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) ) ) ) ) ) ) ) ~l ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ACORD,,, CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY) 4/25/2012 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~~~CT ISU Suncoast Insurance Assoc rllgNrio Extl: 813 289-5200 I ;..e~, Nol: 813289-4561 P.O. Box 22668 E-MAil ADDRESS: Tampa, FL 33622-2668 PRODUCER CUSTOMER ID #: 813289-5200 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: MSA Insurance Company 11066 L I V S Associates INSURER B: Liberty Insurance Underwriters 19917 2121 Ponce de Leon Blvd INSURER C : Suite 610 INSURER D : Coral Gables, FL 33134 INSURER E : INSURER F : Client#: 5764 L1VSASS3 COVERAGES CERTIFICATE NUMBER: 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 DDl~BR P~~Jg6~\ P~~!g6~, LIMITS lTR TYPE OF INSURANCE NSR D POLICY NUMBER A GENERAL LIABILITY BPG94591 02/08/2012 02/08/2013 EACH OCCURRENCE $1,000,000 - ~~~~~iJ9E~~~J~~encel X COMMERCIAL GENERAL LIABILITY $500,000 I CLAIMS-MADE ~ OCCUR MED EXP (Anyone person) $5,000 PERSONAL & ADV INJURY $1,000,000 c- GENERAL AGGREGATE $2,000,000 - ~'L AGGRn LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY ~~P.T LOC $ A AUTOMOBILE LIABILITY BPG94591 02/08/2012 02/08/2013 COMBINED SINGLE LIMIT $1 000 000 - (Ea accident) - ANY AUTO BODILY INJURY (Per person) $ - ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE - $ ~ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ - $ UMBRELLA L1AB H OCCUR EACH OCCURRENCE $ - EXCESS L1AB CLAIMS-MADE AGGREGATE $ c- DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION I':I'~D~T,~I.Y.;~ I Ig~H- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTlVED E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NfA (Mandatory in NH) E,L. DISEASE - EA EMPLOYEE $ If yes. describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B Professional AEA 1005590001 12/10/2011 12/10/201 :. $1,000,000 per claim Liability $2,000,000 annl aaar. DESCRIPTION OF OPERATIONS I lOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Professional Liability coverage is written on a claims-made and reported basis. CERTIFICATE HOLDER CANCELLATION City of Sunny Isles Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Purpose of RFQ ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ~'k. ~Ol..A ~ I ACORD 25 (2009/09) 1 of 1 #S380780/M361199 @ 1988-2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD LWA