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<br />SYSTEMS
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<br />.".... Ardarmn & Associates, Inc.
<br />~ C'roochicaJ. EnvirCXlTerla ad
<br />~. MltenasCorlsUlarts
<br />
<br />([j) I HADONNE
<br />
<br />December 2, 2011
<br />City of Sunny Isles Beach
<br />Request for Qualifications
<br />Civil Engineering Services to Design
<br />Street and Drainage Improvements
<br />RFQ No.: 11-11-02
<br />Page 5
<br />
<br />)
<br />
<br />.---..,
<br />ACORD'
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<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />OPID:JT
<br />DATE (MMIDDNYYY)
<br />
<br />01/17/11
<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
<br />Tanenbaum Harber of Florida
<br />2900 SW 149th Avenue
<br />Miramar, FL 33027-6605
<br />Pat Murphy
<br />
<br />954-883-2900
<br />954-517.7400
<br />
<br />
<br />FAX
<br />~~
<br />
<br />INSURED
<br />
<br />Coastal Systems International
<br />Vanessa Russi-Machado
<br />464 S. Dixie Highway
<br />Coral Gables, FL 33146
<br />
<br />CUSTOMER 10', COAST-1
<br />INSURERj!)~OROING COVERAGE
<br />INSURERA, Hartford Underwriters Ins. Co.
<br />INSURERe ,Hartford Casualt Insurance Co
<br />
<br />INSURER C :
<br />INSURER 0 :
<br />INSURER E :
<br />INSURER F :
<br />
<br />~#
<br />'30104
<br />114397
<br />I
<br />I
<br />
<br />)
<br />
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER,
<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 />Ir~R L mr POLICY NUMBER ; ~8Mgh-~~Y ~gf6~}y~~~ I
<br />I EACH OCCURRENCE
<br />I MA ~D
<br />21 SBMIG4745 PREMISES ,Eaoce"",n,,)
<br />J MEO EXP (Anyone person)
<br />
<br />I
<br />
<br />B
<br />
<br />
<br />LIMITS
<br />
<br />PERSONAL & ADY-INJURY
<br />
<br />1,000,00
<br />300,00
<br />10,00
<br />1,000,00
<br />2,000,00
<br />2,000,00
<br />1,000,00
<br />
<br />,21 UECIN8962
<br />i
<br />I
<br />I
<br />I
<br />
<br />01120/11 I 01/20/12
<br />
<br />I GENERAL AGGREGAT~_ S
<br />I PROOUCTS. tQMPIOP AGG I S-
<br />lEmp Ben. I ,
<br />COMBINED SiNGLE LIMIT I <
<br />(Ea accident) . ..
<br />BODilY INJURY (Per person) ! $
<br />
<br />A
<br />
<br />
<br />DEOUCTIBlE
<br />X I RETENTION' 10 000
<br />WORKERS COMPENSATION
<br />I At~O EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETORIPARTNERlEXECUTlVE n
<br />PJ:~~~~~~EI~~EH~ EXCLUDED? L-J
<br />tfyes, describe uoder
<br />DESCRIPTION OF OPERATIONS below
<br />
<br />,
<br />
<br />121SBMIG4745
<br />
<br />
<br />BOOll Y INJURY (Per acCident) $
<br />I PROPERTY DJ..W.AGE
<br />(Per acciaenl)
<br />I
<br />
<br />B
<br />
<br />I
<br />I
<br />i
<br />
<br />',,,.\
<br />I
<br />
<br />01/20111
<br />
<br />3,000,00
<br />3,000,00
<br />
<br />DESCRIPTION OF OPERATIONS J LOCATIONS IVEHICLES (A"8th ACORD 101, Atldltlonal Remarks Schedule, II more space Is required,
<br />PROOF OF INSURANCE
<br />FOR INFORMATIONAL PURPOSES ONLY
<br />
<br />CERTIFICATE HOLDER
<br />I COASYS1
<br />
<br />Coastal Systems International,
<br />Inc.
<br />FOR INFORMATIONS PURPOSES ONLY
<br />464 S. Dixie Highway
<br />Coral Gables" FL 33146
<br />
<br />CANCELLATION
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRA TION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />~ ~ J.J. ;/ttwyf:p
<br />
<br />Af"nOn ?J::. t?noaIr\O\
<br />
<br />@1988-2009ACORDCORPORATION. All rights reserved.
<br />ThA .ll.l":.nRn n::l;melo :Inn Innn ~rp, rp.oi~hm~=!rt marks of ACORD
<br />
<br />Corporate Office, 464 South Dixie Highway. Coral Gables, Florida 33146. Tel, 305-661-3655 . Fa" 305.661-1914
<br />Regional Office, 2047 Vista Parkway, Suite 1010 West Palm Beach, Florida 33411 . Tel, 561-640-1003 . Fa" 561-640-1009
<br />www.coastalsvstemsint.comeinfo@coastalsystemsint.com
<br />
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