HomeMy WebLinkAboutCertificate of InsuranceEXHIBIT D
A CORD
PRODUCER
305-591-0090
SEITLIN
2001 NW 107 AVE., SUITE 200 -
MIAMI, FL 33172
INSURED
Action Community Center Inc.
Attn: Maria P. Albo
970 SW 1st Street, Ste 304
Miami FL 33130
CO
LTR
A
B
13
• DATEMM1DDlYY!
I
10/06/04
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.
COMPANIES AFFORDING COVERAGE
-
COMPANY A Scottsdale Insurance Company
COMPANY
B Progressive Insurance Co.
COMPANY C Associated Industries
COMPANY D Hartford Fire Ins. Co.
':. �....:. '::.�.: ....?:::::r:..::::„.:i .....:..::.......1:.Y.i?::.:: r..tn.„:.:.n.:::::::::::::.n.. .. ,.. ...:. :. .:.......... r. ..::
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.
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
OWNER'S & CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON•OWNED AUTOS
x
GARAGE LIABILITY
ANY AUTO
EXCESS UABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/
PARTNERSIEXECUTIVE
OFFICERS ARE:
OTHER
CRIME
EMPLOYEE THEFT
DEPOSIT/FORGERY
INCL
EXCL
POLICY NUMBER
CPS0620138
045978983
2003327964
21BDDAH7807
POLICY EFFECTIVE -
DATE IMMIDDIYY1
12/31/03
1 /07/04
1 1 /20/03
7/02/04
DESCRIPTION OP OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS
CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED/LOSS PAYEE
C1".RTi��;Ci
CITY OF MIAM1
444 S.W. 2nd AVENUE 2nd FLOOR
MIAMI, FL 33130
POLICY EXPIRATION
DATE (MM/DDIYYI
12/31/04
1/07/05
11 /20/04
7/02/05
LIMITS
GENERAL AGGREGATE
6
1000000
PRODUCTS - COMP/OP AGG
$
0
PERSONAL & ADV INJURY
6
0
EACH OCCURRENCE
4
500000
FIRE DAMAGE (Any ono rlre!
$
100000
MED EXP lAny one person!
4
1000
COMBINED SINGLE LIMIT
4
300000
BODILY INJURY
IPer person)
4
BODILY INJURY
IPer occident)
$
PROPERTY DAMAGE
6
AUTO ONLY - EA ACCIDENT
4
OTHER THAN AUTO ONLY
i;.,,,,
.,. . ',, .
%I1
EACH ACCIDENT
6
. AGGREGATE
4
,
EACH OCCURRENCE
6
AGGREGATE
6
"OTH-
WC STATUS
X TORY LIMITS ER
.................
.............
EL EACH ACCIDENT
$
500000
EL DISEASE • POLICY LIMIT
4
500000
EL DISEASE - EA EMPLOYEE
6
500000
LIMIT-$50,000/$500 DEDUCTIBLE
LIMIT-$50,000/$500 DEDUCTIBLE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KJg1D, UPON THF/\COMPANY. ITS AGENTS OR REPRESENTATIVES.