HomeMy WebLinkAboutExhibit 28Contr. ' # 506-193
Attachment I:
The C�
it 's Insurance Requirements for
Provider with
Provider's
Insurance Certificates
Rin RrntherS Big Sisters PSA.doc
P • 2
03 200G 3:31PM
3/20/2006 10; 0 ATL
C
�_, TYPE OF INSURANCE
(�,`� GENERAL weitrry
■ COMMERCIALGENERALLIABLLITY
111 CLA<TIS MADE OCCUR
----------
---,-------
GENT AL30REGATE LIMIT APPLIESPER-
III POLICY . MC'■ LOC
ry
Oe1T,E LMEILITY
AUTO
L pWM4ED ALTOS
NEOULEOAUT09
RED AUTOS
CN.DWNEO AUTOS
GARAGE LI/ALMMY
ANY AUTO
FRCEaS MAMMY
OCCUR CLAIMS Naos
DEDUCTIBLE
PI ION
Bmama'OMPEENS COMPENSATION AND
orNER CRIME
HP LASERJET 3200
APR
PROM: SGP 214.449.3999 Summit Global Partners TO: 9,130564963
BIG I
28 0BATEIr Yf
AC.QRD CERTIFICATE OF LIABILITY' INSURANCE 0312015
USIISGP of Florida Inc.-CG ICL
201 Alhambra Circle Suite 1000
Miami, FL 33134
305 689-5000
INSURED
Big Brothers & Big Sisters
of Greater Miami
701 SW 27 Ave Ste 600
Miami, FL 331354024
SAGE: 002 op 003
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE 00ES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED SY THE POLICIES eELOw.
INSURERS AFFORDING COVERAGE
1NBURERA: Progressive
INSURER B. TwinC
INSURER C: St
INSURER D:
INSURER E;
COVERAGEST
ASCIVE FOR THE POLICY
ATED NOTWITHSTANDING
ANY POLICIES OF T, TERM 5TfiD BELOW N }MA SEEN ISSUED TO THE OTHER
HEREIN UM SUBJECT it D E ALL THE TERMS' THIIOD S
CERTIFICATE
MAY IS OF OR
ANY REQUIREMENT, TERM OR CONDITION OF ,ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE SE ISSUED OR
MAYUCH
pERTANV, THE INSURANCE AFFORDED BY 'I �E POLICES DESCRIBED
POLICIES AGGREGATE LIMITS SOWN MAY HAVE! EEN REDUCED BY PAID CLAIMS.
OLICY sA MPER
CA023757142
2iWEEV2 13
406CH2951,
11112105
11112108
01104108 01104107
0610804 06/08107
DESCRIPTION OF IF
Certificate Hold Tis Additional nsured se riepecte General LiabHIC LIIXC WI 'DNS ADDED BY ility L PRDVISIDNs
ty as
required by wrIlten contract
C RTIFICAT NO D
e
nVNAL
CITY OF MIAMI, OFFICE OF THE
MAYOR
3500 PAN AMERICAN DRIVE
MIAMI, FL 33133
INeuRE L C LAT
LIMITS
EACH OCCURRENCE
FIRE DAMAGE One Ere
MED DIP [Any one • rem)
PERSONAL. & ADV INJURY
GENERAL AGGREGATE
PRODUCTS • COMPfOP AGO
COMBINED SINGLE LIMIT
LE■ occlder j
BODILY WURY
(Per pmwnl
BODILY INJURY
IPer Au:trlen1)
PROPERLY DAMAGE
(Po sasowiI
AUTO ONLY • EAACC, DENT
EA ACC
AGO
OTHER THAN
A 0 ONLY:
AGGREGATE
S
6
1
6
$1,000,000
1
a
1
s
3
1
1
500 000
e.L.DISEASE •EAEMPLOYEE $300000
E.L. DISEASE • PcXIGY LIMIT 500 000
$60,00D EMPL DISHONESTY
$80,000 FORGERY
MOULD ANY OF THEABOVE DESGR1ONDFC ORSBOCANCELLED eEFME TheENFPLoN
WRITTEN
DATE THEREOF, THE mumsINIRJRER WLL. ENDEAVOR T'O MA1L�.
NOTICE TO THE CERRFICATF NaDERNAN TDTNELEFT,BUT FAILURE 1 Q*3O SHALL. ENT 6OR
IM PURE NO DE LIGATION OR MAR !LIT' OF ANY ORD V PCN TH E I MIRE R,
ITS REPRESENTATRIES•
171771165
UTHORIZED REPRESENTATWE
AGENT OF RECQRQ SCUEv m ACORD CORPORATION 1965
L,.
