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<br />J <br /> <br />) <br /> <br />'\ <br />; <br /> <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br /> <br />ACORD", <br /> <br />SYNAMAN3 <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />DATE (MMIDDIVYYVI <br /> <br />Client#: 13220 <br /> <br />12/16/2011 <br />THIS CERTIFICA TE IS ISSUED AS A MA ITER OF INFORMA TlON ONL Y AND CONFERS NO RIGHTS UPON THE CERTlFICA TE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVEL Y OR NEGATlVEL Y AMEND, EXTEND OR AL TER 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 pollcy(les) must be endorsed, If SUBROGA TION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsement(s), <br />PRODUCER <br />ISU Sun coast Insurance Assoc <br />P.O. Box 22668 <br />Tampa, FL 33622-2668 <br />813 289-5200 <br /> <br />NAME: <br />uWgN~o EXlJ: 813 289-5200 <br />'..'i.i'A1F- <br />ADDRESS: <br /> <br />]'J:'A)( <br />,(AlC, NO): 813 2894561 <br /> <br />CUSTOME~~Q..~_ <br /> <br />INSURED <br /> <br />INSURER(S) AFFORDING COVERAGE <br />INSURER A: MSA Insurance Company <br />;~;~~;-.; ;NGM'lnsuranceComp-any <br /> <br />INSURER c: XL Specialty Insurance Company <br /> <br />NAIC. <br />11066 <br />14788 <br />37885 <br /> <br />Manuel Synalovski Associates, LLC <br />1800 Eller Drive #500 <br />Fort Lauderdale, FL 33316 <br /> <br />INsUReR 0 : <br />INSURER E : <br />INSURER F : <br /> <br />COVERAGES <br /> <br />REVISION NUMBER: <br /> <br />CERTIFICATE NUMBER: <br /> <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 WiICH 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 />1:"'r':,K TYPE OF INSURANCE NRR MlO ~~JliM~y, POLICY EXP LIMITS <br /> POLICY NUMBER MMIODNYYV <br />A GENERAlllABILllY BPG2189B 12/2312011 121231201< [ACt I OCCURR[r.J<.:[ $1 ,000,000 <br />1- <br /> ~ COMMLRCIAI.. <.7ENrRAl lINm II Y IlIAMA\>I.IU"U<IW $500,000 <br /> ~ CLA..1$-MAUE ~ OCCuR PRfMISFS FAiOWllTAn(".A <br /> I-- MEO EX/"' (AllY VII\' !JVISOIl) $5000 <br /> PEr<sON!>!. & ADV II-l..uRY ~1 000000 <br /> ('~ENER^L AGGREI3ATE 12 000 000 <br /> n"L ^GC'~EnE,LIMI1 /lPr!.st PE" PRODUCTS. COMP/OP N:'~C~ 12 000 000 <br /> POLICY ~~Pi La,: ~ <br />A AUTOMOBILE LIABILITY BPG2189B 12/2312011 12/231201 COMBINED SINGLE liMIT ~1 000000 <br /> - (Ea aCoCidMl:) <br /> - ANY AUIO BOOIl Y If-U;llY {par l>>tf~O") $ <br /> - ALL O~ED AUTOS BODll Y IN-URY (PM IfCCldl:ml:) f <br /> "'- SCHEDULED AUT OS Rf>OPERTY DAMAGE <br /> X HlnEOAUTOS (P~ ac(ldcnt) T <br /> IX NON.OW'JED AUTOS 1 <br /> f-'-' <br /> T <br /> UMBRELLA lIAB H ~CCUR EACIl OCCURRENCE $ <br /> I-- <br /> EXCESS lIAB ClAIMS-MflD[ AGGREGATI; f <br /> - DEDUCTIBLE $ <br /> RElENT lOr< :1, ~ <br />B WORKERS COMPENSATION WCG2723B 1212312011 12/2312012 X WC~ ffU, T -jNH <br /> AND EMPLOYERS' LIABILITY Y/N <br /> ANY PROPRIErOR.J>AAU<ERIEXEC\JtIVED N1A E LEACH ACCIDEr<T 11,000000 <br /> QFFICF.R,MEMOER EXCUJD[[)? <br /> (Mandatory In NH) El DISEASE. EAEMPLOYEE ~ 1,000,000 <br /> gr~~~ft~~ ~~PERATlONS b.'OW E l DISEASE. POLICY LIMIT 1.1 000000 <br />C Professional DPR9698089 12/10/2011 12/101201. $1,000,000 per claim <br /> Liability $5000000 annl aaar. <br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHIClES (AUach ACORD 101, Additional Remlllrks Schedul., Ir mar. IIp.ce I. requIred) <br />Professional Liability coverage Is written on a claims-made and reported basis. <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />For Proposal Purposes <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH lHE POLICY PROVISIONS, <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />~ -?1. ~C)l. A <br /> <br />ACORD 25 (2009/09) 1 of 1 <br />#S355810/M355728 <br /> <br />01988-2009 ACORD CORPORATION. All rights resBrved. <br />The ACORD name and logo are registered marks of ACORD <br /> <br />LWA <br /> <br />RFQ # 12-04-04 <br /> <br />5 <br /> <br />i1 <br /> <br />MANUEL SYNAlOVsKI ASSOCIATES, llC <br />,Hy;'ito:hllt" intml1r dl":'(o,:" . J'/m",i",~ <br /> <br />