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�1 EBSAFOU-01 CHOUDHARYSS ACORD° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `...-/ • 1/21/2016 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). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis of Florida,Inc. PHONE FAX c/o 26 Century Blvd (A/c,No,Ext):1/877)945-7378 (NC,No): (888)467-2378 P.O.Box 305191 ADDRESS:certificates @willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Fire Insurance Company 23035 INSURED INSURER B:Employers Insurance Company of Wausau 21458 Ebsary Foundation Co. INSURER C:Starr Indemnity&Liability Company 38318 2154 Northwest North River Drive INSURER D:Illinois National Insurance Company 123817 Miami,FL 33125 INSURERE:AGCS Marine Insurance Company 122837 INSURER F: ( COVERAGES CERTIFICATE NUMBER: 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. . INSR I TYPE OF INSURANCE I INSD ISWVD I POLICY NUMBER I(MM/DDY/YYYY)I(MM/DD/YYYY)I LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 15 . 2,000,000 X TB2-Z51-021626-675 10/01/2015 10/01/2016 DAMAGE TO RENTED CLAIMS-MADE OCCUR X PREMISES(Ea occurrence) S 300,000 MED EXP(Any one person) 5 10,000 PERSONAL&ADV INJURY S 2,000,000 h GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 4,000,000 POLICY X JECOT X LOC PRODUCTS-COMP/OP AGG 5 2,000,000_ OTHER: 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I S 1,000,000 (Ea accident) B X ANY AUTO ASC-Z51-021626-665 10/01/2015 10/01/2016 BODILY INJURY(Per person) I S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS X HIRED AUTOS X PROPERTY DAMAGE 5 . NON-0WNED (Per accident) AUTOS IS X I UMBRELLA LIAB X OCCUR EACH OCCURRENCE 15 5,000,000 C I EXCESS LIAB CLAIMS-MADE 1000022116 10/01/2015 10/01/2016 AGGREGATE S 5,000,000 I DED RETENTIONS Prod/Comp Ops 5 5,000,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY x I STATUTE I I ERH Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVE WC 067712876 04/22/2015 04/22/2016 E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 E Contractors Equip. MXI93053882 10/01/2015 10/01/2016 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:North Bay Road Pedestrian Emergency Bridge Contract No.C1516-024. General Liability:Additional Insured and Waiver of Subrogation Provided Where Required by written contract. Coverage is Primary and Non-Contributory. Auto Liability:Additional Insured and Waiver of Subrogation Where Provided by written contract.Primary and Non-Contributory where required by written contract. Workers Compensation:Waiver of Subrogation Provided where required by written contract and as permitted by law. • SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The City of Sunny Isles Beach 18070 Collins Ave, o-tzt !Sunny Isles Beach,FL 33160 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD