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<br />OP 10: B8
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<br />ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIVVYY)
<br />~ 07/13/11
<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 endorsementfsl.
<br />PRODUCER 813-226-1300 ~~~~~CT Carrie McCarthy
<br />Brown & Brown of Florida, Inc. 813-226-1313 r~g.N~o Extl: 813-226-1300 I r~ Nol: 813-226-1313
<br />P. O. Box 15519
<br />Tampa, FL 33684-5519 ~~DA~SS: CMcCarthy@bbtampa.com
<br />Jason Sartor ~~~~~~~ID#: TALL Y-1
<br /> INSURERISI AFFORDING COVERAGE NAIC#
<br />INSURED Tally Engineering, Inc INSURER A: WESTFIELD INSURANCE COMPANY 24112
<br /> Suite 300 INSURER B: Bridgefield Employers Ins. 10701
<br /> 1806 N Flamingo Rd INSURER C : Columbia Casualty 31127
<br /> Pembroke Pines, FL 33028 INSURER D :
<br /> INSURER E :
<br /> INSURER F :
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<br />COVERAGES
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<br />CERTIFICATE NUMBER'
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<br />REVISION NUMBER'
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<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 TYPE OF INSURANCE DD I~~..': .~g~l I f~g~~~\ LIMITS
<br />LTR ''''~D POLICY NUMBER
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 ,000,001
<br /> I-- ~~~~~~S Ea occurrance) 150,001
<br />A ~ :5MERCIAL GENERAL LIABILITY X X TRA5183497 04/01/11 04/01/12 $
<br /> CLAIMS-MADE [!] OCCUR MED EXP (Anyone person) $ 10,001
<br /> f-- 1,000,001
<br /> PERSONAL & ADV INJURY $
<br /> GENERAL AGGREGATE $ 2,000,001
<br /> ~'L AGGREME LIMIT APAS PER: PRODUCTS-COM~OPAGG $ 2,000,001
<br /> POLICY X ~~,Q.; LOC $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,001
<br /> - (Ea accident)
<br />A ~ ANY AUTO TRA5183497 04/01/11 04/01/12
<br /> BODILY INJURY (Per person) $
<br /> .~ ALL OWNED AUTOS BODILY INJURY (Per accident) $
<br /> - SCHEDULED AUTOS PROPERTY DAMAGE
<br /> $
<br /> ~ HIRED AUTOS (Per accident)
<br /> ~ NON.QWNED AUTOS $
<br /> $
<br /> ~ UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 4,00O,00C
<br /> EXCESS LlAB CLAIMS-MADE AGGREGATE S 4,000,00C
<br />A TRA5183497 04/01/11 04/01/12
<br /> I-- DEDUCTIBLE S
<br /> X RETENTION $ $
<br /> WORKERS COMPENSATION X I T~~.7T~I#;, I IOJ~-
<br /> AND EMPLOYERS' LIABILITY Y/N 1,000,00C
<br />B ANY PROPRIETORlPARTNERIEXECUTIVE 0 0830-44561 04/01/11 04/01112 EL. EACH ACCIDENT S
<br /> OFFICERIMEMBER EXCLUDED? N/A X 1,000,OOC
<br /> (Mandatory In NHI E.L DISEASE - EA EMPLOYEE $
<br /> ~m::~r~fr8~ 'Cl'~'gPERATIONS below E.L DISEASE. POLICY LIMIT $ 1,00O,00C
<br />C Praff Liab CPB288348283 03/30/11 03/30/12 Limit 1,OOO,OOC
<br /> Oed 5,OOC
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark. Schedule, If more .pace I. required)
<br />Endorsements to be added should written contract require:
<br />Blanket Waiver of Subrogation with respects to both GL & WC coverage.
<br />GL B,I~n~~~~ Additionallns'd endorsement, per written contract.
<br />Per Pr' Annr Ii.....
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<br />CERTIFICATE HOLDER
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<br />CANCELLATION
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<br />TALLY
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Tally Engineering, Inc ACCORDANCE WITH THE POLICY PROVISIONS.
<br />"FOR BIDDING PURPOSES"
<br />1806 N Flamingo Rd, # 300 AUTHORIZED REPRESENTATIVE
<br />Pembroke Pines, FL 33028 \~
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<br />ACORD 25 (2009/09)
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<br />@ 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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