HomeMy WebLinkAboutExhibit 13ACORD CERTIFICATE OF LIABILITY INSURANCE
OP ID R
ACTIO-2
07/05/07
IDUCER
ante Insurance Agency, Inc.
90 West Flagler Street
ami FL 33144
lone:305-648-7070 Fax:305-648-7090
URED II I
Action Community Center Inc.
970 SW 1 Street #304
Miami FL 33130
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 #
INSURER A:
Associated Industries Ins. Co.
INSURER B:
Scottsdale Insurance Company
INSURER C: National Indemnity Co of South
INSURER D:
ITT Hartford Insurance Company
INSURER E:
)VERAGES
/NY
POLICIES.
R
fHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
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 I ti
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
KAUU'L
INSRC
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DDMf)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
CPS0811173
12/31/06
12/31/07
I
EACH OCCURRENCE
$ 5 0 0, 0 0 0
X
COMMERCIAL GENERAL LIABILITY
PREMSES(Eaoccurence)
$ 100,000 .
CLAIMS MADE f X OCCUR
MED EXP (Any one person)
$ 1, 000
PERSONAL B ADV INJURY
$ Included
GENERAL AGGREGATE
$ 1, 000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS • COMP/OP AGG
$ EXC luded
POLICY JECTn LOC
JE
1X
AUTOMOBILE LIABILITY
74APN311949
74APN311949
74APN311949
02/24/07
, 02/24/07
02/24/07
02/24/08
02/24/08
02/24/08
COMBINED SINGLE LIMIT
(Ea accident)
$ 5 0 0, 0 0 0
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED
NON -OWNED AUTOS
BODILY INJURY
(Per person)
5
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
ANY AUTO
I
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
'
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
S
OCCUR CLAIMS MADE
AGGREGATE
$
I
DEDUCTIBLE
RETENTION $
$
$
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
2006327964
11/20/06
11/20/07
X TORS ' LIMITS OER
E.L. EACH ACCIDENT
$ 500, 000
E.L. DISEASE - EA EMPLOYEE
$ 500, 000
E.L. DISEASE - POLICY LIMIT
$ 500000
B
OTHER
Personal Property
Business Income
CPS0811173
CPS0811173
12/31/06
12/31/06
12/31/07
12/31/07
1000 Ded $20,000
1000 Ded $30,000
)ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES l EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
5% Wind & Hail Deductible/ Location: 970 SW 1st St. #1304 Miami, F1 33172
D.BOND 21BDDAB7807 7/02/07-7/02/08 $100, 000 $500 DED
Department of CIP and Transp.
Office of City Manager
444 SW 2n? Ave 10th Floor
NOTICE TO THE CERTIFICATE HOLDER NAMED 70 THE LEFT, BUT FAILURE TO DO 50 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
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