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e DATE(MMIDD/YYYY) CORD' CERTIFICATE OF LIABILITY INSURANCE 1 +r: 08/09/12 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). — CONTACT NANCY ALBEAR _ PRODUCER _NAME;—_ _—__— — PHONE FAX Estrella Insurance#117 lac.No Ex L (305)651-7777 T(AIC,No): (305)651-6444 E-MAIL man er117 estrellainsurance.com 167 NE 167 St.Suite A A••1 :--- — North Miami Beach,FL 33162 _—_.____ INSURER(S)AFFORDING COVERAGE—_ —__ NAIC C Phone (305)651-7777 _ _—Fax (305)651-6444 INSURER A: ESSEX INSURANCE COMPANY __ INSURED INSURER B: _ JOHN P CHURCHILL INSURER C_ — — --- INSURER D: 310 NW 127 Street --- 305 216-1508 INSURER E: _-• — Miami,FL 33168- ( ) ___ INSURER F: _ _ ----- 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 ADD SUER POLICY EFF POLICY EXP LIMITS _— -- LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ _ DAMAGE TO RENTED ❑ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A ❑ ❑ CLAIMS-MADE ❑ OCCUR MED EXP(Any one person) $ ❑ PERSONAL&ADV INJURY _ $ El GENERAL AGGREGATE $ _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ _ _❑_poucyL j J T Li LOC s — — SINGLE LIMIT INED COMB AUTOMOBILE LIABILITY (Ea INEDt) $ 500,000.00 El ANY AUTO BODILY INJURY(Per person) S --- ---- ------ -------- ALL OWNED SCHEDULED 1752859 08/09/2012 08/19/2013 BODILY INJURY(Per accident) $ A ❑ AUTOS ❑ AUTOS GARAGE GENERAL LIABILTY PROPERTY DAMAGE $ NON-OWNED (Per accident ❑ HIRED AUTOS ❑ AUTOS GARAGE LI ❑ BI/PIP DEDUCTIBLE($1000.0 $ 500,000.00 ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE _ $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE _ $ ❑ DED ❑ RETENTION$ ----- - $ WC STATU- OTH- WORKERS COMPENSATION ❑TOY LIMITS ER AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N — —' OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) If Yes,describe under E.L.DISEASE-POLICY LIMIT $ —__- DESCRIPTION OF OPERATIONS below _—._—_ ______-__---- I DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) A/C TECHNICIAN i CERTIFICATE HOLDER CANCE --- - -SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SUNNY ISLES BEACH THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 18070 COLLINS AVE ____ _ SUNNY ISLES BEACH,FL 33160 AUT-•RI4,•REPRESENTATIVE ADDITIONAL INSURED < % ` � F. 19::-2010 ACO r CORPORATION. All rights reserved. ACORD 25(2010/05)QF ' e ' ORD name and logo are registered marks of ACORD