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- I I ACORD~ CERTIFICA TE OF LIABILITY INSURANCE DATE (MM/DDIYYYV) 1/26/2009 PRODUCER (305)714-4400 FAX: (305) 714-4401 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HBA INSURANCE GROUP/BROWN & BROWN, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2500 NW 79th Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite# 101 Miami FL 33122 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American Safetv Indemni tv Soares Da Costa Contractor, LLC INSURER B: AIG INSURER C: Bridgefield Employers 10701 7270 NW 12th St. Suite 860 INSURER D: Miami FL 33126 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN) 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 POLl~~E:nl~;~~RIBED HE~;~~<>IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES INSR ADD'L P~k+~~~~~68,w~ Pg~lf~~llli'~N LIMITS 1Tl> IN~Rn TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - ~~~~f?,~J9E~~~r?encel ~ 5MMERCIAL GENERAL LIABILITY $ 100,000 A - CLAIMS MADE [!] OCCUR ESL0200700801 7/5/2008 7/5/2009 MED EXP IAnv one ""rsonl $ Excluded ~ Contractural Liab. PERSONAL & ADV INJURY $ 1,000,000 _ Included P.D.Ded.$5,000 Per Claim I r.ENERALAGGREGATE $ 2,000,000 ~'L AGGREAE LIMIT AFlES PER: PRODU"TS - COMP/np AGG $ 2,000,000 X POLICY ~~c?;: LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - (Ea accident) $ 1,000,000 ~ ANY AUTO B - ALL OINNED AUTOS AIG2639268 04/14/08 04/14/09 BODILY INJURY (Per person) $ - SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY - $ X NON-OINNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ==i ANY AUTO OTHER THAN EAAr:r: $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY $ 9,000,000 :=J OCCUR [!] CLAIMS MADE AGGREGATE $ 9,000,000 $ A ~ DEDUCTIBLE ESU0201230801 7/5/2008 7/5/2009 $ X RETENTION $ 10 000 $ C WORKERS COMPENSATION AND X I T~~mr,\{;, I IOJ,tt- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 83016362 4/1/2009 4/1/2010 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes. describe under 1,000,000 SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATlONSILOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I I I I I I I I I I ~ I I ~ CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL SUNNY ISLES BEACH GOVERNMENT CENTER ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 18070 COLLINS AVENUE, CITY CLERK FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE SUNNY ISLES BEACH, FL 33160 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE G:7 HBA INSURANCE - ACORD 25 (2001108) UJ<:.n?1; 1n1nQ\ nQ" @ACORD CORPORATION 1988 i ~ Pl:l,,"" 1 nf?