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09/13/2012 23:50 3054063818 STATE FARM PAGE 03/07 <br /> 0 <br /> A a CERTIFICATE OF LIABILITY N INSURANCE ��� <br /> �+ 09/14/2012 <br /> ) t RTIFICATE <br /> 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 en ADDITIONAL INSURED,the potcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the <br /> 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 endorsoment(g). <br /> PF2ppt Peter F Bacallao NAME: <br /> 4291 NW 107 Ave , t Eu]:3_Q 4 sJ s4i i FAx <br /> �,y IAir,11o11_30506,381 B <br /> Dora', FL 33178 ADDA_R_E-SS: <br /> ----_-^- ItSURERMAFFORIXNGCOVERADE ---'NAICA <br /> WeAIFtEp INSURER A:State Farm Mutual Automobile Insurance Cnmpsny..._ 25179 <br /> AWARE DIGITAL INC INSURER e: <br /> 3991 COMMERCE PKWY INSURER C: <br /> MIRAMAR Fl..33025 INSURER I5: <br /> INSURER E: <br /> USURER¢: <br /> CERTIFICATE NUMBER: <br /> COVERAGES 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 PERIOo <br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1/44TH RESPECT TO WH/CH 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 CONOCnONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> AGOL 5U8R' <br /> QTR TYPE OF INSURANCE ( POLIcY NUMgEit _ EM POLICY _ > rn LIMITS <br /> GENERAL LIABILITY <br /> - - <br /> EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY <br /> PREMISES(ER oeelmR[R) S <br /> .'..I CLNMS-MADE I OCCUR MEDEXP(Any ant!pe on) $ <br /> PF.REONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ — — <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br /> POLICY^ LOC PRODUCTS-CGMP/DP AGG $ <br /> r AUTOMOBILE LIAB�ITY $ <br /> A I Y I f 901 6645-020-59 o3rmf2012 08/20/2012 CO u 1 <br /> ANY AUTO �a°��1.,. $ 1u000,00D <br /> ALL AUTO BODILY INURY(PerpeBdn) $ <br /> AUTOS x NON-0WkEb SICILY INJURY(PmAcdderl(] S <br /> x HIRED AUTOS X AUT•O5 + TY DAMA <br /> x2007 Chen 7--��--9 _ _ j erd] $ <br /> 1 — UMBRELLA LIAR T OCCUR v 1 11 I $ <br /> 1�E 1�1 EACH DCCURRENCE $ <br /> exams LIAR_ CLAIMS-MADE AgGRF.CiATE ; ••- <br /> DED I renew-ICNF <br /> WORKERSCOMPENSA'IION S _.4 <br /> ANC EMPLOYERS'LUIaN.JTy WC STATU• tJTN- <br /> ANY PROPRIETOR/PARTNERIEXECLITNE Y!N —iORY.,UM.IY.S E� <br /> OFFICMEMRER EXCLUDED? N I A E.I.EACH ACCIDENT $ <br /> FJ <br /> (M.ndetoty In NH) <br /> Irym,dosarbe Under ELI,.DISEASE•EA EMPLOYEE $ <br /> .. ..: a.-,, c •- :•I,kn• •01cre E.L DISEASE-POLICY UM1T $ <br /> A ENOL I I 6671998.00459 04/04/2012 10,04/2012 1"c"CEL <br /> OPTION OF OPERATIONS I LOCATIONS I YERICLES(Attach ACORD 101,Add Ilene RemaM:s Schndain,Ir more splice Is requited') <br /> RFP#12-09-01 <br /> CERTIFICATE HOLDER CANCELLATION <br /> The City of Sunny Isles Beach <br /> SHOULD ANY OF THE ABOVE Dt scereto POLICIES BE CANCELED BEFORE <br /> 18070 Collins Ave ACCORDANCE WITH THE POLICY PROVISION. YIfILL BE DFIJVERED IN <br /> Sunny Isles Beach, FL 33160 <br /> Ptu_ ••REPRESENTAy�E'}Ifs^ /�iEJ/LL(L <br /> 01988-2010 ACORD CORPORATION. AN Eights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15-2010 <br />