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<br /> ACORD, CERTIFICATE OF LIABILITY INSURANCE DATEPJMIDDM(WI
<br /> 4.4.....------.4.4.....------. o
<br /> . 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 pollcy(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 CONTAOT
<br /> Seitlia PHOO:
<br /> PHONE
<br /> 6700 North Andrews Avenue, Suite 300 EMAILP-EIaL (954) 938-8788 IWC,NPI'.(954) 938.8566
<br /> EMAILIIID
<br /> Fort Lauderdale FL 33309 .tPPRE33: —
<br /> INSURER(S)AFFORDING COVERAGEMAICY
<br /> INSURER A:Zurich American Ine Co of IL 127255
<br /> INSURED INSURER B:Lloyd'a Underwriters at London
<br /> Keith and Schnare, P. A.
<br /> INSURERC:Travelers Indemnity Co of CT 125682
<br /> 6500 North Andrews Avenue NSURER 0.Charter Oak Fire Ins Co
<br /> 25615
<br /> Fort Lauderdale FL 33309 INSURERE:St. Paul Fire & Marine Ins. Co. 124767
<br /> INSURER . I
<br /> COVERAGES CERTIFICATE NUMBER:cart ID 30770 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 or 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 /> INSA IAODLISues POLICY EFF POLTCFE%P
<br /> LTR TYPE OF INSDNANGE NNERI WVDI POLICY NUMBER .IMMIDDNYYY)1 IMMIOOIYYYY) LIMITS
<br /> GENERAL LJABILITY I EACH OCCURRENCE 15 1,000,000
<br /> C 1 X1 COMMERCIAL GENERAL LIABILITY I P660-193X5294-TCT-11 18/14/2013 8/14/2012Ipg SES En occurrence) ,S 300,000
<br /> I MED EXP(Any one Derson S 10,000
<br /> . . Contractal I . I I PERSONAL&ADV INJURY SI S 1,000,000
<br /> II ECL'. Broad Porn PD I I GENERALAGGREGATE I5 2,000,000
<br /> 1 GGEEN'L AGGREGATE LIMIT APP�LIEjS PER: PRODUCTS-COMP/OP AGGj5 2,008,000
<br /> I PRO-I ZIPOLICY) IJEEOT 1 ILOO I
<br /> AUTOMOBILE LIABILITY I I 'COMBNEO SINGLE LIMIT
<br /> I(En ecdmnD 1,000,000
<br /> D IP810-290X0594-COP-11NEO —�ANY AUTO PB10-29058594-COs- e/14/]01118/14/]012 !BODILY INJURY(Ferlrendn) IS
<br /> ALL SCHEDULED
<br /> I
<br /> AUTOS NAUTOS
<br /> ON.O I I I BODILY INJURY(Per emderOl 5
<br /> `I HIRED AUTOS I AUTOSWNED P Drscpd.NDAMAG_ I S
<br /> I ) I I `.S
<br /> E 1 %111NBRELIA IAB Y. OCCUR 0506804589 18/14/2011 !e/14/2012 (EACH OCCURRENCE j5 5.000,ODD
<br /> j EXCESS LIARCLAIM&MAD=_ I I AGGREGATE 15 5,000,000
<br /> I I
<br /> I I DED I I RETENTION5 i S
<br /> WORKERS COMPENSATION I WC STATU- 1
<br /> A I AND EMPLOYERS:LABILITY 9598999 112/1/2011 112/1/2012 I X .TORY LIMITS+ IOER I ._
<br /> N;
<br /> ANY CER/MEMBERJEXCLUDED xECUnvE E.L.EACH ACCIDENT c
<br /> i. 1,000,000 I ,A
<br /> I IMandeR/MEMNER EXCLUDED', N 14 I 5y
<br /> j E Vp''naemryln NH) II E.L.DISEASE EA EMPLOYEES 1,000,000
<br /> DESCRIPTIONO OPERATIONS balsa i I 1 EL.DISEASE-POLICY LIMIT'1 1,000,000
<br /> B Maritime Employers Lim. F12M1N697-3081-11 12/1/2011 1112/1/2012 I Anly one none accident or$ 1,000,000
<br /> II I 5
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Alum ACORD 101,Addelanel Remarks Schedule.II mere epees a Hauled)
<br /> PROOF OF INSURANCE ONLY.
<br /> 0
<br /> CERTIFICATE HOLDER CANCELLATION 0
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE fPI
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> KEITH AND BCBNARS, P.A. ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 6500 N. ANDREWS AVE AUTHORIZED REPRESENTATIVE
<br /> —�7
<br /> FORT LAUDERDALE FL 33309 Y '. L'�
<br /> C1988-2010 ACORD CORPORATION. All rights reserved, Q
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
<br /> •
<br /> I KEITH KEITH and SCHNARS,P.A. _ �,. ..APa e
<br /> FwaDn's�igt,DcALFlrun -____
<br /> PACE 4 RFC/J2-04-02
<br />
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