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W79 <br />A✓ °® CERTIFICATE OF LIABILITY INSURANCE <br />°" ea �°,3" <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: H 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 polity, 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 />NN"E; Susan Casey <br />Commercial Lines - (561) 655 -5500 <br />PHONE 561 55 -5500 F^X N .561-655 -5509 <br />ADOR susan.ceseyl@welisfargo.com <br />Wells Fargo Insurance Services USA, Inc. <br />WSURERS AFFORDWG COVERAGE <br />NNCS <br />2054 Vista Parkway, Suite 400 <br />West Palm Beach, FL 33411 <br />WSURER A: Star Surplus Lines Ins. Co. <br />13604 <br />WsuRED <br />WSURER a: Star Indemnity and Liability Company <br />38318 <br />AshBritt, Inc. <br />WSURER C: Federal Insurance Company <br />20281 <br />WSURER o: <br />565 East Hillsboro Blvd. <br />WSURER E: <br />^ OCCUR <br />CLAIJ MADE � <br />WSURER F: <br />I <br />Deerfield Beach, FL 33441 <br />COVERAGES CERTIFICATE NUMBER: 6423488 REVISION NUMBER: See below <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 />WSR <br />LTR <br />TypE OF WSIIRANCE <br />DDRI <br />POLICY NUYBEA <br />MP�DYEFF <br />PYEXP <br />LOUTS <br />A <br />GENERAL LMSILITY <br />X <br />X <br />SLSLEIL72032213 <br />5/22!2013 <br />5/2212014 <br />MmocO CURRENCE <br />$ 1.000,000 <br />PREMISES En aminenra <br />f 100.000 <br />X COMMERCIAL GENERAL LMBILRY <br />^ OCCUR <br />CLAIJ MADE � <br />MED EXP ( ale petal) <br />f 10,000 <br />PERSONAL a ADV INRIRY <br />$ l,000.000 <br />X <br />X <br />Bla,kat Waiverd $Ub09MW1 <br />GENERAL AGGREGATE <br />f 2.000.000 <br />GENL AGGRE�GGA�TTE APIPL�IEIS PER: <br />PRODUCTS - COMPIOP AGG <br />S 2.000.000 <br />POLICY I A I PRP I LOC <br />; <br />Prof®vW d PM Loci <br />I S 1.000000 <br />B <br />AUTOYO6LE UABRJTY <br />X <br />X <br />SISIPCA08263213 <br />522/2013 <br />5/22/2014 <br />�'1B1N,gy„nEDSWGLE LUArt <br />I 1,Om,0oo <br />BODILY (Par parson) <br />S <br />x ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />n <br />BODLY WJIIRY (PeramOenl) <br />S <br />PROPERTY DAMAGE <br />Per emeeel <br />$ <br />NON -OMED <br />x HIRED AUt05 X AUTOS <br />s SW WOS by mXaa <br />x Blkt Add1 Insr x BIM WOS b c <br />A <br />uYBRELLA LIAR x OccuR <br />X <br />X <br />SLSLXNV73D23813 <br />5/222013 <br />5 222014 <br />EACH OCCURRENCE <br />s 10.000.000 <br />X <br />AGGREGATE <br />S 10.000.000 <br />EXCESS LNB CWMSMADE <br />X <br />'ED I RETENTIONS 0 <br />f <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LUJUL TY YIN <br />OFFILERlMEMBER EXCLUDED? ECUTNE I <br />(MansCaWy In Ntq <br />NIA <br />X <br />004472753900 <br />51222013 <br />52212014 <br />% YIC STATLL OTH' <br />E.L. EACH ACCIDENT <br />f 1.000.000 <br />E.L. DISEASE - EA EMPLOYE <br />f 1.000,000 <br />If <br />DESCRIPTION OF OPERATIONS bebw <br />E.L. DISEASE - POLICY LIMB <br />I S I.M.OX) <br />C <br />Rented/Leased/Borrowed <br />06639855ECE <br />5.22- 2013 <br />5-22 -2014 <br />swa.fou <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Arun ACORD 101, AEENbnsl Remarks Sc W, U m sped b r u4W) <br />GENERAL LIABILITY - Comprehensive Commercial General Liability including Pollution and Professional Liability. Coverage is Primary & Non - Contributory, <br />and includes Blanket Additional Insured including products and Completed operations per policy forms CG 2010 (04 -13) & CG 20 33 (04 -13). Blanket <br />Waiver of Subrooation endorsements per policy form SL023 (06 -11). AUTO: Includes Blanket Additional Insured per policy form SICAl020 (03 -12) and <br />Waiver of Subrogation when required by written contract per policy forth CA9948 (03-06). EXCESS LIABILITY: Follow -Form Over Commercial General <br />Liability, Pollution Liability and Professional Liability, Auto Liability and Workers Compensation policies. EQUIPMENT FLOATER: $500,000 policy limit for <br />rented, leased, or borrowed equipment. <br />The City of Sunny Isles Beach <br />18070 Collins Ave <br />Sunny Isles Beach, FL 33160 <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 />AUT11ORG:ED REPRESENTATIVE <br />9/ <br />The ACORD name and "o are registered marks of ACORD 0 1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) <br />