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ACORD® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
<br />11/17/2020
<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 rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />Erinn E Collinsworth
<br />Collinsworth Ins&Risk Mgmt Services Inc
<br />PHONE — FAX
<br />P.O. Box 661628
<br />AIC No Ext: _ (786) 930-4795 _ (AIC N(786) 930-4794
<br />_
<br />EMAIL erinn@collinsworthinsurance.com
<br />ADDRESS:
<br />Miami Springs FL 33266
<br />1,000,000
<br />INSURERS) AFFORDING COVERAGE NAIC #
<br />INSURER A: Travelers Cas & Surety Co of A 31194
<br />INSURED (305) 648-0010
<br />INSURER B: Travelers Ind. CO. 25658
<br />Pedelta, Inc.
<br />INSURERC:Travelers Ind Co of Amer 25666
<br />2,000,000
<br />INSURER D: Travelers Cas & Surety Co 19038
<br />2000 Ponce de Leon Blvd.
<br />Suite 624
<br />INSURER E: Travelers Property Casualty of 25674
<br />Coral Gables FL 33134
<br />INSURER F:
<br />AUTOMOBILE LIABILITY
<br />COVERAGES CERTIFICATE NUMBER: Cert ID 4221 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
<br />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 />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ILTR''. ADDLTYPE
<br />POLICY EXP
<br />Att: City Clerk, Sunny Isles Beach Government Ctr
<br />LTR OF INSURANCE INSID VD POLICYNUMBERFF
<br />MMIDDPOLICY/YYYY MMIDD/YYYY LIMITS
<br />18070 Collins Ave.
<br />B X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE S
<br />1,000,000
<br />X
<br />_
<br />DAMAGE TO RENTED
<br />_
<br />CLAIMS -MADE OCCUR Y 6606245N62A
<br />04/25/2020 04/25/2021. PREMISES (Ea occurrence) S
<br />1,000,000
<br />MED EXP (Any one person) S
<br />10,000
<br />PERSONAL& ADV INJURY S
<br />1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE S
<br />2,000,000
<br />POLICY X PRO LOC
<br />---. JECT __
<br />PRODUCTS - COMP/OP AGG S
<br />2,000,000
<br />OTHER:
<br />S
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT S
<br />(Ea accident)
<br />1, 000, 000
<br />C ANY AUTO Y BA0152P632
<br />04/25/2020 04/ 25/2021 BODILY INJURY (Per person) S
<br />OWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />X X
<br />PROPERTYDAMAGE S
<br />AUTOS ONLY AUTOS ONLY
<br />-- --
<br />Per accident
<br />S
<br />E X'. UMBRELLA LIAB X OCCUR Y CUP -7R016949
<br />04/25/2020104/25/2021 EACH OCCURRENCE S
<br />1,000,000
<br />EXCESS LIAB CLAIMS -MADE '..
<br />AGGREGATE S
<br />1,000,000
<br />DED X RETENTIONS 10,000,
<br />$
<br />11000,000
<br />WORKERS COMPENSATION
<br />PER OTH-
<br />X
<br />D AND EMPLOYERS' LIABILITY YIN UB-3X45170A
<br />04/25/2020104/25/2021 STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT S
<br />1,000,000
<br />OFFICER/MEMBEREXCLUDED? NIA
<br />—
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE. S
<br />11000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT S
<br />1,000,000
<br />A Professional Liability 107081630
<br />04/25/2019'04/25/2021Each Claim
<br />$
<br />2,000,000
<br />Errors and Omissions Claims Made Basis
<br />Annual Aggregate $
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: RFQ 20-10-01 Professional Engineering and Architectural Services
<br />for Pedestrian Bridge with
<br />Park Elements across AlA at 174TH ST. CCNA
<br />Upon Award of RFQ20-10-01 and when required by written contract,
<br />City of Sunny Isles Beach is named
<br />as an additional insured including completed operations on the general
<br />liability on a primary &
<br />non-contributory basis; & on the Auto Liability on a primary basis; excluding professional services.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo dfd-registered marks of ACORD
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<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 />City of Sunny Isles Beach
<br />Att: City Clerk, Sunny Isles Beach Government Ctr
<br />AUTHORIZED REPRESENTATIVE
<br />18070 Collins Ave.
<br />4th Floor
<br />Sunny Isles Beach FL 33160
<br />v 1.
<br />1Ln �
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo dfd-registered marks of ACORD
<br />Page 1 of 1
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