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HomeMy WebLinkAboutExhibit910/27/2004 1.3: 29 35415939718 PARAGON DENTAL rg,_3t. UL/ ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID IC2! oA'E r7 mature' XR71/461-3 10/25/04' ettOOVCER USi Florida - Plantation 8100 SW Tenth 9t=tet, W2000 Plantation II. 33324-321E1 Phone:954-474-9700 £ax:954-974-2101 THIS CERTIFICATELS ISSUED AS A MATTER OF IMFORMA77oN ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIf'ICATE DOES NOT AMEND. EXTEMD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE I...N1IED Paragon Benefits 9olutions,Inc 8751 W Broward Blvd1, R300 Plantation FL 33324 1,0S7EP A: Penn -America Insurance Co. Ir,c.cr_A Lexington Insurance Company VGTST'RC Zuzich rttS.PER (7 nMAzER E: .-v.crv..,•c.. 111E P0,10ES of Ti USTW OF.LOW NAVE'SEEN I!.. -SUED TO THE UNLUFEO MN.EO A¢C'.E FOP THE POLICY PED100 0,0ICATED. nOTV•ATK;TaN01NG Arlf AFfAARE14NT TEAT•.. OR Cpprnal CV "Ks Co rTRACT oq OTIEA masc.-, wm iEr SPE CT To wNICI•7HIS CERTIFICATE MAY BE LSS..EO OR ItAY rEERTAW, TTE wrStRANCE Of frY,OCO D' THC POLICIE: OE SCfi9ED KEEN IS SLA�ECT TO A.L Rif TEAMS. EXCLUSIONS AND CO•QrTI0`4 Cr S1A1 DOLICIES eOCOf LATE LWITS 9Y1 N ..A•I H.VE BEEN REO( jCZD eY PAID C1NI.6. I. TYPE OF Ir.ytIRANCE' POLICY 1•AMBEC rt1LR.T d. EL,t/t DATE 4. ulOcursI LA r U- r tP'••d.N . TIV DATE IH ,00r7Y) UMl'S A cSACR.AL jt L14B4.1rY CCI..'-ERCN riIO:RALILAM WI 1016453 09/OS/04 09/05/05, [ACM OCO..PvOICE 1 1, 0 0 0, 0 0 0 PIRfo....GElpryenike) i50.000 CI AMC L.4ce n 0':CW .•£U E7P (Ny en Dw--onl t 5 . 00 0 PERSPie& A Aov iMj Y :excluded "` WIN.. X1P.c.t GEfEsw,.uaECNE 12.000,000 AGGCEGATE LIMi APPLIES PER n,R� riLCC PROOLFTS • CMPMP AGG :excluded Avto•.o#ACLIAe1tm — �; MIN' AUTO All OWED AUTOS OCK OLLEO ALIT OS MRED AUTO$ ror. CMfED AUTOS COIBINEDSINCiEIIMIT IE• Aoode.A) 1 ecor i v' t,, i.•WA) 1 , BOOR7 INJURY ID.I .ca0�'Q 1 , FYIOPOr Y 0..4.043E IP., .d..d.111 t . CRA CE L 1.61Urr, ANY AUTO AUTO O11Y• EA ACCIDENT 1 F OT1EP TIIAR C AARO OrIY. K.; 1 E3CG5e 7 ~— L.Aaurr mac C) ClAefi...ADE oEOICTrBLE PETEMIO.1 1 EAO1 DC0RPEFCE 1 Ar3REr3ATE t t 1 1 r W OAHoq COroY 4 ATOM Ar.O BIPLOv1rc' LIABILITY WC )IxTlh N1H• I T00Y =.1 J EF I. E.L. EArr Acres 1 el- nrsnAsr- - EA EMPLOYEE 1 E.L. OIOEASE • D0.ICY U 4I 1 C D^ER Employee Theft CCP0059819 00 09/05/04 09/05/05 • CRIME 50,000 o% cn now Oft OrY3MTCM/LOCATKOVSA,E.CLE,.:A;�CLUSONT AOOEO BY ENDOR_0.0W irECIAL rROVIS101.1t J9) Lexington ins Co Policy #10761S3 Effective 09/05/04-05 Professional Liability 41,000,000 each claim, S1,000,000 aggregate. CERTOCATE HOLDER AOOMOtuL NSUR'ED: N1UR I LETTE : CANcEL1ATION DEPTOT? City of Miami 444 SW 2nd Avenue Miami, FL 33130 ACORD 25S (71477) ?