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<br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />~ <br />. <br />a <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />(t <br />. <br />. <br />. <br />~.l <br />. <br />. <br />I. <br />. <br />. <br />,e <br />. <br />.(l <br />. <br />. <br />. <br /> <br />DATE (MMIDDIYV) <br />3f1Sl20i 1 <br /> <br />ACORD <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONL.Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND, OR <br />AL.TER THE COVERAGE AFFORDED BY THE POLICIES BEL.OW <br />INSURERS AFFORDING COVERAGE NAIC # <br /> <br />PRODUCER <br /> <br />Phone. 954 583-5444 <br /> <br />Fax - 954-583-2820 <br /> <br />Pelican Insurance Agency <br />6950 Cypress Rd Ste 208/7 <br />Plantation, FI ~.3~17 <br /> <br />INSURER A: <br /> <br />nvc:.I'OC''' <br /> <br />INSURER B: <br /> <br />Snack Time LLC <br />149 NW 70 St. #302 <br />Boca Raton. FL 33487 <br /> <br />INSURER c: <br /> <br />-...--------------.----...-.-- <br /> <br />INSURER 0, <br /> <br />INSURER E: <br /> <br />COVERAGES <br /> <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L1STE,D 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 /> <br />..__._ ._n_.__u._.__--.- <br /> <br />Pending <br /> <br />i jPOLlCY EFFECTIVE POLlCV EXPIRATIONl <br />DATE (MMIODIYYI DATE IMM/DDIYY) : <br />, I <br />. ---r. ~~':iri,?~~.I;- i::~~ <br /> <br />\ \ 'MEO ~XP (An'{ ere oc:son) , S S5.000 <br /> <br />Ii I ~:::;::::;" .. j:.. i~:.:: <br />\ PROD~~~S-~OV.P~~~i3? . .\.~~.- S2,OOO,OQQ <br />I <br /> <br />LIMITS <br /> <br />INSF <br />L TR TYPE OF INSURANCE POLICV NUMBER <br /> <br />I- ____._.... ........ -'. .._--.--1----. <br />GENERAL LIABILITY <br />!XI COMMERCV-.L GE~ERAL L1AB!L1TV <br />~___[] CLAMS WAllE Ci OCCUR <br /> <br />-1 <br /> <br />GEN'L AGGREGATE LIMiT APPLIES PER I <br />1----\ POLICY 1-1 ~~T II LaC <br />i AUTOMOTIVE LIABILI1Y <br />C\Af<V AUTO <br />I AU. OWNED AUTOS <br />R~\SCHEDULED AUTOS <br />HIRED AUTOS <br />__: """.m"," """' <br /> <br /> <br />I GARAGE LIABILITY <br />~IO ANY AUTO <br /> <br />PCESS UABILITY <br />I OCCUR II CLAIMS \lADE <br /> <br />-I <br />I DEDUCnIlL~ <br /> <br />II RETENTION $ <br />VlORKER'S CO~\PENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPR,ETORi?I,RTNERiEXECUTIVE <br />OFFICERilAEMBER EXCLUDED? <br />It y<!s. cescnoo cflde' <br />SPECIAL PROVISIONS below <br /> <br />\ $ <br /> <br />COIABlNED SINGLE LIMIT <br />(Ea acdc6'lt) <br />1-...--...- .-- <br />BODie V INJURY <br />{Per persen: <br /> <br />--'-- <br /> <br />BODlL V INJURV <br />{per a::ddcnti <br /> <br />Is <br /> <br />PROPERTY DAlMGE <br />{Per accicen:j <br /> <br />$ <br /> <br />AUTO O'll Y - EAAC~.IDE"''T _._\ $ <br /> <br />OTHER THAN EA ACC S <br />AUTO 0'" Y- <br /> <br />AGG <br /> <br />EACH CCCUHENCE <br /> <br />s <br /> <br />AGGREGATE <br /> <br />s <br />s <br /> <br />s <br /> <br />~L;';;0l:;:&L~~~ . -- <br />I E.L. EACII ACCIDENT · <br />,E.L OISf~.S5~EAE~'~ S _ _ _ <br />IEL DISEASE - POLICY LIMIT $ <br />I <br />I <br /> <br />\mH" <br /> <br />DESCRIPTION OF OPERATIONS,l.OCATIONSNEHICLESIEXCLUSIONS ADDED BV ENDORSEMENT/SPECIAL PROVISIONS <br />COVERAGE PENDING THE AWARD OF THE CONTRACT <br />Certificate holder named as an additional insured with regards to general liability. <br /> <br />CERTIFICATE HOLDER <br /> <br />I X !ADDITIONAL INSURED; INSURER LETTER: A <br /> <br />CANCELLATION (See Belowl- <br /> <br />City Of Sunny Isles Beach <br />18070 Collins Ave. 3rd Floor <br />Sunny Isles Beach, FI. 33160 <br />305-947-5107 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />10 EXPIRATION DA.T THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br /> <br />BiJ1#~~J~~VJ~~I~~~J~~~i~~~[LCI~ITfO~~~~E~~tf~~IJ~ 6~EL:t:'DTY <br />OF ANY KIND UPON THE COfAPANY,lTS AGENTS OR REPRESENT.}TIVES, <br />/f //' ./ <br />AUTHORIZED REPRESENTATIVE /// ~/ .,/ /t:-. <br />S /" -~-~::--; / -t/"":~ <br />amuel Jacks ;;:::--_'~:'-c:.~:"'~ <br /> <br />0ACORD CORPORATION 1988 <br /> <br />ACORD 25 (2001/08) 1 of 2 <br /> <br />(0 <br />