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INSR ADDLSUBR <br />LTR INSR WVD <br />DATE (MM/DD/YYYY) <br />PRODUCER CONTACT <br />NAME: <br />FAXPHONE <br />(A/C, No):(A/C, No, Ext): <br />E-MAIL <br />ADDRESS: <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) <br />COMMERCIAL GENERAL LIABILITY <br />AUTOMOBILE LIABILITY <br />UMBRELLA LIAB <br />EXCESS LIAB <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUTHORIZED REPRESENTATIVE <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />Y / N <br />N / A <br />(Mandatory in NH) <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ <br />$ <br />PRO- <br />OTHER: <br />LOCJECT <br />COMBINED SINGLE LIMIT <br />$(Ea accident) <br />BODILY INJURY (Per person) $ANY AUTO <br />OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS <br />AUTOS ONLY <br />HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) <br />$ <br />OCCUR EACH OCCURRENCE $ <br />CLAIMS-MADE AGGREGATE $ <br />DED RETENTION $$ <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below <br />POLICY <br />NON-OWNED <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 />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 />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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If 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 any rights to the certificate holder in lieu of such endorsement(s). <br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />CERTIFICATE HOLDER CANCELLATION <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) <br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE <br />Travelers Indemnity Company of CT <br />Travelers Casualty and Surety Company <br />Hartford Accident & Indemnity Company <br />8/06/2020 <br />USI Insurance Services LLC <br />2502 N Rocky Point Dr. Suite 400 <br />Tampa, FL 33607 <br />855 874-1270 <br />SANDRA BURONE <br />855 874-0777 <br />sandra.burone@usi.com <br />Ross Engineering, Inc. <br />3325 S University Dr. <br />UNIT 111 <br />Davie, FL 33328 <br />25682 <br />19038 <br />22357 <br />A X <br />X <br />X <br />6601B452576 11/30/2019 11/30/2020 1,000,000 <br />1,000,000 <br />5,000 <br />1,000,000 <br />4,000,000 <br />2,000,000 <br />C <br />X <br />X X <br />20UECKL6700 03/01/2020 03/01/2021 1,000,000 <br />B <br />Y <br />UB8K2361942047G 08/10/2020 08/10/2021 X <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />Proprietors/Partners/Executive Officers/Members Excluded: <br />Melissa Ross <br />Robert Ross <br />City Of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />1 of 1 <br />#S29550143/M29501009 <br />ROSSENGClient#: 1054822 <br />JZDER <br />1 of 1 <br />#S29550143/M29501009 <br />Page 113