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<br />AFRO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (NI
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />4"'
<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.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the 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 1- 305 -592 -6080
<br />Arthur J. Gallagher Risk Management Services, Inc.
<br />8333 NW 53rd Street
<br />Suite 600
<br />CONTACT
<br />NAME:
<br />PHONE pA7I
<br />AIC No.
<br />E -MAIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAICS
<br />Miami, FL 33166
<br />INSURERA: TRAVELERS PROP CAS CO OF AMER
<br />25674
<br />INSURED
<br />PAC COMM INC
<br />INSURERS: ARCH INS CO
<br />11150
<br />INSURERC: TRAVELERS PROP CAS INS CO
<br />36161
<br />SITEWORK & MARINE CONTRACTORS
<br />4226 SW 70 Court
<br />INSURERD: GREAT AMER INS CO
<br />16691
<br />INSURER E:
<br />CLAIMS-MADE Fi-J OCCUR
<br />MIAMI, FL 33155
<br />INSURER F: Signal Mutual Indemity Association Ltd.
<br />.... 'T - --- _____ _
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />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,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR ADDL SUER POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE POLICY NUMBER MM /DD/YY MM/OD/YYYY LIMITS
<br />A
<br />GENERALLIABILITY
<br />X
<br />ZOL 13S79892
<br />08/10/1
<br />08/10/15
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />X
<br />COMMERCIAL. GENERAL LIABILITY
<br />PREMISE ff E occurrence)
<br />$ 50,000
<br />CLAIMS-MADE Fi-J OCCUR
<br />MED EXP (Any one person)
<br />$ 5, 00 0
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENI AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS- COMP /OPAGG
<br />$ 2,000,000
<br />X POLICY PRO- F LOC
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />BA- SD274565
<br />08/10/14
<br />08/10/15
<br />COMBINED SINGLE LIMIT
<br />X
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident)
<br />$
<br />AUTOS AUTOS
<br />X
<br />HIRED AUTOS X NON•OWNED
<br />AUTOS
<br />PROPERTYDAMAGE
<br />Persocid t
<br />$
<br />X
<br />Hired PD
<br />$
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />ZOB 14S4453A
<br />08/10/1
<br />08/10/15
<br />EACH OCCURRENCE
<br />$4,000,000
<br />X
<br />EXCESSLIAB
<br />CLAIMS-MADE
<br />AGGREGATE
<br />$4,000,000
<br />DED I X I RETENTION $ 25, 000 7
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ZAWCI9876500
<br />03/03/1
<br />10/01/14
<br />X WCSTATU - OTH•
<br />TORY
<br />Y/ N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory yes, d be and
<br />If yes, describe under
<br />E.L. DISEASE - POLICYLIMIT $ 1,000,00°
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />Hull Protection &Indemnity
<br />ZUP 15P67491
<br />08/10/1
<br />08/10/15
<br />(1)Crew /Employee 1,000,000
<br />D
<br />Vessel Pollution
<br />OMH 1441628
<br />08/10/1
<br />08/10/15
<br />See Schedule
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />F)Workers Compensation (USL &H)- Signal Mutual Indemnity Assn - Policy# 48600- Effective 03/03/14 - 10/01/14
<br />Certificate holder shown as Additional Insured as respect General Liability & Auto, if required by written contract,
<br />and as granted by the Additional Insured endorsement on file with the carrier.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Sunny Isles Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Government Center ACCORDANCE WITH THE POLICY PROVISIONS.
<br />18070 Collins Avenue AUTHORIZED REPRESENTATIVE
<br />Sunny Isles Beach, FL 33160 V\_a
<br />I II3A
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />11%,%JKU ca t/u-IU/UO) rtle ACURD name and logo are registered marks of ACORD
<br />GABSAN
<br />41014605 E k
<br />'J' ri
<br />
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