HomeMy WebLinkAboutcertificate of insJ. 11W V VIA V V 111L .
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ACORD. CERTIFICATE OF LIABILITY
INSURANCE D I 1Pq
°"ssi i 02
PROOUCEiR
Inaource, Inc.
9500 Bouth Dad.lawd Blvd. ,1200
* 561567
P.O. Sox
Mimi FL 33256-1567
Phone: 305-670-6111 Fa.x: 305-670-9699
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
W
INSURERS AFFORDING COVERAGE
NAIC a
INSURED y
Ei PDlZ�C&�k 4 C m, Ina
BFAvenue
L 33 i
INSURER A: Assurance Company of America!
19305
rNsU ER Twin City Piro 'neurones Co.
29459
INSURER C.
INSURER (3:
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LrSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAILED ABCME FOR THE POLICY PERIOD IND/CATEO NOTWITHSTANDING
ANY JIRW ENT, TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVTi NEN REDUCED SY PAID CLAIM5.
01141
LTR
wan
INWRE
TYPE OF INSURANCE
POLICY NUMBER
OinalW
a ElaNiv
LIMITS
A
X
GENERAL
UABIUTY
CCMMERCrALGENERAL LIABLrrY
PA4213653
12/18/02
12/18/03
EACH OCCURRENCE
S 2000000
X
mamma
PREMISES
SMeeminence)
$ 2000000
1 CLAIMS MADE n OCCUR
MED EXP (Any one person)
i 10000
PERSONAL EADVINJURY
$ 2000000
GENERAL AGGREGATE
s 4000000
GENT• AGGREGATELENT APPLIES PER
PRODUCTS - COMPIOP AGO
$ 4000000
7 POLICY I l JEST FA { LOC
AL TOW/BILE
LIABILITY
ANY AU O
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON•OWNED AUTOS
PA824213653
12/18/02
12/18/03
CaJ�EIN1"e08INLiLELIMrr
SEe ataMergl
-
f 1000000
B001LY INJURY
(Iryperson}
S
_
X
BODILY INJURY
(Per sexism)
S
X
PROPERTY DAMAGE
IPer occident)
`
GARAGE
LIAA)LLTY
ANY ALrTO
AUTO ONLY - EA ACCIDENT
$
R
OTHER THAN EAACC
$
AUTO ONLY; AGO
$
A
EXCIEWURESIELLAUAEILITY
PA824213953
12/18/02
12/19/03
EACH OCCURRENCE
$ 4000000
J OCCUR CLAWS MADE
AGGREGATE
$ 4000000
DEDUCTIBLE'
RETENTION 1 0
S
1
R
X--;
$
H
WORKERS COMPENSATION ANO
BaIPLA7YLIR11'LOR?AY
ANY PROPRIETORMARTNIERIEXECUTtVE
OyPaaFICERTMEAABER am:LUDE07
sPEG1A�l PRavral°ka'WS below
211fd101P7465
10/01/02
10/01/03
r
X Y milli' M.
'rD
E.L. EACHACCtOENT
s 1000000
E.L. DREAM • EA EMPLOYEE
$ 1000000
ex. DREAM • POLICY 14fl
s 1000000
r
OTHER
DEECRIPYIQNOf OPERATIONS 1 LOCATIONS I VEFRCLES !EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
Certificate holder is included as additional insured with respects to
general liability reference Projects 2002 tbrougb 2004. *30 days notion on
workers comp.
CERTIFICATE HOLDER
CANCELLATION
CIT2K1A
City of Miami Bldg. 4 Losing
Dept.
444 8# 2nd Avenue
Miami, IL 33130
SHOULD ANY OF THE AMOK CESOMITED FOAM GE CAM: M M ORE TNlC79RATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10* OATS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NATECITOTHE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR UABIIJIY OF ANY RIND UPON THE INSURER, ITS AGEINTS OR
REPRESENTATIVES.
A P NTH.,
ACORO 26t2001l0S)
aD ACORD CORPORATION 'MSS