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WESTCON-04 LGLEASON
<br /> ACORO' DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 10/22/2015
<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 /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Lori
<br /> NAME: B. Gleason
<br /> Collinsworth,Alter,Lambert,LLC PHONE 561 776-9001 FAX
<br /> 23 Eganfuskee Street (NC,No,Ext):( (NC,No): (561 427-6730
<br /> Suite 102 E-MAIL
<br /> ADDRESS:
<br /> Jupiter,FL 33477
<br /> INSURER(S)AFFORDING COVERAGE NAIL#
<br /> INSURER A:Amerisure Insurance Co 19488
<br /> INSURED INSURER B:North River Insurance Company 21105
<br /> West Construction, Inc. INSURER C:Travelers Property&Casualty Co.of America 25674
<br /> 318 South Dixie Highway
<br /> Suite 4-5 INSURER D:
<br /> Lake Worth,FL 33460 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X X CPP20857740201 01/01/2015 01/01/2016 DAMAGE Io HEN IED ,
<br /> 100 000
<br /> PREMISES(Ea occurrence) $
<br /> X XCU&Contractual MED EXP(Any one person) $ 5,000
<br /> X Broad Form Prop.Dam PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X jE 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: S
<br /> AUTOMOBILE LIABILITY COMB
<br /> aBINEDit)INGLE LIMIT $ 1,000,000
<br /> (Ea A X ANY AUTO X X CA12999291801 01/01/2015 01/01/2016 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED • BODILY INJURY(Per accident) $ •
<br /> AUTOS AUTOS
<br /> X X =OWN ED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS (Per accident)
<br /> PIP Coverage $ 10,000
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> B EXCESS LIAB CLAIMS-MADE X X 5811038172 01/01/2015 01/01/2016 AGGREGATE $ 20,000,000
<br /> DED X RETENTION$ 0 $
<br /> WORKERS COMPENSATION x PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE YNN N/A X WC204157409 01/01/2015 01/01/2016 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> C Rented/Leased Equip. QT6609215L272TIL15 01/01/2015 01/01/2016 Limit 200,000
<br /> C Inland Marine QT6609215L272TIL15 01/01/2015 01/01/2016 Scheduled Equipment
<br /> r '
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> C1516-003-SAMSON OCEANFRONT PARK IMPROVEMENTS
<br /> The Certificate Holder is named as additional insured including products and completed operations for general liability per form CG7048,automobile liability,
<br /> and-umbrella liability when required by written contract. General Liability and Auto Liability are primary and non contributory when required by written
<br /> contract. Waiver of subrogation applies to general liability per CG7049,automobile liability,umbrella liability,and.workers'compensation when required by
<br /> written contract Umbrella extends over general liability,auto liability and employer's liability.Should any of the above described policies be cancelled,
<br /> notice will be delivered in accordance with the policy provisions.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Sunny Isles Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> tY Y :ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 18070 Collins Avenue
<br /> Sunny Isles Beach,FL 33160
<br /> AUTHORIZED REPRESENTATIVE
<br /> go,* B. 47ar,
<br /> I
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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