HomeMy WebLinkAboutCertificate of Liability Insurance 2DATE IMMIDDTYY)
10/06/04
aODUCER ...... ..............
SEITLIN
305-591-0090
2001 NW 107 AVE., SUITE 200
MIAMI, FL 33172
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.
COMPANY
A.
COMPANIES AFFORDING COVERAGE
Scottsdale Insurance Company
4SURED
Action Community Center Inc.
Attn: Maria P. Albo
970 SW 1st Street, Ste 304
Miami FL 33130
COMPANY
B
Progressive Insurance Co.
COMPANY
C
Associated Industries
COMPANY
• D
Hartford Fire Ins. Co.
a. •
rt .•,.....:.�......1.... �. r,:, ..., ::.......;.:.; ..... ..a,s:: ::•:: ., .>:: ,•,,. :.....,,t<ox•e,::;.:,:•:.,.•,•.;x:::.r. •:.. o
1:V:n��.:i:.�:.v.:w}.i..v:..rn:.::...::r•.,:::t�::,•..::::f:...:v....:....: 1...,.::.:.: �...n...v ..
THIS 4S 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.
CO
.TR
A
B
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
lqin CLAIMS MADE I "' 1 OCCUR
OWNER'S & CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
X SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
C
0
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' UABIUTY
THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
CRIME
EMPLOYEE THEFT
DEPOSIT/FORGERY
INCL
EXCL
POLICY NUMBER
• CPS0620138
04597898 3
2003327964
21BDDAH7807
°POLICY EFFECTIVE -
DATE IMMIDDIYYI
12/31/03
1/07/04
1 1 /20/03
' 7/02/04
DESCRIPTION OF OPERATIONS!LOCATIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED/LOSS PAYEE
GE1~tT F=1CAfE.:Hl1�........ g::.:Wa:<:;:::.<•;s:
CITY OF MIAMI
444 S.W. 2nd AVENUE 2nd FLOOR
MIAMI, FL 33130
POLICY EXPIRATION
DATE IMIVI/DD(YY)
12/31 /04
1/07/05
3'f
1 1 /20/04
7/02/05
LIMITS
GENERAL AGGREGATE
0 1000000
PRODUCTS - COMP/OP AGG
1 0
PERSONAL & ADV INJURY
$ 0
1
EACH OCCURRENCE
1 500000
FIRE DAMAGE IAny one Tire!
$ 100000
MED EXP IAny one person,
$ 1000
COMBINED SINGLE LIMIT
5 300000
BODILY INJURY
IPer person)
• •
BODILY INJURY
IPer accident)
•
L
PROPERTY DAMAGE
•
AUTO ONLY • EA ACCIDENT
$
OTHER THAN AUTO ONLY: ':<$;Jr:
E' i •: i:sic i-i,:.
EACH ACCIDENT
$
AGGREGATE
$
EACH OCCURRENCE
4
AGGREGATE
$
VX
,;.'
TORY A IJ 1OER -
'`u�iia:::`::`ti i:;i`ii '<',:;:!:''=.;•` ?i;i
EL EACH ACCIDENT -
$ 500000
EL DISEASE - POLICY LIMIT
$ 500000
EL. DISEASE - EA EMPLOYEE
$ 500000
LIMIT-S50,000/5500 DEDUCTIBLE
LIMIT-$50,000/$500 DEDUCTIBLE
'its•: ".::;:i
'ci'�.�'<'....... :i:�':�:?'' �?fir:::;:"' .:.•. r;.x...., ...:..,
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 KNIIOI UDN THrn COMPANY, ITS AGENTS OR REPRESENTATIVES.
iR > [TRWORATlOf?1