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~ ACORD@ CERTIFICATE OF LIABILITY INSURANCE r DA TE (MMlDDIYYYY) ~ 10/31/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may reqUire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ~2~r~CT Mari tza Rodriguez I r~gNJo Evt): (305) 556-1488 I FAX NSI Insurance Group iivc No!: (305) 556-3680 8181 Northwest 154th Suite 230 ~tb1l~ss: mari tzar@nsigroup. org ~~~~~~~~ 10 tf.)0054403 Miami Lakes FL 33016 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A :Al terra Excess & Surplus Ins Co 133189a INSURER B :TRAVELERS INDEMNITY 125658 Elite Tent Co. INSURERc:Commerce & Industrv Ins Co 19410 2375 SW 58th Avenue INSURER 0 :Bridqefield EmPlovers Ins Co 0701 INSURER E: Hollywood FL 33023-4034 INSURER F: COVERAGES CERTIFICATE NUMBER:ll/12 GL,AUTO,WC & XS REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ~~~; SUBR I ,~~J5~1 ,~~5~1 LTR WVD POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - X COMMERCIAL GENERAL LIABILITY ~~~~~~J?E~~~u~~nce\ $ 100,000 A I CLAIMS-MADE [iJ OCCUR MAXGL002142 111/1/2011 1/1/2012 MED EXP (Anyone person) $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 ~'L AGGREnE LIMIT APFlS PER: PRODUCTS-COM~OPAGG $ 2,000,000 X POLICY ~~,9;: LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 - (Ea accident) X ANY AUTO - BODILY INJURY (Per person) $ B ALL OWNED AUTOS BA9599R884 1/1/2011 1/1/2012 - BODILY INJURY (Per accident) $ - SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ - I- NON-OWNED AUTOS Medical payments $ Uninsured motorist combined $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ 1,000,000 l- X EXCESS L1AB CLAIMS-MADE AGGREGATE $ 1,000,000 I- DEDUCTIBLE $ C RETENTION $ BE011655849 1/1/2011 ~2/1/2012 $ D WORKERS COMPENSATION I WC STATU- I IOTH- AND EMPLOYERS' LIABILITY Y/N X TORY LIMITS ER ANY PROPRIETOR/PARTNERlEXECUTIVE 0 EL. EACH ACCIDENT $ 500 000 OFFICER/MEMBER EXCLUDED? MIA (Mandatory In NH) 83040216 11/1/2011 111/1/2012 EL. DISEASE - EA EMPLOYEE $ 500 000 If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddItional Remarks Schedule, If more space Is required) 30 days notice of cance11ation except 10 days for nonpayment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SUNNY ISLES BEACH ACCORDANCE WITH THE POLICY PROVISIONS. 18070 COLLINS AVE SUNNY ISLES BEACH, FL 33160 AUTHORIZED REPRESENTATIVE G Nenezian/MARITZ -~ ~~~ , ACORD 25 (2009/09) INS025 (200909) @ 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD