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FORMS + ATTACHMENTS© Professional Architecture Services for Government Center Lobby+Gateway Park II 1 SONG8AS-01 MATERAT Ac-ORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MWDOrrYYY) ks.----- 12/21/2016 1 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 POUCIES 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 have ADDITIONAL INSURED provisions or 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 License B 0E67768 NCAMTA,cT Brenda Mullis Insurance Office of America,Inc. PHONE FAX 1150 NW 72nd Avenue (AIC,No,Est):(407)998-5156 15156 I(AIC,NO): Suite 530 nniss:Brenda.Mullis@ioausa.com Miami,FL 33126 INSURERS)AFFORDING COVERAGE MAIC d INSURER A:American Casualty Company of Reading,Pennsylvania 20427 • INSURED INSURER B: - Song 8 Associates,Inc. INSURER C: 1545 Centrepark Drive North INSURER D: West Palm Beach,FL 33401 INSURER E: 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD MD IMMIDDIYYYYI (MWOCa frit A X COMMERCIAL GENERAL LIABILITY2,000,000 EACH OCCURRENCE 3 CLAIMS-MADE OCCUR 66020869686 01/03/2017 01/03/2018 DAMAGETORENTED 300,000 X MEOEXESIEadepon at s 10,000 MED EXP(Any one penonj 3 PERSONAL SACM INJURY 5 2,000,000 G-NL AGGREGATE UNIT APPLES PER: ,-GENERAL AGGREGATE S 4,000,000 POLICY El JrECT I I LOC PRODUCTS-COMP/OP AGO',3 4,000,001 i I OTHER: AUTO HIRED MONO 5 1,000,000 A AUTOMOBILE LIABILITY IE accident) LIMIT 5 1,000,000 -ANY AUTO -VYNED )( B6020869686 01/03/2017 01/03/2018 BODILY INJURY(Per Person) 3 AUTOS ONLY AUTOSU�O BODILY INJURY(Per acdda t) S i / • !MS EE PROPIn10AMAGE 5 X AUTOS ONLY X A�UTONIDY l�P 1) _ S A X UMBRELLA UAB X OCCUR EACH OCCURRENCE S • 5,000,000 EXCESS UAB CLAMS-MADE 6020871700 01103/2017 01/03/2018 AGGREGATE s 5.000.111 DED I X I RETENTIONS 10,000 5 WORKERS COMPENSATION PER RI- EL. EMPLOYERS'LIABIOTY Y/N STATUTE I IFR ANYp�PROPREIETggOE�RRIPARTNER/EXECUTNE - I E.L.EACH ACCIDENT 5 (Mandatory In NN)EXCLUDED? I N I A II yeESa denalbe un0er EL DISEASE•EA EMPLOYEE 3 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 701,Additional Rwarts Schedule,may be&Ached U more space is requIed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For proposal purposes AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I SONG +ASSOCIATES 77