NSURER E: <br />NSURER F <br />CERTIFICATE NUMBER: 920967 <br />REVISION NUMBER: <br />vTHIS 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 />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CERTIFICATE HOLDER CANCELLATION <br />INSRADDL <br />LTR TYPE OF INSURANCE <br />INSRD <br />SUER <br />WVD <br />POLICY NUMBER <br />POLICYEFF <br />(MMIDDIYYYY) <br />POLICY EXP <br />(MM/DDIYYYY) <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURENCE <br />S <br />CLAIMS MADE ❑OCCUR <br />DAMAGE TO RENTED PREMISES (Ea <br />accurence) <br />S <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />POLICY❑PROJECT F7 LOC <br />PRODUCTS-COMP/OP AGG <br />S <br />OTHER <br />S <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE UNIT (Ea accident) <br />S <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />OWNED AUTOS SCHEDULED <br />BODILY INJURY (Per accident) <br />5 <br />ONLY AUTOS <br />HIRED AUTOS NON -OWNED <br />PROPERTY DAMAGE (Per accident) <br />S <br />ONLY AUTOS ONLY <br />$ <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURENCE <br />5 <br />EXCESS UAB <br />CLAIMS MADE <br />AGGREGATE <br />$ <br />S <br />DEO <br />I <br />RETENTION S <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />X <br />PER STATUE <br />OTHER <br />ANY PROPRIETOR/PARTNERIEXECUTIVE <br />E.L. EACH ACCIDENT <br />511000,000 <br />A <br />OFFICER/MEMBEREXCLUDED7 <br />(Mandatory In NH) <br />NIA <br />WC202200000 <br />01/01/2022 <br />01/01/2023 <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />If yes, describe under DESCRIPTION OF <br />OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />51,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Effective 02/28/2022, coverage is for 100% of the employees of FrankCrum leased to RDF Construction & Services Corp. (Client) for whom the client is reporting hours to <br />FrankCrum. Coverage is not extended to statutory employees. <br />JLD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />DRDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />CITY SUNNY ISLES BEACH / <br />18070 COLLINS AVENUE <br />SUNNY ISLES BEACH, FL 33160- <br />©1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />
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