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FORMS & ATTACHMENTS INSURANCE CERTIFICATE SO14B2B A ® CERTIFICATE OF LIABILITY INSURANCE GATE (MMIDDIYYYY) 2/25/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Commercial Lines Wells Fargo Insurance Services USA, Inc. NTA NAME. =. ut, 888 -572 -2412 a Na ,. E-DMAIL A DRE carts ®tdnel.com 6100 Fairview Road INSURERISJ .AFFORDING COVERAGE NAICN Charlotte, NC 28210 WSURERA: Indemnity Insurance Company of North America 43575 INSURED INSURERS: S Strategic Outsourcing, Inc. INSURER C : PERSONAL S ADV INJURY PO Box 241448 INSURER D S INSURER E: $ Charlotte, NC 28224 INSURER F: AUTOMOBILE COVERAGES CERTIFICATE NUMBER: 8786161 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE AD DL Us POLICY NUMBER POLICY EFP MMIO POLICY EXP MlDD LIMITS IA COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER POLICY FJ JEE 0 LOC OTHER. Suite 200 Fort Lauderdale FL 33309 1 EACH OCCURRENCE S Pq MI S s S MED EXP (Any — amen) S PERSONAL S ADV INJURY S GENERAL AGGREGATE S PRODUCTS- COMP /OP AGG $ 5 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NONZWNED HIRED AUTOS AUTOS MBINED SINGLE LIMIT Gent $ BODILY INJURY (Per perm) 5 BODILY INJURY (Per accident) 5 PROPERTY DAMAGE racatlaM $ S UMBRELLA LNB EXCESS LIAR HOCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ OED I I RETENTION 5 A WORKERS COMPENSATION AND ENPLOYERS•L1/1BRITY YIN N ANY PROPRIETOR/PARTNERIEXECUTE OFFICE EMBER EXCLUDED? �N (M datory- NH) Lf yyeas deeaiba uMer DE5CRIPTION OF OPERATIONS below NIA WLRC485E0349 03/07/2015 D3/0112�1E X S R O TH EL EACH ACCIDENT $ 1,000.000 E.L. DISEASE - EA EMPLOYE S 1.00D,000 EL DISEASE - POLICY LIMIT 5 1000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddiOanel R-0,, Schedule, may be atbct d It mare apace b mqul Tad) Workers' Compensation coverage Is limited to employees leased to ACAI Associates, Ina by Strategic Outsourcing, Inc. CERTIFICATE HOLDER CANCELLAIION ACAI Associates, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2937 W. Cypress Creek Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Suite 200 Fort Lauderdale FL 33309 1 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ®1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) RFQ No. 15 -04 -01 f ARCHITECTURAL DESIGN SERVICES FOR A NEW FACILITY AT 18080 COLLINS AVE. $