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C G. BATISTA <br />C' & ASSOCIATES <br />INSURANCE INFORMATION <br />GENERAL LIABILITY INSURANCE <br />OP ID: CM <br />A �RO CERTIFICATE OF LIABILITY INSURANCE DATE IMM DO YYYY) <br />j <br />l <br />7 <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 954 -467 -8738 <br />Premier Protection Insurance <br />NAMEACT , <br />'HONE E,q: FAX No): <br />409 BE 7th St 854 -844 -1881 <br />Fort Lauderdale, FL 33301 <br />Douglas A. Levy <br />EMAIL <br />ADDRESS: <br />usEa cT to a: REALE -1 OM <br />- <br />INSURERS) AFFORDING COVERAGE NAIC8 <br />INSURED G. Batista & Associates <br />INSURER A: United Specialty Ins. Co. <br />10400 Griffin Road Suite 201 <br />INSURER a: Evanston Insurance Co. <br />Cooper City, FL 33328 <br />INSURER C <br />INSURER O: - <br />INSURERE: - - <br />INSURER F <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 />,,,,�„ INSURED COPY " " "' <br />FOR YOUR RECORDS ONLY <br />INS" ADDL 5Uek <br />TR TYPE OF INSURANCE POLICY NUMBER M L D/YYYYY MMIDDnYYP <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE 3 1,000,00 <br />A X COMMERCIAL GENERAL LIABILITY NS1211055 10127111 10127112 <br />14TED <br />ED 100,00 <br />- <br />CLAIMS -MADE X OCCUR <br />PREMIESjEl. <br />PREMISE$(Ea nceJ $ <br />MED EXP (Any one Person) $ 5,00 <br />PERSONAL B AOV INJURY <br />- <br />GENERAL AGGREGATE $ 2,000,00 <br />GIN' L AGGREGATELIMIT APPLIES PER <br />PRODUCTS - COMP'OP AGG S 2,000,00 <br />X POLICY PRO LOC <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />(Ea ac —I I 3 <br />All OYMEO AUTOS <br />BODILY INJURY (Per person) S <br />- <br />SCHEDULER AUTOS <br />BODILY INJURY (Per denil $ <br />aR <br />.. AIRED AUTOS 'PROPERTY <br />DAMAGE 3 <br />IPer —,en') <br />NON OWNED AUTOS <br />$ <br />$ <br />UMBRELLA UAB OCCUR <br />EACH OCCURRENCE S <br />EXCESS LUIS CLAIMS MADE <br />AGGREGATE $ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />S <br />WORKERS COMPENSATION <br />WC STATU� OTH <br />AND EMPLOYERS' LIABILITY YIN <br />_TORY LIMITS ER . <br />ANY PRO PRIETO"ARTNER/EXECUTIVE <br />OFFICE MEMBER EXCLUDED' F NIA <br />E L EACH ACCIDENT S <br />(Mandatory In NH) <br />E L DISEASE - EA EMPLOYEE 3 <br />II y de— wider <br />DESCRIPTION OF OPERATIONS Oelux <br />E L DISEASE POLICY LIMIT $ <br />ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional R—A, ScheWla, It more apace Ia n illredl <br />0neral Contractor <br />CERTIFICATE HOLDER CANCELLATION <br />t <br />3 <br />INSURED <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />,,,,�„ INSURED COPY " " "' <br />FOR YOUR RECORDS ONLY <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />I <br />©1988.2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />4@ <br />CITY OF SUNNY ISLES BEACH <br />RFQ No. 12 -04 -01 <br />