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PAGE 14 | RFQ 26-07-01; CITY OF SUNNY ISLES BEACH CONTINUING PROFESSIONAL ARCHITECTURAL AND ENGINEERING CONSULTING
<br />SERVICES (CCNA)
<br />TAB 1 - COMPANY INFORMATION
<br />| Proof of Insurance
<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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 endorsement(s).
<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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBRWVDADDLINSD
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
<br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
<br />SUCH POLICIES. *LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE
<br />HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED.*Not Applicable in WY
<br />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS belowIf yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2025/12)© 1988-2025 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIREDAUTOS ONLY
<br />8/3/2026
<br />Ames &Gough859WillardStreetSuite320QuincyMA02169
<br />617-328-6555 617-328-6555
<br />boston@amesgough.com
<br />Berkshire Hathaway Specialty Insurance Company 22276
<br />CHAHOLDING Phoenix Insurance Company A++,XV 25623CHAConsulting,Inc.III Winners CircleP.O.Box 5269AlbanyNY12205-0269
<br />Travelers Indemnity Company,A++,XV 25658
<br />Charter Oak Fire Insurance Company A++(XV)25615
<br />2039654214
<br />B X 1,000,000
<br />X 500,000
<br />15,000
<br />1,000,000
<br />2,000,000
<br />X X X
<br />Y Y 630-7E170386 8/1/2026 8/1/2027
<br />2,000,000
<br />B 1,000,000
<br />X
<br />X X
<br />Y 810-4S407410 8/1/2026 8/1/2027
<br />C X X 15,000,000CUP-4S539836 8/1/2026 8/1/2027
<br />15,000,000
<br />X 10,000
<br />D X
<br />N
<br />Y UB-4S429322 8/1/2026 8/1/2027
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />A Professional Liability&Pollution Y 47-EPP-308429-08 8/1/2026 8/1/2027 Per Claim LimitAggregateLimit $6,000,000$10,000,000
<br />If AI box is checked,GL Endorsement Form #CGD604,Auto AI #CAT499 to the extent provided therein applies and all coverages are in accordance with thepolicytermsandconditions.RE:Professional engineering and related professional services.City of Doral,Florida shall be included as additional insured with respects to General and AutoLiabilitywhererequiredbywrittencontract.General and Auto Liability is Primary and Non-contributory as required per written contract.A Waiver of Subrogationand30DayNoticeofCancellationisprovidedinaccordancewiththepolicytermsandconditions.Pollution Liability coverage is provided and included withintheProfessionalLiabilitypolicynotedabove.It shares the limits of the Professional Liability policy.
<br />City of Doral,FloridaATTN:Jacqueline Lorenzo,Procurement &Asset Management Director8401NW53TerraceDoralFL33166
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