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<br />Ac" ° CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM /DD /YYYY)
<br />07/2212011
<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 />iBELOW. 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
<br />Marsh USA Inc.
<br />1560 Sawgrass Corporate Pkwy, Suite 300
<br />CONTACT
<br />NAME:
<br />P FAX
<br />HCNNo Ext AIC No
<br />E -MAIL
<br />ADDRESS:
<br />Sunrise, FL 33323
<br />Attn: FtLauderdale.CertRequest @ marsh.com F:212- 948 -0512
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: St. Paul Mercury Insurance Company
<br />24791
<br />101309 -GAWU- PROF -11 -12
<br />INSURED
<br />Inlermedix Corporation
<br />6451 North Federal Highway, Suite 1002
<br />INSURER B: Farmington Casualty Company
<br />41483
<br />INSURER C: Columbia Casualty Company
<br />31127
<br />INSURER D: Travelers Property Casualty Insurance Company
<br />36161
<br />Fort Lauderdale, FL 33308
<br />INSURER E:
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY PE LOC
<br />INSURER F:
<br />$ 2,000,000
<br />COVERAGES CERTIFICATE NUMBER: ATL- 002988451 -04 REVISION NUMBER:5
<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 />IN
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />MMIDDY /YYYY
<br />MM /DD /YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE IT] OCCUR
<br />TE06804866
<br />06/30/2011
<br />06/30/2012
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea Occurrence)
<br />250,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY PE LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />S
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS NON -OWNED
<br />HIREDAUTOS AUTOS
<br />BA- lA817433
<br />06/30/2011
<br />06/30/2012
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />S 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />S
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />Comp /Coll Ded.
<br />S 1,000
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />TE06804866
<br />06/30/2011
<br />06/30/2012
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />X
<br />DED RETENTION $ 10,000
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER /EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED? N
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />1A83727 -2 -11
<br />06/30/2011
<br />06/30/2012
<br />X WC STATU OTH-
<br />T RY L - E
<br />E.L. EACH ACCIDENT
<br />$ 500,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 500,000
<br />E.L. DISEASE - POLICY LIMIT
<br />500,000
<br />S
<br />C
<br />Professional Liability
<br />Retro Date: 10 /1/2002
<br />287142446
<br />SIR: $75,000
<br />06/30/2011
<br />06/30/2012
<br />Each Claim or Proceeding 3,000,000
<br />Aggregate 3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Evidence of Insurance
<br />CERTIFICATE HOLDER CANCELLATION
<br />Intermedix Corporation
<br />6451 N. Federal Highway, Suite 1002
<br />Ft. Lauderdale, FL 33308
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Carmen Gordon --a —�J
<br />@ 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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