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<br />CITY OF SUNNY ISLES BEACH
<br />SECTION ONE: COMPANY INFORMATION
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<br />ACOROfg CERTIFICATE OF LIABILITY INSURANCE I DATE {MM/OD/YYVY)
<br />~' 8/15/2011
<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 CON ACT
<br />Seitlin ~-"_..- ; FAX
<br />6700 North Andrews Avenue, Suite 300 ,WgNJo EXII: (954) 938-8788 ! lAIC. N'1l: (954) 938-8566
<br /> E.MAIL
<br /> ADDRESS:
<br />Fort Lauderdale FL 33309 !
<br /> ..- INSURER(S) AFFORDING COVERAGE NAIC#
<br />_._~-_.- INSURER A : Insurance C.o of the State of Pen ! 19429
<br />INSUREO INSURER B : Ll~Xd I a Underwri tera at Lond.on - ;
<br />Keith and Schnar.. P. A. -
<br /> INSURERC: Travelers Ind~~ Company of C i 25682
<br />6500 North Andrews Avenue J!!ISURER D : Charter ,,9ak Fire Ins Co i 25615
<br />Fort Lauderdale FL 33309 INSURER E: St. Paul Fire & Marine Ins. Co. I 24767
<br /> INSURER F :
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<br />COVERAGES
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<br />CERTIFICATE NUMBER: Cert ID 29698
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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 />'r~:i ,,- jAODL SUBR I 1~8rtigYJ~1 ~gT6~M~ !
<br /> TYPE OF INSURANCE POLICY NUMBER LIMITS
<br /> i GENERAL LIABILITY I f EACH OCCURRENCE i 1,000,000
<br /> 1$
<br /> ~""'~'~'~'AA"~"~ DAMAGE TO RENTED ..
<br />C P660-193X5294-TCT-11 8/14/20ll 8/14/2012 . PREMISES (E. occurrence i 5 300,000
<br /> I I ~ ! $
<br /> i ..J CLAIMS,MADE L!J OCCUR I MED EXP (Anyone person) 10,000
<br /> ~ --E9E..;~E'tual r..iab. i PERSONAL & ~DV INJURY i S 1,000,000
<br /> W XCU, Broad Form PO i i GENERAL AGGREGATE I S 2.000,000
<br /> ! GEN'L AGGREFf LIMIT APPLIE~ PER: i , ! PRODUCTS. COMP/OP AGG ! S 2.000.000
<br /> I X J POLICY ! P'~RT i I LOC I t is
<br /> ~OMOBILE LIABILITY ! COMBINED SINGLE LIMIT Is 1.000.000
<br /> !8/14/20ll : (Ea accident)
<br />D X i ANY AUTO P810-290K8594-COF-ll 8/14/2012 ! BODILY INJURY (Pe'pe,."n) IS
<br /> i ALL OWNED II SCHEDULED ~DIL Y INJURY (Per .ceiaenl)! $
<br /> : _--.i AUTOS ~ AUTOS --,-
<br /> : i j I NON~OWNED I I PROPERTY DAMAGE i S
<br /> H HIRED AUTOS L..J AUTOS I I Per accide.n1) i
<br /> ! I J 5
<br />E ~ UMBRELLA LIA~ ~ OCCUR I I QK06804589 !8/14/20ll i 8/14/2012 LEACH OCCURRENCE 1 $ 5.000.000
<br /> i ..- I
<br /> i I EXCESS L1AB ; ; CLAIMS-MADE i , ! I i AGGREGATE ! S 5,000,000
<br /> r j I RETENTION S ! i -
<br /> iDEO , I 1$
<br /> I WORKERS COMPENSATION [12/1/2010 ; I X ! WC STATU, I 10TH,;
<br />A , AND EMPLOYERS' LIABILITY Y / N ! i WC5226685 I ,,,,,,on. "'''' W". ''':
<br /> I ANY PROPRIETORlPARTNERlEXECUTlVE 0 N/AI I I E.L. EACH ACCIDENT i $ 1,000,000
<br /> ! OFFICER/MEMBER EXC\..UDED? L E.L. DISEASE - EA EMPL()YEa $ 1,000.000
<br /> i (Mandatory In NH) :
<br /> 1 If yes. describe under ! E,L. DISEASE - POLICY LIMIT I $
<br /> ! DESCRIPTION OF OPERATIONS below 1.000,000
<br />B ! Maritime Employers Liab. I i F12M1M697-308l-10 !12/1/2010 :12/1/20ll !AnY one accident or$
<br /> 1.000,000
<br /> I ; i ; j jillnBss
<br /> ! i $
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<br />OESCRIPTrON OF OPERATIONS I LOCATIONS J VEHICLES (Attach ACORD 101, AddlUonaJ Remarks SChedule. if mere spac& Is requiredl
<br />PROOF OF J:NSURANCE ONLY.
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<br />CERTIFICATE HOLDER
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<br />CANCELLATION
<br />
<br />KEJ:TH AND SCHNARS, P.A.
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<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,
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<br />6500 N. ANDREWS AVE
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<br />AUTHORIZED REPRESENTATIVE
<br />~-,-9 (-:;) .I)
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<br />FORT LAUDERDALE FL 33309
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<br />ACORD 25 (2010105)
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<br />@ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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<br />. -:: "
<br />;,:.IYo;"X, "'II~ KEITH and SCHNARS, P.A.
<br />:jJ~~::: , 12.:
<br />".Ji....,1 FWRlDAS /.lit-!DeAL FIRM
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<br />PAGE 2
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<br />RFP #11-11-02
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