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<br />
<br />"CI'TYOF"SUNNY!SLE"SBEAC'H'" -', ',' ',.
<br />SECTION ON'E: COMPANY INFORMkTION" " - . ", ,"-, -
<br />'I' ':: IL .~ ~
<br />
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<br />
<br />~
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<br />
<br /> ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
<br /> ~ 2/24/2011
<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 polley, 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 CONTACT
<br /> NAME:
<br /> f1:.JjgNJo Exj)' - I FAX
<br /> Ames & Gough (703) 827-2277 I lAIC, No}: (703) 827-2279
<br /> 8300 Greensboro Drive E.MAIL
<br /> ADDRESS:
<br /> ~~~ID#:OOO02075 ,
<br /> Suite 980
<br /> McLean, VA 22102 INSURER{S) AFFORDING COVERAGE I NAIC#
<br /> INSURED INSURER A :Continental Casualty Company 120443
<br /> INSURER 8 :
<br /> Keith and Schnars, P.A. INSURER C :
<br /> 6500 North Andrews Avenue INSURER D :
<br /> INSURER E : i
<br /> Ft. Lauderdal.e FL 33309-2132 INSURER F : I
<br />
<br />COVERAGES
<br />
<br />CERTIFICATE NUMBER:
<br />
<br />REVISION NUMBER:
<br />
<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 />
<br />Ir~ I TYPE OF INSURANCE
<br />~ERAL L1A81L1TY
<br />
<br />~MMERCIAL GENERAL ~IABILlTY
<br />I i I CLAIMS,MADE 0 OCCUR
<br />0=
<br />I I
<br />~
<br />fl GEl'N'L AGGREGATE, LIMIT A~~S PER:
<br />,. ,PRO, I '
<br />" POLICY I 'JEt:T , LOC
<br />nUT,OMOBlLE LIABILITY
<br />
<br />, ANY AUTO
<br />
<br />ALL OWNEO AUTOS
<br />
<br />I SCHEDULED AUTOS
<br />
<br />~ HIRED AUTOS
<br />
<br />~ NON-OWNED AUTOS
<br />
<br />~~~,;- ~~
<br />
<br />POLICY NUM8ER
<br />
<br />II~ghl%Myy, 1~2T6~rV~1 \
<br />
<br />i EACH OCCURRENCE
<br />; DAMAGE TO RENTED
<br />; PREMISES lEa occurrence $
<br />MED EXP (Anyone person) $
<br />
<br />PERSONAL & ADV INJURY $
<br />
<br />GENERAL AGGREGATE $
<br />I
<br />PRODUCTS. COMP/OP AGG I $
<br />I j $
<br />
<br />) COMBINED SINGLE LIMIT I: $
<br />, (Ea accident)
<br />
<br />BODILY INJURY (per person) I $
<br />
<br />BODILY INJURY (Per accidenl)' $
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />
<br />LIMITS
<br />is
<br />
<br />L UMBRELLA L1AB
<br />
<br />I I EXCESS LIAS
<br />
<br />! I DEDUCTIBLE
<br />
<br />n RETENTION $
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETORlPARTNERlEXECUTIVE D
<br />OFfiCER/MEMBER ExCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />A I PROFESSIONAL LIABILITY
<br />
<br />! J OCCUR I
<br />n CLAIMS-MADEl
<br />
<br />i
<br />i
<br />I
<br />i
<br />I
<br />I
<br />I
<br />I
<br />I
<br />
<br />! EACH OCCURRENCE
<br />
<br />i AGGREGATE
<br />!
<br />
<br />!
<br />, i T"X?,Jr ~TN~ I
<br />
<br />$
<br />1$
<br />
<br />i$
<br />i$
<br />$
<br />$
<br />
<br />IOJ~'
<br />
<br />~EH 00 609 12 27
<br />
<br />/1/2011 3/1/2012
<br />
<br />E,L. EACH ACCIDENT $
<br />I
<br />EL. DISEASE - EA EMPLOYES $
<br />
<br />i E,L, DISEASE, POLICY LIMIT! $
<br />i PER CLAIM
<br />
<br />I AGGREGATE
<br />
<br />---
<br />
<br />N/A'
<br />
<br />2,000,000
<br />4,000,000
<br />
<br />OESCRIPTrON OF OPERA TrONS I LOeA TIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required)
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />For Proposal Purposes Only
<br />
<br />SHOULD ANY OF mE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH mE POLICY PROVISIONS,
<br />
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />r
<br />
<br />Dan Knise/BHARRI
<br />
<br />__..-~~~~-_ -~ . ::~ __ _ ~.,r-:g:::;--::.~::. ~::.)-
<br />
<br />ACORD 25 (2009/09)
<br />INS025 (2009091
<br />
<br />@1988-2009ACORD CORPORATION. All rights reserved.
<br />The ACORD name and 1090 are registered marks of ACORD
<br />
<br />RFP #11-11-02
<br />
<br />PAGE 3
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<br />:ldl;'\.I'~ KEITH and SCHNARS, P.A.
<br />:l J~~ '1 FLORIDAs 13i9' LoCAL FIRM
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