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® ------"S DATAM-1 OP ID: DF
<br /> • A�R� CERTIFICATE OF LIABILITY INSURANCE DAT` "
<br /> 0510312016
<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 /> S REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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
<br /> NAME: Rodney Floyd
<br /> Mr. Insurance Agency, Inc. PHONE
<br /> ® Box 2689 _iu*�No,E.0 325-655-6702 I ,Nol: 325-6i55-2918
<br /> San Angelo, TX 76902 ADDRESS:
<br /> ® Rodney Floyd INSURER(S)AFFORDING COVERAGE I NAIC It
<br /> INSURER A:Charter Oak Fire Insurance Co. I
<br /> ® INSURED Data Management, Inc. INSURER B:Traviers Indemnity Co 125658
<br /> ®
<br /> 1 Time Clock Drive
<br /> San Angelo, TX 76904 INSURER c:Farmington Casualty Co
<br /> INSURER D:Travelers Property&Casualty I
<br /> O INSURERE: I
<br /> ® INSURER F: I
<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 /> ® ADOL SUER 1 POLICY EFF I POLICY EX? LIMITS
<br /> LTR TYPE OF INSURANCE INSDI%WOI POLICY NUMBER (MgoorrY 'p 1 tMMIDDIVrni
<br /> 0
<br /> B X I COMMERCIAL GENERAL LIABILITY I EACH OCC't ENCE 1,000,000
<br /> I .CLAIMS-MADE I X 1 OCCURZLP 51M57103TrES
<br /> 04115/2016 04/15/2017 cOr ""�I 1,000,000
<br /> M SES IE=_o::urrance) 1
<br /> O I MFD Ex:I-m On-pxsa.l S 10,000
<br /> ® I PEFSOLUL&ADV INTLer $ 1,000,000
<br /> GENT Ar,GPEGAT=LSM =??LIE=FEF. GEIJEP'L AGGREGATE 2,000,000
<br /> I- ET
<br /> Irt Li L
<br /> • HI LOC I PFODUCb-CCNPIOP A'2,3A'2,3t 2,000,000
<br /> OT ER
<br /> I S
<br /> ® AUTOMOBILE LLIABILITYLIABILITYIEa OYnL GLE ulnT 1,000,000
<br /> p,BI,acrldzna
<br /> e A X I Arr ALTO BA 9G138068 04/1512016 04/1512017 BOOLY INduer(Per perscal 5
<br /> I II C'er_D ❑U DULED I BO LY INJLnY(Per acOde4D 1
<br /> ® I IPDPED ALTOS I I aITOSLNED PPOPER=(DAMAGE
<br /> (Pe'aco..ep:)
<br /> ® I I 1-1 '
<br /> I UMBRELLA LIAB I X OCCUP EACH CCCLTPE CE $ 3.000,000
<br /> ® B X I EXCESS LIAB I I CLAIMS-MADE ZUP 71M54803 04/15/2016 04115/2017 AGG-EGA _ 3,000,000
<br /> I DED I X I EE-FTGN S 1 OA00 I I
<br /> WORKERS COMPENSATION M I I...:Fin-
<br /> AND
<br /> ® I STA,_= F
<br /> AND EMPLOYERS'LIABILITY
<br /> ® C ANY PROPRETORPAFThE:JEYECUmE YIN UB 71M54803 04/15/2016 04115/2017 E L EACH ACCIDENT S 1,000,000
<br /> OE:ICE411.EMBEF Ewe UL+EEP NIA
<br /> (Mandatory In NH) I E L Ary 1,000,000
<br /> CEASE-EA EMPLOYEE S
<br /> S I;Des.isc::beunde-
<br /> DES=PoPTICX1OFOF:EPATIONSbelm. I EL DISEASE-FO_IC,LINT 5 1,000,000
<br /> e D CyberFirst • ZPL 1573845046-15 04115/2016' 04/15/2017 $5 MIL Each claim
<br /> $5 MIL Agg
<br /> 0
<br /> ® DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addelonal Remarks Schedule.may be smashed if more space Is required)
<br /> el
<br /> co
<br /> ea
<br /> ® CERTIFICATE HOLDER CANCELLATION
<br /> ® CITYSUN
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ® City of Sunny Isles Beach ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 18070 Collins Ave.
<br /> ® Sunny Isles Beach, FL 33160 AU,T(HO/�RIZEEDDRREEPRESENTATIVVEE ,
<br /> ssp
<br /> ® i
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> O ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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