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<br />CERTlFlCA TE OF INSURANCE <br /> <br />NO <br /> <br />184 <br /> <br />CERT1FJCA TE HOLDER <br /> <br />NAMED INSURFJ:! <br /> <br />CITY OF SUNNY. ISLES BEACH <br />OFFT.CE OF THE CITY CLERK <br />FOURTH FLOOR <br />18070 COLLINS AVENUE <br />SUNNY ISLES BEACH, FL 33160 <br /> <br />DRe. Inc., DRC Emergency ServicES. LLC <br />740 Museum Drive <br />Mobile, AI. 16608 <br /> <br />o NO <br />o NO <br />o NO <br />o NO <br /> <br />01.\ ~1I policic:~ conr~il1 a Waivc:r of Slobrogadol1 in ravor of C:cni(icalc: Holder if required by \Urinen e(\n(racl'? <br />Do ~II policies excepr (he WOrkl:T~' C(\tl\llen~ation n~me the Cenific~le Holder ~s ^d<.lilinnal 111.ured if rcqlo;rell by wrirlen conrrac(? <br />Do policies pro vi lie 30 day~ wrirren nollce of cRncen~lion II) CerrificBre HCllr.ler? <br />Is covernge llllder all in~llr~IT~e curriell by NalTlelllnsurcd Primary Insurance if required by ",riflen conrrncr: <br /> <br /> LIMliS OF LlABIJJTY IN <br />CONFIRMATION TYPlo: OJ' INSURANCE POLICY POUCY THOUSANDS <br />OF COVERAGE NUMBER PERrOD (000) <br /> WORKERS' COMPENSATION &. XSWC-071]529 OJ/OJ /2008 WORKERS COMPENSATION <br /> EMPJ~OYERS LIABILITY 03/011201 J <br /> ll. S. Longshoremen's ~l1cJ Harbor Workel'S EMPLOYERS LIABILITY <br />~ YES 0 NO F.~eh Accident .11,000 <br /> CompenSll~ion Ac( Coverllgc Disell^, . Policy Limit $ 1.0(l0 <br />~ YeS 0 NO OureT Continental Shelf Land ACt Di~case - Each Ernployee $ 1.000 <br />IiSI YES 0 NO Jonc~ Acr (incl\lding TranWOf(~liol1_ Wagc.l. <br /> M~intenance. and Cure). Death 011 the tligh MARITIME EMPLOYERS <br /> Seas Act &. Gener~l Maritime L1W L1AB.IUTY $ 1,000 <br />~ YES 0 NO Voluntllry Compensalion Enrlorsement <br />rnJ YES 0 NO Otller St~tes Insurance <br />(3l YES 0 NO Altcm~te Employer/Borr(lwed Strvanr E.ndorsemem <br />~ YF.S 0 NO "In Rem" EndoT~emel)l <br />[gIYES 0 NO Gul( of Mexico Territorial EXTension <br /> GF.NERAL LJABTUTY >tSGI...073197 03/01/2008 <br /> form & Edition Dllre ISO CG 0001 J 1188 03/0 1/2011 General Aj1.greg3te Unlimirecl <br /> ?rodum-Comp/OPS Agg, $ 3.000 <br />Dll YF..s 0 NO BroRu Form Property Oamllge Liability PCr50nnl & Advcrtising Injllry .t 1.000 <br /> ineh,lding X. C. lJ I:.llch Occurrence $ 1,000 <br />~ YES 0 NO PrOdllc!S/Compkted Operation5 Fire DnlllJlge .$ 50 <br />12!1 YES 0 NO COn[raClllRI Liability (Any I)ne fire) <br />~ YES 0 NO Sudden and Accidental PolhHion Liabiliry Meclic~1 Ellpem;e r, 5 <br />!XI YES 0 NO Occurrence Form (Anyone person) <br />~ YES 0 NO Personal Injury <br />~ YES 0 NO "Tn Rem" Endorsemenr <br />~ YES 0 NO Cross Liability <br />~ YES 0 NO Watercrllft 1!:1l,CI\I~;On ha~ been modified by lhe <br /> \/c~sels endor$emen{ on SCheduled equipmcnr <br />