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4 <br />r <br />A O <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (uwnaivn} <br />8 /s /zo14 <br />THIS CERTIFICATEIS 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. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />INSOURCE /PHS <br />226159 P:(866) 467 -8730 F:(888) 443- 6112E1 <br />PO BOX 29611 <br />CHARLOTTE NC 28229 <br />CONTACT <br />NAME' <br />1— (866) (866) 467 -8730 <br />i �.): (888) 443 -6112 <br />ESS: <br />wwREWSIA FoPvm covERAGE NACA <br />I wsoRERA: Hartford Cascalty ins Co <br />=UtED <br />R E CHISHOLM ARCHITECTS, INC. <br />4921 SW 74TH CT <br />MIAMI FL 33155 <br />w91REi B: T.in City F1Ie IDs CO <br />WwftE4 C _ <br />wwR£RO: <br />wwRER E: <br />wSURER I: <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 />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I, \;SR <br />)1'PEOFI. \SERI,\TE <br />ADD/. <br />YBRR <br />KJLICI:\D.4B£R <br />POLICY£(F <br />NN M <br />FOLIC) "EXP <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />1, 000, 000 <br />CLAIMSJRADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES IEa octtrmxel <br />300 OOO <br />NED FAR ("one person) <br />1Q, QQQ <br />A <br />General _ -ab <br />21 SEA VJ1701 <br />06/24/2014 <br />066/24/2015 <br />I <br />PERSONAL d AW INIURY <br />1, QQQ, QQQ <br />AGGREGATE LIMIT APPLIES PER <br />GENL <br />GENERAL AGGREGATE <br />k2,000,000 <br />JECT POLICY O- ❑ LOC <br />PRODUCTS - COMPR)P AGG <br />�2, 000, 000 <br />OTHER: <br />AUTOMOBILE LIABILITY <br />(EaaaPesmSINGLE OMIT <br />�11 OQO1 QQQ <br />SODTY w1URY (Per.) <br />ANY AUTO <br />A <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />21 SBA VJi701 <br />06/2S/20i4 <br />06/24/2015 <br />BODRY w.luev (Peramderq <br />I_ <br />F <br />PROPERTY DAMAGE <br />(vm scmenq <br />I <br />X HIRED AUTOS X NO"-0 ED <br />AUTOS <br />kF <br />X <br />UMBRELLAUAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />k1, 000, 000 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />21 SBA VJ1701 <br />06/24/2014 <br />06/24/2015 <br />AGGREGATE <br />1,000,000 <br />of X RETEN:roM1T 10, 000 <br />xpR[fRSCVMFE\TI110\ <br />A\UE4KOY6CCLLn9lLT <br />ANY PROPRIETORIPMTNERIEXECUiNE YIN <br />X PER OTF- <br />STATUTE IN <br />E. L. EACH ACCIDENT <br />r1, QQQ, QQQ <br />B <br />OFFICERIMEMBER EXCLUDED' <br />IMAnearory In NN) ❑ <br />wA <br />76 WEG GC4i:01 <br />12/24/2013 <br />12/24/2014 <br />E.L. DISEASE-EA EMPLOYEE <br />r1, QQQ, QQQ <br />II yes, desmm uget <br />DESCRIPTION OF OPERATIONS xIOM <br />EL. DISEASE - POLICY LIMIT <br />I =1, QQQ, 000 <br />DESCIBPT)ON OF OPERAT IONS / LOCATIONS / VEHICLES (ACORD 101, Additional R &sSCMdu4, Ray be A=CA Jmen span is Uq, ) <br />Those usual to the Insured's Operations. <br />L <br />CERTIFICATE HOLDER CANCELLATION <br />V 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AIJFHORREDREPRESENTATIVE <br />'CITY OF SUNNY ISLES BEACH <br />18070 COLLINS AVE <br />SUNNY ISLES BEACH, FL 33160 <br />V 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />