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N. FORMS AND ATTACHMENTS TheACORDnameandlogoareregisteredmarksofACORD CERTIFICATE HOLDER ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES(Eaoccurrence)$DAMAGE TO RENTED EACHOCCURRENCE$ MEDEXP(Anyoneperson)$ PERSONAL&ADVINJURY$ GENERAL AGGREGATE$ PRODUCTS - COMP/OP AGG$ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE$ EACHOCCURRENCE$UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L.EACHACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE Ifyes,describeunder DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALLOWNEDSCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILYINJURY(Perperson) BODILYINJURY(Peraccident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Eaaccident) (Peraccident) OTHER: 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 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). COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC# INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S)AFFORDINGCOVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) 9/21/2015 Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. O. Box 1927 Pompano BeachFL33061 Holly Buzen (954)943-5050 (954)942-6310 holly@furmaninsurance.com Emerald Construction Corp. 1211 Stirling Road #105/#106 DaniaFL33004 Evanston Insurance Company35378 Ohio Security Insurance Company24082 Bridgefield Employers Ins Co 10701 15-16 Liability W/out A X X X X 3C064966/12/20156/12/2016 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 B X XX BAS(16)56223080 8/11/20158/11/2016 1,000,000 Personal Injury Protection 10,000 A X X MKLV20LE1018786/12/15 6/12/16 5,000,000 5,000,000 C N 830-535674/15/154/15/16 X 1,000,000 1,000,000 1,000,000 City of Sunny Isles Beach is an Additional Insured for General Liability as required by written contract. Dirk DeJong/HB City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160