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OP ID:.i
<br />AFRO
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/YYYY)
<br />05/20/11
<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 />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 954 - 735 -5500
<br />Gateway Insurance Agency 954 - 735 -2852
<br />Fort Lauderdale Branch
<br />2430 W. Oakland Park Blvd.
<br />Fort Lauderdale, FL 33311
<br />PJK Old business
<br />CONTACT Margaret La
<br />NAME: ar g Lary
<br />PHONE 954 - 975 -0098 nAic No
<br />Alc No Ext
<br />E-MAIL
<br />ADDRESS:
<br />PRODUCER SHEGE03
<br />CUSTOMERID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED Shenandoah General
<br />Construction Company
<br />INSURER A: Commerce & Industry Ins Co
<br />PERSONAL & ADV INJURY
<br />INSURER B: New Hampshire Insurance Co.
<br />GENERAL AGGREGATE
<br />INSURER C: Ohio Casualty Insurance Co.
<br />024074
<br />1888 NW 22 Street
<br />Pompano Beach, FL 33069
<br />INSURER D: James River Insurance Co
<br />INSURER E:
<br />INSURER F:
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X LOC
<br />PRODUCTS - COMP/OP AGG
<br />f,UVLKAt7LJ VCRIIf I<M1G 19Vnlu���.
<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 />INSR
<br />LTR
<br />A
<br />TYPE OF INSURANCE
<br />MMERCIAL GENERAL LIABILITY
<br />TXOwner/Cont L LIABILITY
<br />CLAIMS -MADE OCCUR
<br />Prot.
<br />L
<br />X
<br />POLICY NUMBER
<br />4581761
<br />POLICY EFF
<br />MMIDD /YYYY
<br />12/31/10
<br />POLICY EXP
<br />MM/DD/YYYY
<br />12/31/11
<br />LIMITS
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />PREMISES Ea occurrence
<br />$ 100,00
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,00
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,00
<br />Emp Ben.
<br />$ 1,000,00
<br />B
<br />AUTOMOBILE
<br />X
<br />,PRO
<br />LIABILITY
<br />ANY AUTO
<br />X
<br />8263755
<br />12/31/10
<br />12/31111
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1 ,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />SCHEDULED AUTOS
<br />HIREDAUTOS
<br />NON - OWNEDAUTOS
<br />X
<br />$ -
<br />X
<br />C
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />EU01154322844
<br />12/31/10
<br />12/31/11
<br />EACH OCCURRENCE
<br />$ 2,000,00
<br />AGGREGATE
<br />$ 2,000,00
<br />DEDUCTIBLE
<br />$
<br />W0 SL M T OTH-
<br />X TORY LIMITS PER
<br />RETENTION $
<br />WORKERS COMPENSATION
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00C
<br />B
<br />D
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />Pollution Liab
<br />NIA
<br />A
<br />WC006988274
<br />000369743
<br />01/01/11
<br />03/22/11
<br />01/01/12
<br />03/22/12
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,00
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,00
<br />Ea Claim 1,000,00
<br />Aggregate 2,000,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Street, Sewers, Drains & Watermain cleaning.
<br />Bid #11 -04 -03 - Storm Water Catch Basin Cleaning & Line Jetting
<br />ULK I Ir It..A I C PIVLLJr_—
<br />— —
<br />CITOSUN
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />18070 Collins Avenue
<br />Sunny Isles Beach, FL 33160
<br />AUTHORIZED REPRESENTATIVE
<br />9A.09*
<br />v Iyaa -[uva M%Ivrcv —
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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