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III
<br /> INSURANCE CERTIFICATE ` ',TAB 1r' "
<br /> , ,}
<br /> /-1 WESTCON-04 LGLEASON
<br /> ASR° CERTIFICATE OF LIABILITY INSURANCE 1 °"�° a
<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),AUTHORED
<br /> REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. i
<br /> IMPORTANT: If the certificate holder Is an ADDmONAL INSURED,the poficyfes)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 certtcate does not confer rights to the
<br /> certificate holder In lieu of such endorsement(s). i
<br /> FRODUm' ME." Lori B. Gleason I
<br /> Collinsworth,ln eSte Alter,Lambert,LLC �^n"E j561)776-9001 I j i"e,re1(561)4274730
<br /> Suite 102 ware.,IgleasonecallIc.com I
<br /> Jupiter,FL 33477
<br /> etsuatuirsi ANOROSC C0TfPAGE I SAC•
<br /> Nvmmsee:Amerlsure Insurance Co I 115488
<br /> INSURED INSURER a:North River Insurance Company 121105
<br /> West Construction,Inc. NSVREI C: 1
<br /> 318 South Dixie Highway I
<br /> Suite 44
<br /> INSURER°i
<br /> Lake Worth,FL 33460 INSURER 5: I
<br /> INSURER F: I 1
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE P000ES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO TIE INSURED NAMEDABOVE FOR TIE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONOIPON OF ANY OOP/TRACT OR OTHER DOCUMENT WOE RESPECT TO WHOI TMS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.TIE INSURANCE AFFORDED BY Tit POLICIES DESCRIBED IEREINIS SLEJECT TO ALL TIE TERMS.
<br /> �N[EpX�CLUSIONS MID COMMONS OF SUCH POLICIES.LUATS SHDWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS.
<br /> M TYPE OF INSURANCE Ins:1 l wR) racY KLOMER IoWxylEFWI InP n1 , LUSTS
<br /> A I wrana.sCORRAL I1ABEm I EACH cs s 1,000,000
<br /> I rru..cuAnr IT OCCUR CPP2085]]41310015 01101/2015 0110112016 '..'' oRm,m
<br /> X xcuacontmmm ��cE �-el 1
<br /> 100,000
<br /> X Broad Form Prop.Dam �� ��, 1 000,000
<br /> IERS]nAia wvvum s 1,
<br /> Gan AGGEGAIE UNIT APRIES LER GENERAL/GGREGATE f 2,000,000
<br /> NUCY©sr, Fl toe PRODICTS-COPOPAGG 1 2,000,000
<br /> ere I f
<br /> I AUrOrtlenrusatu Y I I6 oSttO Lr4lE War s 1,000,000 CO
<br /> A X •AN—Y Aura ri ED
<br /> 11:109)AUTOS AUTOS
<br /> ' ED
<br /> A UTOS CA12899281101 011012015 01101/2016 stay ewer Es.m
<br /> mV f
<br /> BO.lY etaAYpV=OWN a
<br /> i tt39fAO3iA0E
<br /> (Pei asks)
<br /> PIP Coverage f
<br /> 1 10,000
<br /> X UMBRELLA USD X OCCUR EAOIC a r s 10,000,000
<br /> B D r 0<s s we H0 nor vmvI 5311024627 01101/2015 011/1/2016 As Rf3r*1E f 20,0013,000
<br /> I am I x'Pt-romans 0I I i s
<br /> BOWERS CONWEJGATON I x I PEN •E I I Wµ
<br /> Ian EIVLOYE61MBa1TY
<br /> A ANYPRpNIETCRFARnNEReECVRJE YF'-"N WC204157408 0110112015 01/01/2016 ELEAPI/LTmen s 1,000,009
<br /> ORi(FFMEIIER EIKLUDEEI I I�H I A
<br /> IlleedmrY N tau ELD A9<-1A EWWrE S 1,000,000
<br /> CEECNPIC*I OF OERsno.a beb. ( I EL f14A¢-PCUCY lam is 1.000,000
<br /> A 'Rented/Leased Equip. I i T8685215L272TILI4 01/0112015 01/0112011 Limit I 200,000
<br /> A Inland Marine 0T660S215L272TIL14 01101/2015 01/01/2016 IIIScheduled Equipment
<br /> ▪ TON OF OPERATIONS/LOCATIONS rVERl6(AEONS 101,M01 Rmarta Scesd .may be seabed a am Nam Y nom f) I
<br /> The Certificate Holder is named as edditlonat Insured i ncisedbq products and mmpletad operations for general liability per loins CG7046,automobile Dab0lty,
<br /> and umbrella liability when required by written contract General Li biltty and Auto Liability as primary and non contributory when required by written
<br /> contract Waiver of subrogation applies to general liability per CG7049,automobile lability,umbrella liabIlity,and workers'.compensation when required by
<br /> written contract Umbrella extends over general liability,auto Debility and employer's liability.Should any of the above descried policies be cancelled,
<br /> notice will be delivered In emrdance with the policy provisions.
<br /> •
<br /> CERTIFICATE HOLDER CANCELLATION .
<br /> SHOULD ANY OF THE ABOVE DESGRIBEO POIJGES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W
<br /> FOR PROPOSAL PURPOSES ACCORDANCE WITH THE POLICY PROT/MONS.
<br /> i
<br /> gCRIZED REI£4MATNE j
<br /> am: B.sS.Ewl
<br /> 0 19 58-2 014 ACORD CORPORATION. AD rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I
<br /> CI
<br /> • SAMSON OCEANFRONT PARK IMPROVEMENTS / BID NO. 15-05-01
<br /> CITY OF SUNNY ISLES BEACH
<br />
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