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RFQ No. 15-08-02 Construction Management at Risk for Government Center Annex at 18080 Collins Avenue 57 Ho l d e r I d e n t i f i e r : 77 7 7 7 7 7 7 0 7 0 7 0 7 0 0 0 7 7 7 6 1 6 1 6 0 4 5 5 7 1 1 1 0 7 6 7 7 1 6 0 1 6 2 0 4 4 5 7 2 0 74 5 3 1 3 7 6 6 2 5 1 6 3 0 0 0 7 3 6 4 1 5 7 7 1 4 7 3 2 1 1 2 0 7 7 6 4 5 0 4 0 6 1 2 7 5 5 5 7 0 74 7 7 1 5 0 3 7 3 6 6 5 5 1 2 0 7 5 6 2 7 2 3 4 2 2 4 7 7 3 3 1 0 7 0 4 2 2 2 3 5 7 2 1 2 3 7 6 2 0 76 1 5 1 1 1 7 4 1 3 7 6 4 0 3 0 7 6 7 2 7 2 4 2 0 3 5 7 7 2 0 0 0 7 7 7 7 7 7 7 0 7 0 0 0 7 0 7 0 0 7 77 7 7 7 7 7 7 0 7 0 7 0 7 0 0 0 7 3 5 2 5 6 7 7 1 1 5 4 5 6 0 0 0 7 3 3 1 1 1 4 0 7 5 2 3 1 1 6 5 0 76 6 4 4 1 5 1 7 0 6 7 4 5 6 0 0 7 6 2 4 4 1 0 4 3 0 2 6 3 1 3 3 0 7 0 2 2 2 3 7 3 5 2 1 7 2 0 1 1 0 70 3 3 3 2 7 2 4 2 0 6 3 1 0 0 0 7 1 2 2 3 2 6 2 4 3 0 7 3 1 1 1 0 7 0 2 2 3 2 7 3 4 2 0 7 3 1 1 1 0 70 3 3 2 2 7 2 5 3 1 6 2 0 0 0 0 7 7 7 5 6 1 6 3 3 5 1 7 6 5 5 4 0 7 7 7 7 7 7 7 0 7 0 0 0 7 0 7 0 0 7 Ce r t i f i c a t e N o : 57 0 0 5 9 3 6 8 2 6 9 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/17/2015 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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). 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. PRODUCER Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive Suite 1100 Miami FL 33131 USA PHONE(A/C. No. Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 16535Zurich American Ins CoINSURER A: 20699ACE Property & Casualty Insurance Co.INSURER B: 15989Catlin Specialty Insurance CompanyINSURER C: INSURER D: INSURER E: INSURER F: FAX(A/C. No.):(800) 363-0105 CONTACTNAME: Kaufman Lynn Construction 4850 T-Rex Avenue #300 Boca Raton FL 33431-4496 USA COVERAGES CERTIFICATE NUMBER:570059368269 REVISION NUMBER: 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X XX GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 $300,000 $10,000 $2,000,000 $4,000,000 $4,000,000 A 02/28/201502/28/2016GLO011159600 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) BODILY INJURY (Per accident) COMBINED SINGLE LIMIT (Ea accident) EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $25,000,000 $25,000,000 $25,000 02/28/2015 SIR applies per policy terms & conditions UMBRELLA LIABB 02/28/2016XOOG2763820A RETENTIONX X SIR E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH-ERPER STATUTEA02/28/201502/28/2016 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WC011159900 Professional LiabCPL751062021602/28/201502/28/2016 SIR applies per policy terms & conditions $5,000,000Pollution SIR $100,000 Cont Poll/ProfC $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: RFQ No. 15-08-02, Construction Management at Risk (CMAR) for Government Center Annex at 18080 Collins Avenue. The City of Sunny Isles Beach is included as Additional Insured in accordance with the policy provisions of the General Liability and Umbrella Liability policies. General Liability evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of the City of Sunny Isles Beach in accordance with the policy provisions of the General Liability policy. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Sunny Isles Beach Office of the City Clerk 18070 Collins Avenue Sunny Isles Beach, FL 33160 USA ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Forms & Attachments Section N