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• . <br /> -----141 ® TE <br /> A�o . CERTIFICATE OF LIABILITY INSURANCE DA (MM/DDIYYYY) ' <br /> 5/2018 j. <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTFTCATE HOLDER. THIS • <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TIE POLICIES <br /> ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTIORIZED <br /> EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDPfIONAL INSURED provisions or be endorsed. <br /> tf SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CAONTACT Darius-Mcjimpson <br /> Teamworks Insurance Agency,LLC PHONE FAX <br /> 23371 Mulholland Dr.#306 rarc No Fell (805)531 5060 (A/C,No): (805)531-5065 <br /> Woodland Hills CA,91364 ADDRESS: certholder@teamworkinsurance.com <br /> INSURER(S)AFFORDING COVERAGE NAC# <br /> INSURERA: Employers Preferred Insurance Company <br /> DP&O.Inc.Dba Triquetra Inc INSURER B <br /> Robert Hirsch CPA C/O DPO ENSURER C: <br /> 10033 Sawgrass Dr.W.Ste.121 INSURER 0: <br /> Ponte Vedra,FL 32082-2832 INSURER E: <br /> • - <br /> INSURER F: I <br /> COVERAGES CERTIFICATE NUMBER: 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 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 /> LTR I TYPE OF INSURANCE IN O SWVD 1 POLICY NUMBERPOLICY EFF I POLICY EXP UMITS I(MM/OD/YYYY) <br /> I COMMERCIAL GENERAL UABIUTY <br /> EACH OCCURRENCE S _ <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES{Ea oca+rrence) $ <br /> MED EXP(Any one person) S <br /> PERSONAL&ADV INJURY S } <br /> GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S rk <br /> POLICY JET LOC PRODUCTS-COMP/OP AGG S <br /> OTHER: S I{{{I <br /> AUTOMOBILE UABS.ITY - COMBINED SINGLE LIMIT S <br /> (Ean) <br /> ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) S <br /> HIRED NON-OWNED PROPERTY DAMAGE S <br /> ❑ AUTOS ONLY AUTOS ONLY (Per accident) <br /> S <br /> I UMBRELLA UAB OCCUR EACH OCCURRENCE S <br /> EXCESS MB CLAIMS-MADE AGGREGATE S <br /> DED I RETENTIONS S <br /> WORKERS COMPENSATION LI PER OTH- <br /> MD EMPLOYERS'LIABLm YIN EIG2539335-00 08/28/17 08/28/18 STATUTE Ea <br /> A MYICERY PROMEE OR/ PAEXTTNER/?XECUTIVE y NIA E.L.EACH ACCIDENT S C$1,000,000 <br /> (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S $1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S $1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Sunny Isles Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Office of the City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 18070 Collins Avenue, ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Sunny Isles Beach, FL 33160 <br /> AUTH REPRES ATI <br /> MBetancur@sibfl.net � <br /> Ox: (305))792- 1563 � <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> I <br /> I <br /> •I <br />