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0 0 0 RO CODATE WM DD YYYYI ® A1/4 CO CERTIFICATE OF LIABILITY INSURANCE 09-22-2011 ® THIS CERTIFICATE'S 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(SI.AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. ® IMPORTANT: If the certificate holder is an ADDITIONALINSURED,thepoEcyiesl must be endorsed. II SUBROGATION'S WAIVED.subject to the terms sad con ditionsof the oolky,certain policies may require en endorsement. A statementcn this certificate does not confer rights to the (1110 certificate hdder in Emu of such endoreementle). MODULO LON ACT 0 USI INSURANCE SERVICES LLC/PHS PHOMNE FAX cat No. Eat {866)467-8730 sc.fmt (677)538-8526 226144 P: (866)467-8730 F: (877)538-8526 t.w ® PO BOX 29611 YAMILODoucnn CHARLOTTE NC 28229 cUSTOMERID.: ® INSV�ROI A=FORGING COVERAGE NAICF INSURED DIMMER A: Hartford Ins Co of the Southeast ® SAVINO & MILLER DESIGN STUDIO INSURE,s: rNin City Fire Ins Co ® 12345 N.E. 6TH AVE. STE A W549E9 MIAMI FL 33161 N$uRIAD` ® INSURER E: INSURER F: ® COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ® IAVICATED. 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 ALT THE TERMS. ® EXCLUSIONS AND CONDITIONS OF SUCH/POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LR A TYPE OF iU,ANCe 1'NFRIFVryQI POLICE MIMEO I I N:OD.YEVYTI IM 0 YUYTE LRCM GENERAL UAEe1FY : EACH OCCURRENCE 3 2,000,000 ® — o u! ,UQ\I!U s 300,000 COMMERCIAL GENERAL llAbllTr P WEES/Et manor, ® A CLAIMS-MADE I X I OCCUR I MED SAP IA,N et mewl .110,000 X General Liab 21 SBA LF5961 !GS/2e/2011 01/28/2012 PERSONAL A AD?:HAIRY . 2,000, 000 ® _ GENERAL AGGREGATE .4,000,000 ® tin AGGREGATE UMI AEJfS PER: I MONK IS•COMP OP AGG',4,000,000 Pao I POOCY: _dfcr `X I lac 3 ® AUTOYOeLE DAIRRY ' D COVNW SINGLE L.W.L ifs,ci 32,000,000 My AUTO 4en BODILY Wary n.,Ie-.>„ I ® _'cat OS VIED AUTOS • i sooty POUT.'Ya tcibnr 1 SCHEDULED AUTOS • • PROPERTY DAMAGE O A X LASD AUTOS -21 SBA LF5961 .Ge/2e12oI L: ae/29/2G1a,IPe,, .R, + ® X NON 0W.ED AUTOS ; + • ® -UMIRELLA DAR LI OCCUR I FS • EA[ OCCURRENCE1 CtSf 11Ae I I RAIMS#UDE! I AGGREGATE I 4) DeouCTrsa I I • s RETENTION I I t ® MPEMSATION ANe[YRWORFEPS OEIIS�WaALTY YfNI ! :X=MY�M.rS OERN- ® ANY PROPRCTOOPARTNEREIECUTIVE— I • El.EAC=.ALCUENT i 1,000,000 B IMOF t..0 II 1141 XRUDED! U MIA 121 WEC ZS4648 I 11!07!2011 11/07/2012 EI.DISEASE LAD/P_OVE f 1,006,000 e ref.describe unto 4) DESORPTION OF OPERAllONS below EI.DISEASE•POLICY LO.T't 1,000,000 i I 0 DESCRIPTION Of OPERATIONS I LOCATIONS f VEHICLES UIbd,ACOR0 101.Adttiml RAwb SMNF.II woe IPF[F is epuFdl ® Those usual to the Insured' s Operations. O ® CERTIFICATE HOLDER CANCELLATION ® SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE 0 Leat 20W Insurance DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. olfin1 Td nnnn em cmn. nnD AUTHOR2 RESt 1AITVI 1 0 0 0 Savino(](tuat7Desi.nStudio okiX0#12-04-02 12