HomeMy WebLinkAboutexhibitDEXHIBIT D
CERTIFICATE OF INSURANCE
(See Section 45.5 - Insert form Certificate's of Insurance)
51
EXHIBIT D
ACORQ CERTIFICATE OF LIABILITY INSURANCE RECRB-1
CSR DI DATEjMMlISD/YYYY)
12/0104
PRODUCER
P.J.K. INSURANCE, INC.
2500 NORTH POWERLINE ROAD
POMPANO BEACH FL 33069
Phone:954-979-5855 Fax:954-979-6788
INSURED
Recreational Design &
Construction, Inc.
3990 Powerline Rd
Oakland Park FL 33309
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,
INSURERS AFFORDING COVERAGE
NAIC ill
INSURER A: Lexington taeuraacs Coolpaay
INSURER B: LANDMARK INSURANCE CO.
INSURERC: ASSURANCE CO OF AMERICA
19305
INSURERO: HARBOR SPECIALTY INS. CO.
INSURER E: COLUMBIA CASUALTY INS. CO.
------
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT. 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NUN ADIJNy
LTR1NSRC TYPE OF INSURANCE
A
X
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
X $10,000 Ded.
GEM. AGGREGATE LIMIT APPLIES PER:
711
POLICY f l JEC n LOC
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS/UMBRELLA LIABILITY
jOCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION 510 , 000
POLICY NUMBER
2897484
037733871
LHN025066
DATE IMWDONYIE
06/09/05
03/12/04
03/15/04
POLICY
CMMIODm)
03/15/05
03/12/05
03/15/05
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
Professional
Liability (E&O)
099000006248203
CPE114045042
12/01/04
10/01/04
12/01/05
10/01/05
LIMITS
--
EACH OCCURRENCE
s1,000,000
UAMACrtiTORERTED-
PREMISES (Ea occurence)
S50,000
MED EXP (Any one person)
$ --
PERSONAL & ADV INJURY
S 1 , 000 , 000
GENERAL AGGREGATE
s2,000,000
PRODUCTS • COMP/OP AGG
S 2, 000, 000
COMBINED SINGLE LIMIT
(Ea accident)
S1,000,000
BODILY INJURY
(Per person)
S
BODILY INJURY
(Per accident)
S ,
PROPERTY DAMAGE
(Per accident)
S
AUTO ONLY.. EA ACCIDENT
S
OTHER THAN EA ACC
$
AUTO ONLY: AGG
5
EACH OCCURRENCE
s3,000,000
AGGREGATE
$
$
5
•
$ __ �_
X OILY LIMITS ER•
E.L. EACH ACCIDENT
$ 10 0 0 0 0 0
E.L. DISEASE • EA EMPLOYEE
$ 3.000000
E.L, DISEASE • POLICY LIMIT
51000000
Per Claim $1,000,000
Aggregate $1,000,000
DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT i' SPECIAL PROVISIONS
CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED FOR GENERAL LIABILITY.
CERTIFICATE HOLDER
MIAMIDA
leT748X - `D}IOS 'wellItIVTY
GSA, RISK MGMT DIVISION
111 NW FIRST STREET
MIAMI FL 33128
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
aarg Ujung, IbIEJSIWINDJdSURERWLLI.ENDEAVORTOMAIL 30 DAYS WRITTEN
-NOTICE`PO`TigEVERTI R1111011,111111.
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPR 'E,TAT S.
A T • PRESENT V
41%a er 6L'',0
ACORD 25 (2001I08)
® ACORD CORPORATION 198