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ACORD", CERTIFICAtE OF LIABILITY INSURANCE f DATE (MMJDDNYYYI 11/12/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFlRMA TlVEL Y OR NEGA TlVEL Y 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 certlficate holder is an ADDITIONAL INSURED, the pollcy(les) must I.>e endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies .may r(qulre an endorsement..4. statement on this certlflcate does not confer rights to the certificate holder In lieu of such endorsement(a). PRODUCER I~~~'" Paul H. DeSilva :-r~gNrfo Exl': 954 941-0000 I r~. No': 954 786-5342 Bateman, Gordon & Sands, Inc. ~'.>SS: P.O. Box 1270 CUSTOMER 10 ,: Pompano Beach, FL 33061 INSURER(S) AFFORDING COVERAGE NAlCII INSURED INSURERA: American Safety Ind/Eidyia Ins. The BG Group, LLC INSURER B: Amerisure Insurance Co. 19488 1140 Holland Drive; Suite 1#19 INSURER C : Boca Raton, FL 33487 INSURER D : 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. NOlWlTHSTANDING AtN REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wrrH RESPECT TO WHICH THIS CERTlFlCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS. EXCLUSIONS AND CONDmONS OF SUCH POLlCIE~Mrrs SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS. ~~ TYPE OF INSlIRANCe r..~~1. POUCY NUMBER =~l P~M86~, UMlTS A GENERAL UABIUTY ENV0273151001 11/10/2010 11/10/2011 EACH OCCURRENCE 51 000.000 - ~ OIJERCIAL GENERAL UABlUTY PREMISES lEa ocaJ'fel1C8\ s50,OOO - ClAIMS-MADE [!] OCCUR' MEO'EXP (Anv llll& perwon) 55,000 ~ BIIPD Ded:5,OOO PERSONAl.. & NJV INJURY s1,000.000 ~ GENERAL AGGREGATE 52,000,000 nl. AGGREri] UMIT APnS PER: PRODUCTS - COMPIOP AGG 52,000,000 POLICY X .\rg: LOC . A ^ 5 AUTOMOBrL.E; UABlUTY );pr/)'Y- COMBINED SINGLE LIMIT $ I---- (Ea accident) I-- />NY AUTO ^ I BODILY INJURY (per pet'Bon) 5 / 'V ~ . - ALl. OWNED AUTOS BODILY INJURY (Per accidef1t) $ f- SCHEDULED AUTOS PROPERTY DAMAGE $ - HIRED AUTOS (Par._t) NON.QWNEO AUTOS i,/ 5 - s A UMBREllA UAB hc-1 OCCUR ENU0273461 001 11/1012010 11/10/2011 EACH OCCURRENCE 55 000.000 - EXCESS UAB X CLAIMS-MADE AGGREGATE $5 000 000 !-- DEDUCTIBLE S X RETENTION $ 10000 5 B WORKERS COMPENSATION WC206561801 11/1012010 11/10/2011 X WC STAlU. I 12JH- AND Eloll'LDYERS' UABIUTY YIN />NY PROPRIETORIPARTNER/EXECUTI"LliJ E,L EACH ACCIDENT 51.000,000 OFFlCERlMEMBER EXCLUDED? N NIA (Mandatory In NH) E.L. DISEASE - EA EMPlOYEE 51,000,000 g~~:~~ '(1c;PERATIONS below EL. DISEASE - POLICY UMlT 51,000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddlUonal RemarK. Schedule, If more opace '0 requlted) BID# CP-0019-11 Demolition & Site Clearance of 6 Apartment Buildings (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Jacksonville, Procurement DivisIon 214 N. Hogan Street Suite 110 Ja onvill L 32202 SHOULD ANY OF THE ABOVE DESCRJBED POUC1ES BE CANCELLED BEFORE THE EXPIRATION DATE TIlEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POliCY PROVISIONS. AUTHORlZEO REPRESBIITATIVE @1988-2009ACORDCORPORATION.AII rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S332273/M332017 JMR