ACORD 25.3 {7j97j1 of 2 #542T5651N1120445
P • 3
APR 03 2006 3:31PM HP LASERJET 3E00
ent By: Jphn 1. Kirby 8 Associate) Inc. ; 904 387 9270;
CERTIFICATIIE OF LIABILITY INSURANCE
ORPII,
Apr-3-08 4138PM; Page 2!2
PIIODOcat
John L. Kirby a Assoc i*tea
4196 Herschel Streit
d4CX1011Vl110 FL 32210-2240
Phone004-387-9798 Pax1904-381-9270
itaimiG
81 SroLh ss Big aistel•1 oT
Qqxx star ami
7SaiSWe2 h Avenue
0
Miami FL 33135
pppp�� DATE IMAMIOoITYYYI
MIAMI- 11. 00/03/G6
THIS CERTIFICATE 15I85UED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE ROES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED 4Y THE POLICIES RELOW.
INSURERS AFFORDtNO COVERAO!
INSURER A: sl.Ic■ ;IAMr%ont!. Co.
INSURER E.
INSURER Dl
INSuf%ER E:
COVERAGES
•IHEPOl1GlFSOFINSuMNriIIVIED 6ELOWNAVE SEER II UFO 1VTHE !NM ERFr NAMEDAIOV& FOR Tilt Mum,'rCR140INDICATCO,Nor W1lHJTANDINU
ANY NEOUIREMENT. TERM DR CONDITION or ANY CONTMI' r OR OTHER DOCUMENT WITI I RESPECT 10 WHICH 1'Hi6 CE6T6I(ft IT[ MAY 06 IRei IwLI OR
NAY rEll•AIN, TM FN9lIkANCe Arrofoin eV THE 001.11:Ik:i ileaCR116n HEREIN re RIrpJEC1 TO ALL THE'I CRME. EXCLUSIONS ANR CON1M1'ICN8 OF SUCH
P0LICIF.,b. AG01lClGATG LIMIT6 SHOWN MAY HAT, SECN AEI it rj) 6Y PAID CLAwti.
+LTA Ni TYPE OF INSU ANCE '• POLICY NUMNR
A X
0IMEMAL LMeIL11Y
X 1 CONMCnCoL. SC. NeHALLiAD11.ITY
CLAIMS MADE A. OCCUR
OENLAGARFI+AIF. LIMITAPPL16S PEN'
POI.Irr n SECT ILOC
AUTI MOEILILIASILITY
ANY AIIT(I
ALL mice Nee AUT08
SCHEDut6O Aurni
X HIRED AOTUI.
X IioN-OwNEOAWTOS
02-LIi.9291254.1
01/01/D6 01/01/07
EACHUCCIIRRENCE WAITE$ 1 0001000
OE TTTRL•'RTD
PliCMIigt (FH Esoorra f • •
MCD E11P (MYOA' D11Wnj
PERSONAL 6 ADV INS 11HY
L; ./T.AL AGCMFOAIL
PRODUCTS - COM1lA]P AOG
02-CA •3193013-1
OARAGE UARILITV
ANY AUTO
111CISSiumeULLA LIA$ILITT
JsacUR L 1 rA.AIMSMAOE
I OF.OUc+TOLE
RETFNTwN S
WORMER§ COMPENSATION aNp
EMPLOYERS' LSAEILITT
orriCERIME1�1gTF'H unar.ryll/PARTNEREA[CLITIVF, E �l Comilla Ilr
1p'(;IAL PRO SIUNb LEW*
OTHER
01/O1/06 01/01/07
s 1 9.LiHr
65,000
11112121000
LU00020
21,000,0D0
COMOINFr AINCILE LINT j i 1,000 , 000
1E111.70M111 j{
BODILY INJURY •• E
(Per 63I lan1
RO)DLY INJURY
rwrrAMArm
PROPERTY DAMAGE
IPa1 EKC dM d)
AL1TS1 ONLY • to ACCIDENTt
f°TWATI•IAN EA ACC 1
AuinONLY: AGO
EACH0L•CLJRRLNCE S
•AOG1CGATE .E
t.L. E"ACIl ACCI'EN r ,
F I MSF.ASE•EACAAPLOYEI:
C.L. DIEEARF. • PLkl4Y LIMIT
E
S
E
DE$CR1PfC$ OF OPERATIONS I I.0CATION11 VENIO1 ES ! TJICLUN ONE A=DEO EV ENDD#6emENT! 41P0CIAL PiLOVISI0P16 • .
Additional Tosuredr City of Miami as rsspacts to garlorsl liability
Funding Grantor.
CERTIFICATE HOLDER
City o! 1Eiami
Office of tha Mayor
3500 Pen American Drive
Miami FL 13333
ACORD 25 (2001101)
as
CANceLLATION
SHOULD ANY OF 0141 A1l0VE 6E1GRISED rDUCEE3 NE CANCEIXEO GENRE Da (EPIRATIDN
DATE THEREOF tHeiE31ANOINSURER VALLENOEAMOR TO MAIL 30, ,- GAYS WRITTEN
NOTICE TO ThE CER1ILCAYG I10LbER NAMED TO THE LEFT, Sur FAILURE TO DD 60 SMALL
IMPOSE MO OIILIGATION DR LiAUIILTY OF Airy HIND UPON THE IMSURAK ITS AGENTS OR
RRPRE$ENTATNIR•
AUTNOWAD Wog; nvi
John LOr
IT ' ORD EORRORATION 1841
1