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<br />West Construction Insurance
<br />1
<br />'4 ° °® CERTIFICATE OF LIA611 ATV IM-5, DATE(MMIDD/yyyy)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
<br />UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER
<br />THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN
<br />THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pOIICy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement.
<br />A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement (s).
<br />PRODUCER
<br />NAME: CT Annie Uribe
<br />Collinsworth, Alter, Lambert, Inc
<br />PHONE (561]776 -9001 aC N (561)147 -6730
<br />23 Eganfuskee Street
<br />MAIL auribe(�callnc.com
<br />ADDRESS
<br />Spite 102
<br />PRODUCER 00001377
<br />LISTOM .8
<br />FL 33477
<br />ISURED
<br />INSURERS AFFORDING COVERAGE
<br />NAIC0
<br />_
<br />INSURED -
<br />EACH OCCURRENCE j
<br />-
<br />INSURER A:Ameri sure Insurance Co
<br />19488
<br />_INSURER B:American Guarantee & Liability
<br />50,000_
<br />Construction, Inc.
<br />INSURER C:Ameri sure Mutual Ins C
<br />Cc
<br />23396
<br />23396
<br />31
<br />318 South Dixie Highway
<br />INSURERO:Travelers Property & Casualty
<br />Suite 4 -5
<br />INSURERE: -
<br />1,000,000
<br />Lake Worth FL 33460
<br />—
<br />INSURER F:
<br />2,000,00o
<br />COVERAGES rrFOTler!`AYC,.,na.,,vr•.,,
<br />..0 :o, , v%�
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE
<br />KEVISION NUMBER:
<br />INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
<br />OR OTHER
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
<br />DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID
<br />INSR - - - - --CLAIMS.
<br />A Z—UBR
<br />LTR TYPE OF INSURANCE
<br />im A POLICYNUMBER MMIIDY� MMI UYtYEYrr
<br />LIMITS
<br />GENERAL LIABILITY
<br />X
<br />EACH OCCURRENCE j
<br />-
<br />1, 000, 000
<br />COMMERCIAL GENERAL LIABILITY
<br />A CLAIMS-MADE OOCCUR 1/1/2011
<br />A
<br />PREMISES Ea occurrent S
<br />50,000_
<br />L202037700 1/1/2012
<br />MED EXPAn one axon j
<br />5,000
<br />X BF trop Dam XCU
<br />X
<br />PERSONAL B ADV INJURY j
<br />1,000,000
<br />Contractual
<br />"
<br />GENERAL AGGREGATE j
<br />2,000,00o
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />PRO- X
<br />PRODUCTS- COMP/OP AGG $
<br />2,000,000
<br />POLICY LOC
<br />S
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />COMBINED SINGLE LIMB S
<br />(Es accident)
<br />1,000,000
<br />A ALL OWNED AUTOS 1/1/2011 1/1/2012
<br />BODILY INJURY (Per person) S
<br />SCHEDULED AUTOS
<br />BODILY INJURY (Per acddenl) S
<br />LA12999,29
<br />X HIREDAUTOS
<br />PROPERTY DAMAGE S
<br />X
<br />(Per accident)
<br />NON-OWNED AUTOS
<br />Primary Non Contributory S
<br />X UMBRELLA LIAR X OCCUR nds Over
<br />Uninsured motorist combined $
<br />30,000
<br />EXCESS LAB CLMMS•MADE GL/Al/EL
<br />EACH OCCURRENCE _ $
<br />10,000,000
<br />AGGREGATE S
<br />10,000,000
<br />DEDUCTIBLE
<br />--
<br />8 X RETENTION S O &UC938008301 1/1 /2011 1/1/2012
<br />$
<br />L, WORKERS COMPENSATION
<br />j
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORMARTNER/EXECUTIVE
<br />X WC STA7U• OTH-
<br />_
<br />OFFICER /MEMBER EXCLUDED? O NIA
<br />E.L. EACH ACCIDENT _ $
<br />1,000,000
<br />(Mandatory In NH) C2041574 1/1/2011 1/1/2012
<br />H yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - FA EMPLOYE $
<br />1 000 000
<br />D Owned Equipment and 660921SL272 1/1/2011 1/1/2012
<br />E.L. DISEASE - POLICY LIMIT S
<br />000 000
<br />Rented or Leased
<br />As Scheduled Ded$1000 AOP TRLR Wind Ded
<br />railers and contents 1
<br />$160.000 OCd$200.000 Agg
<br />$5000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is required)
<br />CERTIFICATF Hot nFR ......._.. __._ -.
<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 />For proposal purposes AUTHORIZED REPRESENTATIVE /1
<br />ACORD 25 (2009109)
<br />II.IC,.9¢
<br />© 1988.2009 ACORD CORPORA ON. All rinhfc
<br />-- -- •- -- - - -• r....+,... name anu wuv ary rvuluiere0 marKS OT AGUKU - - --
<br />RFP # NO. 11 -10 -01
<br />Design & Construction of Canopy Structures at
<br />Heritage Park and Golden Shores Park
<br />City of Sunny Isles Beach
<br />Page 6
<br />Company Information
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