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,.-' ACORDT" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) 04/26/2012 J THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CE~TIFICATE 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 1 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) 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 NAME: ISU Suncoast Insurance Assoc r~gNJo Exll: 813289.5200 I FAX I iivc, Nol: 8132894561 P.O. Box 22668 E-MAIL ADDRESS: Tampa, FL 33622.2668 CUSTOMER ID II: 813289.5200 INSURER(S) AFFORDING COVERAGE NAICII INSURED INSURER A : Phoenix Insurance Company 25623 Laura M. Perez and Associates, Inc. INSURER B : Travelers Indemnity Company 25658 2401 N.W. 7th Street INSURER C : Travelers Casualty & Surety Co 31194 Miami, FL 33125 INSURER D : Colony Specialty Insurance Comp 36927 INSURER E: Travelers Property Cas Co of Am 25674 INSURER F : Client#: 5783 PERELAU3 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. :~';.K TYPE OF INSURANCE I...... Wvn POLICY NUMBER 3.'i18~~\ P3.'i18~~, LIMITS A GENERAL LIABILITY 6802965L418 08/04/2011 08/04/201" EACH OCCURRENCE 51 000,000 - ~~~a:;~s Ea occurrence) ~ COMMERCIAL GENERAL LIABILITY 51,000,000 - ~ CLAIMS-MADE ~ OCCUR MED EXP (Anyone person) 510,000 - PERSONAL & ADV INJURY 51,000,000 GENERAL AGGREGATE 52,000,000 - GEN'L AGGREGATE LIMIT APPlS PER: PRODUCTS - COM PlOP AGG 52,000,000 , ~ POLICY n ~~ LOC 5 ~ AUTOMOBILE LIABIUTY BA7221 L50A 07/01/2011 07/01/2012 COMBINED SINGLE LIMIT 51 000 000 ,)" - (Ea accident) X ANY AUTO BODILY INJURY (Per person) 5 - ALL OWNED AUTOS BODILY INJURY (Per accident) 5 f--- SCHEDULED AUTOS PROPERTY DAMAGE f--- 5 ~ HIRED AUTOS (Per accldenl) X NON-DWNED AUTOS 5 f--- X Drive Other Car 5 B ~ UMBRELLA LIAS H OCCUR CUP3561T473 08/04/2011 08/04/2012 EACH OCCURRENCE 52.000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE 52 000 000 f--- DEDUCTIBLE 5 X RETENTION S 10 000 5 C WORKERS COMPENSATION UB6659Y254 07/01/2011 07/01/201~ X 1~2~~"':~!.Y.;" I I~~H- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORlPARTNERlEXECUTIVE~ N/A E.L. EACH ACCIDENT 5500,000 OFFICERlMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE 5500,000 g~s~~rps.rr~ ~W~PERATIONS below E.L. DISEASE - POLICY LIMIT 5500,000 D Professional IAE1226001 04/20/2012 04/20/20~ $1,000,000 per claim Liability $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rema,lla Schedule, If more apace II ,equlred) Professional Liability coverage is written on a claims-made and reported basis. CERTIFICATE HOLDER CANCELLATION For Proposal Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I I olJ..;P.-?\. M-oL.."a ACORD 25 (2009/09) 1 of 1 #S381010/M381008 LAURA M. PEREZ AND ASSOCIATES, INC @1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MRL RFQ #12-04-02 PAGE 2