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A CORD," CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) 1/11/2011 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 NAME: Paul H. DeSilva rlJgN~o Extl: 954 941-0900 I r..c2, Nol: 954 786-5342 Bateman, Gordon & Sands, Inc. ~~D~~SS: P.O. Box 1270 CUSTOMER 10 #: Pompano Beach, FL 33061 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: American Safety Ind/Eidyia Ins. The BG Group, LLC INSURER B : Amerisure Insurance Co. 19488 1140 Holland Drive; Suite #19 INSURER C : Boca Raton, FL 33487 INSURER 0 : INSURER E : INSURER F : Client#: 57209 BGGRO 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 DDLSUBR IP~~8~fi~1 P~~8~fi~~1 LIMITS LTR TYPE OF INSURANCE NSR WIlD POLICY NUMBER A GENERAL LIABILITY X ENV0273151001 11/10/2010 11/10/2011 EACH OCCURRENCE $1,000,000 ~ DAMAG.~ TO RENTED ~ COMMERCIAL GENERAL LIABILITY PREMISES lEa occurrence) $50,000 I-- ~ CLAIMS-MADE [!] OCCUR MED EXP (Anyone person) $5,000 X XCUlContractual Liab PERSONAL & ADV INJURY $1,000,000 X Broad Form PO GENERAL AGGREGATE $2,000,000 n'L AGGRE~E LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X ~~P.T n LOC BI/PD Dedt $$5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ f- (Ea accident) ANY AUTO BODILY INJURY (Per person) $ f- ALL OWNED AUTOS BODILY INJURY (Per accident) $ f- ~ SCHEDULED AUTOS PROPERTY DAMAGE $ ~ HIRED AUTOS (Per acadent) NON-OWNED AUTOS $ ~ $ A ~ UMBRELLA L1AB ~ OCCUR ENU0273461 001 11/10/2010 11/10/2011 EACH OCCURRENCE $5,000 000 EXCESS L1AB CLAIMS-MADE AGGREGATE $5,000,000 ~ DEDUCTIBLE $ X RETENTION $ 10000 $ B WORKERS COMPENSATION WC206561801 11/10/2010 11/10/2011 X Ir5R~T6~YTs I I~JH- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTlVE[Rj E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, descflbe under $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Sunny Isles Beach is listed as an additional insured on General Liability coverage only as their (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Sunny Isles Beach 18070 Collins Ave Sunny Isles Beach, FL 33160 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 ACORD 25 (2009/09) 1 of 2 #S342788/M335657 @1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JMR