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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD,rYW)
<br />�.. /
<br />12/1/2011
<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
<br />C NTACT
<br />NAME:
<br />Seitlin
<br />1,000,000
<br />6700 North Andrews Avenue, Suite 300
<br />041 Ext) (954) 938 -8788 fNC.No1: (954) 938 -8566
<br />1 DAMAGE TO REN TED
<br />PREMISES (Ea occurrence! !S
<br />4
<br />Fort Lauderdale
<br />e FL 33309
<br />ADDRESS:
<br />- -
<br />_ WSURER(S) AFFORDING COVERAGE NAIC k
<br />_
<br />INSURER A: Zurich American Ins Cc of IL 27655
<br />.
<br />INSURED
<br />INSURER B: Lloyd ' a Underwriters at London
<br />--
<br />Keith and Schnars, P. A.
<br />INSURER C: Travelers indemnity, Cc of CT 25682
<br />2, 000,D00
<br />6500 North Andrews Avenue
<br />INSURER D: Charter Oak Fire Ins Cc :25615
<br />INSURERE:St. Paul Fire a, Marine ins. Co. ;24767
<br />Fort Lauderdale FL 33309
<br />INSURER F
<br />j PRO.
<br />X 11 - LOC
<br />COVERAGES CERTIFICATE NUMBER: Cart XD 30770 REVISION NUMBER,
<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
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR TYPE OF INSURANCE IADOL SU9Rt'.
<br />LTR POLICY NUMBER
<br />POLICY EFF '�. POLICY EXP
<br />MM1007YYYY MM100/YYYY
<br />LIMITS
<br />GENERAL LIAatLITY
<br />EACH OCCURRENCE j S
<br />1,000,000
<br />C X COMMERCIAL GENERAL LIABILITY i P660- 193X5294- TCT -11
<br />18/14/2011 18/1412012 -
<br />1 DAMAGE TO REN TED
<br />PREMISES (Ea occurrence! !S
<br />300,000
<br />MED EXP (Any one Person) S
<br />_
<br />10,000
<br />I CLAIMS -MADE I OCCUR I
<br />PERSONAL &ADV INJURY ,;
<br />1,000,000
<br />X - Contractual Liab. )
<br />GENERAL AGGREGATE S
<br />2, 000,D00
<br />XXCU, Broad Form PD
<br />' PRODUCTS - COMP /OP AGG 5
<br />2, 000, 000
<br />I GENt AGGREGATE LIMIT APPLIES PER:
<br />j PRO.
<br />X 11 - LOC
<br />S
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />a accident) $
<br />1, 000,000
<br />b X ANY AUTO P810- 290K8594- COF -11
<br />!6/14/2011 18/14/2012 , BODILY INJURY (Per person) i S
<br />ALL OWNED SCHEDULE ^u
<br />AUTOS !AUTOS !
<br />1 BODILY INJURY (Per accident) 5
<br />NON-OWNED
<br />HIRED AUTOS L "r
<br />I PROPERTY pAMAG S
<br />AUTOS
<br />I
<br />I IPer eaidentl I
<br />I
<br />I S
<br />E g i UMBRELLA LfA6 i Y !OCCUR QK06B04589
<br />;8/14/2011 !8/14/207,2 EACH OCCURRENCE !S
<br />51000, 000
<br />EXCESS LIAR ! CLAIMS-MADE
<br />AGGREGATE S
<br />5, 000, 000
<br />I
<br />DED RETENTIONS
<br />S
<br />A IWORKERS COMPENSATION !
<br />AND EMPLOYERS' LIABILITY 9588998
<br />WC STATU- {0TH
<br />1x2 /1/2011 12/1/2012 T` IT E3Y LIMITSI - ER
<br />Y!N
<br />ANY PROPRIETORIPARTNER/EXECUTIVE I
<br />• OFFICERIMEM13ER EXCLUDED? IN/A;
<br />E.L. EACH ACCIDENT
<br />{ 1S
<br />1,000,000
<br />(Mandatory In NH)
<br />1 E.L. DISEASE - EA EMPLOYEE S
<br />1,000,000
<br />If yes, tlescdhe Under
<br />DESCRIPTION OP OPERATIONS halow
<br />! FE . DISEASE - POLICY LIMIT S
<br />11 000, 00 D
<br />73 Maritime Employers Liab. I I F12M1M697- 3081 -11
<br />112/1/2011 112/1/2012 'Any one accident or$
<br />� illn,, Be
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space is required)
<br />PROOF OF INSURANCE ONLY.
<br />KEITH AND SCHNARS, P -L,
<br />6500 N. ANDREWS AVE
<br />FORT LAVDERDALB FL 33309
<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.
<br />AUTHORIZED REPRESENTATIVE
<br />i
<br />Uc Taub -ZUTU ACUKD GUKPUKA IIUN, All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />T� KEITH and SCHNARS, P.A.
<br />FLOPIDAS 5l� LOCAL FIRn4
<br />�� PAGE 2 RFQ #12 -04 -05
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