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<br /> =CITY4K. F:S, FANNY ISLES BEACH
<br /> itilSIECT,ION ®NT1C0MPArN,Y,IN)F,ORMATION � � ,
<br /> tai 1i4Jn''"amP'Sar _. -abEfad" '41 VA'.',L /e oue,E w &,. e9ao"lm .uu, , .l„ �..x l...f�. ,Tiller" . Tr ,. , y,,,.. . i ..r,r.S1;4dWa
<br /> ACO g CERTIFICATE OF LIABILITY INSURANCE OA'E"M"DYVYY1
<br /> lia../ 12/1/2011
<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. M 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 CONTAEI
<br /> Seltlin NAME:
<br /> 5700 North Andrews Avenue, Suite 300 (AEC.No Fill' (954) 938-8788 ZINC.No):(554) 93e-8566 •
<br /> E•NAI_
<br /> Port Lauderdale FL 33309 AODRRas:
<br /> INSURER(S)AFFORDING COVERAGE HAIOP
<br /> INSURER A:Zurich American Ins Co of IL 27855
<br /> INSURED INSURER a:Lloyd'a Underwriters at London
<br /> Keith and Scenero, P. A.
<br /> INSURER C:Travelers Indemnity CO of CT 25582
<br /> 6500 North Andrews Avenue INSURER O:Charter Oak Fire Ins Co 125615
<br /> Fort Lauderdale FL 33309 INSURER E:St. Paul Fire & Marine Ina, Co. 124767
<br /> INSURER F: I
<br /> COVERAGES CERTIFICATE NUMBER:Cert ID 30770 REVISION NUMBER: .1.
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE 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 /> eaR1 TYPE OF INSURANCE IABbLISUSR; IPOLICY EFF PODGY EXP
<br /> IINSRIW'OI POLICY NUMBER •INMiObn'YYTII(NMIUDNYYYI LIMOS
<br /> 1 GENERAL LIABILITY I I EACH OCCURRENCE $ 1,000,000
<br /> I
<br /> BAMAGE TO RENTED I
<br /> C 1 X COMMERCIAL GENERAL�LIABILITY P660-19315294-CCT-11 8/14/2011 10/14/1012 'PREMISES(Ea occurrence, I5 300,00E
<br /> 1 CLAIMS-MADE % I OCCUR 1 I MED EXP(Any one perem) 5 10,000
<br /> It
<br /> ' Contractual Liah. I PERSDNAL&ADV INJURY I5 1,000,D00
<br /> Ix
<br /> ICU, Broad Porm PD
<br /> GENERAL AGGREGATE IS 2,000,000
<br /> i GENLAGGREGATE LIMITAPPLIES PER: 1PRODUCTS-COMP/CPASS I S 2,000,000
<br /> I X I POLICY I 1 jRQr—I LOC ) 15
<br /> I AUTOMOBILE LIABILITY ) I I I COMBINED SINGLE LIMIT
<br /> 118aooNdenll S 1,000,000
<br /> D XANY AUTO I P910-290K0594-COP-11 e/14/201118/14/20121 BODILYINJURY(Pereerson) $
<br /> ALL I AUTOS OWNED
<br /> —I AUTOSUUEC am
<br /> :merit)!INJURY(Per eUeN)I 5
<br /> HIRED AUTOS
<br /> AUTOS _ PROPERTY I5
<br /> I I I5
<br /> E Y I UMBRELLA UAe l Ili OCCUR CA0E804589 0/14/201118/14/2012 I EACH OCCURRENCE I5 5,000,000
<br /> 1 EXCESS one IEGATE S 5,000,OOD
<br /> 1
<br /> I CIAIMSMADE AGGR
<br /> I DED 1 I RETENTIONS I 1 1 I S
<br /> WORKERS COMPENSATION1 WC STAT.)' 1 101H-1
<br /> A AND EMPLOYERS'LIABILITY YIN 9598999 12/1/2011112/1/2012111 TORYLMITS• • ER
<br /> I ANY PROPRIETOR/PARTNER/EXECUTIVE F� - I I EA.EACH ACCIDENT I S 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? INI A'
<br /> I WendMery N NH) I I EL DISEASE'EA EMPLOYEE 5 1,D00,000
<br /> Pyy O oe[mbe YnI,,
<br /> DESCRIPTION OF OPERATIONS below I EL.DISEASE-POLICY LIMIT!5 1,000,000
<br /> B 1 Maritime Employers Limn. I I 1 F12M1M697-3051-11 13/1/3011 112/1/2012 1A1ynone accident or$ 1,000,000
<br /> $
<br /> PROOF OF OF OPERATIONS/ONLY.LOCATIONS,VEHICLES (ANOI ACORD 101,Aedrom[I Reme1Y[BM[duM,tlmory apace a nqulr[d)
<br /> PROOF OF INSURANCE ONLY.
<br /> 0
<br /> CERTIFICATE HOLDER CANCELLATION 0
<br /> SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION PATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> KEITH AND SCENARS, P.A.
<br /> 6500 N. ANDREWS AVE AUTHORIZED REPREEENTATNE 0
<br /> FORT LAUDERDALE FL 33309 `a ^ C^'--'I' f4,`
<br /> ®1985.2010 ACORD CORPORATION. All rights reserved, '4®r
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br /> 0
<br /> I�]`\IY KEITH and SCHNARS,P.A. ._„ •-awrwunw.muwan _
<br /> r FLORIDnsgi�;LOCALFlw`A ...'. PAGE 4 ,,, , . „�n. „e•� „�, „�,..�. RFQI2-04-02 t
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