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• • / -1 GURD9-1 OP ID: CR ® `'��R� CERTIFICATE OF LIABILITY INSURANCE DATE04/2 / YY ® 04/25/1 2 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 POLICIES 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(les) must 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 305-262-0086 NAMEACT RAFAEL F.ALAYON BUTLER,BUCKLEY,DEETS INC. PHONE 305-262-0086 I FAX . 6161 BLUE LAGOON DR.,STE 420 IA/C.No.Eat): lac,No): 305-262-0187 MIAMI,FL 33126 ADDRESS:E-MAIL RALAYON@BBDINS.COM ® RAFAEL F ALAYON INSURER'S(AFFORDING COVERAGE NAICII ® INSURER A:Nationwide Insurance Company 25453 INSURED GURRI MATUTE,P.A INSURER B:BRIDGEFIELDEMPLOYERS 5001 SW 74 COURT SUITE 208 0 MIAMI, FL 33155 INSURER C: INSURER D: 0 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 0 /LTR I TYPE OF INSURANCE ADDL UBR INSR SWVD POLICY NUMBER I EXP IMM)DDYEFF IYYYY)I AOLIYDIYYYYI I LIMITS GENERAL LIABILITY EACH OCCURRENCE I5 1,000,000 ® A 1—X1 COMMERCIAL GENERAL LIABILITY X ACP5904473786 07/12/11 07/12/12 DAMAGE TO REN ED PREMISES(Ea r.-warence) 15 100,000 ® I CLAIMS-MADE X OCCUR MED EXP(Anyone Dersm) I5 5,000 PERSONAL.5 ADV INJURY 15 1,000,000 ® I X HIRED& NON OWNED GENERAL AGGREGATE 15 2,000,000 ® GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP,OP AGG 15 2,000,000 I POLICY fI -c fl we 15 COMBINED SINGLE LIMIT I AUTOMOBILE LIABILITY (Ea accident) I$ 1,000,000 ® A I ANY AUTO ACP5914473786 07/12/11 07/12/12 BODILY INJURY(Per Person) 5 ALL OWNED I1 SCHEDULED ® HAUTOUTOS JI 1 BODILY INJURY(Per aCtidenQ $ REDSAUTOS I X I NON-OWNED PRROPE DAMAGEper ent) 5 ® I I IS UMBRELLA UAB (_I OCCUR EACH OCCURRENCE IS ® EXCESS UAB I I CLAIMS-MADE AGGREGATE '5 I I DED I I RETENTION 5 1 5 0 WORKERS COMPENSATIONWCSTATOTH- AND EMPLOYERS'//ABILITY YIN I LL TORY LIMITS ERI ® 8 ANY PROPRIETOPJPARTNER/EXECUTLVE 0830 25278 08/01/11 08/01/12 E.L.EACH ACCIDENT I5 500,000 OFFICERrIAEMBEP EXCLUDED.; N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE'5 500,000 • II yes.describe under DESCRIPTION Oe OPERATIONS Delay E.L.DISEASE-POLICY LIMIT I5 500,000 • • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Addldonal Remarks Schedule,If more space Is required) ® ARCHITECTS ENGINEERS RE-City of Sunny Isles is named ad additional insured in respects to CO Proposal/Bid 12-04-02" • • ® CERTIFICATE HOLDER CANCELLATION ® CITYOSR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ® CITY OF SUNNY ISLES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 0 18070 COLLINS AVENUE AUTHORIZED REPRESENTATNE ® SUNNY ISLES, FL 33160Ate'+ ©1988-2010 ACORD CORPORATION. All rights reserved. ® ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Gurri Matute PA/RFQ No. 12-04-02/Page 7 A