+OKO ANT C.0 TIE ABOVE OGO ERRED POucIE; BE CANCEU,EV VEFORETE E7tP+RATION OA7F THte-tOEOF, TM r=oton MSURF.TI WLL ENDEAVOR TO NAIL 30 OAT= WRTr EN I.arTCE TO PE CETITFIGATE MOL DR' UEO TO rwo LEA'T, OUT FAILU IE TO DO 00:AU.LI IMPOSE NO OtLIGATION OA UAE 1Jrr OC ANY RIND WON TWE 4.1T1RER, 1TS ACFNTX OR REPREJRATNE3. RV rTESENTAINE IDACOR0 CORPORATION 1981 Client#: 51292 PARDE ACORDr. CERTIFICATE OF LIABILITY INSURANCE PRODUCER Jason T. Brown Bateman,Gordon & Sands, Inc P.O.Box 1270 Pompano Beach, FL 33061 INSURED DATE (MM/DO/YYYY) 12/01/04 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. INSURERS AFFORDING COVERAGE Paragon Dental Services, Inc. and Paragon Benefits Solutions, Inc. 8751 W. Broward Blvd, Suite #300 Fort Lauderdale, FL 33324 INSURER A. Zurich American Insurance NAIC # INSURER B: INSURER C: INSURER D; INSURER E. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR LTR ADD NSRC L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMlODIYY) POLICY EXPIRATION IY DATE (MMIDDY) LIMITS A Y GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY PAS40485493 05/14104 05/14/05 EACH OCCURRENCE 51,000,000 DAMAGE RENTED PREMISES IOEE occv rrencel S1 ,000,000 S 1 0,000 jCLAIMS MADE f xj OCCUR BI/PD Ded:250 MED EXP (Any one person) X GENII_ PERSONAL b ADV INJURY S1,000,000 $2,000,000 S2,000,000 GENERAL AGGREGATE AGGREGATE LIMIT APPLIES PER: POLICY JECT I I PRO j—( LOC PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A'Q4� 1 Tl J O. yYJ V. / 7 I//4 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident)) S PROPERTY DAMAGE (Per accident) b GARAGE LIABILITY ANY AUTO *J/ AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY; AGG $ EXCESS/UMBRELLA 7 LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUOED7 It yes. describe under SPECIAL PROVISIONS below TORY I NITS1 ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT_ $ OTHER DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Holder captioned below is an additional insured for general liability coverages only as their interest may appear for the work performed by the insured. CERTIFICATE HOLDER CANCELLATION City of Miami 444 SW 2 Avenue, Miami, FL 33130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL sn DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #147832 LH 0 ACORD CORPORATION 1988 Client#: 1043084 PARAGSLN ACORD- E T JF CATE OF LIABILITY INSURANCE : -73J4 --- 1(alnirr, D�rrf 11(t12/04 c,inFr:rr "THIS CERTIFICATE IS ISSUED .AS A MATTER OF INFORMATION Insul:allce of Florid :;olri erciai Lines 310E SW 10t11 ,treet, Sulite 2000 Jlantation, FL 33324-3218 hsUREL' Paragon Benefits SclLliiut-is Inc Paragon Dental Services Inc 8751 W i3rcward Blvd, #300 Plantation, FL 33324 ;OVERAGES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE IxsunCRA Lexington Insurance Company roar rt 19437 IN .k••L h: Fidelity & Deposit Co r,suhEH C: It LIRER r INEUPER E. it .E POLICIES OF INSURANCE LISTED BELCJVHAVE BEEN'SCUED TO THE IN.SURFD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNMITHSTAIg,ING ,ANY RES1UIRLMENT• TERM CR. CCNDf lICN OP -ANY CONTRACT OR DINER COCUMENT Wit H RE(iPECT TO OMICh T}IIS CERTIFICATE MAY BE ISSLED OR MA'( PEN: AIN. THE INsuk/ r cE AFFCRDED BY THE POLICIES OESCR:BED HEREIN ;S SUBJECT -MALL THE TERMS. EXCLUSIONS AND CCNDITIONS OF SUCH PCUCIES. AGGREGATE LIMITS SHOW.' MAY HAVE BEEN REDUCED BY PAJD CLAIMS. 1SP..IODU ,R. N; TYPE OFSNSURA NCE POLICY NUMBER FOLICY EFFECTP/fd I DATE IMht/DOrv'n POLICY EXP'RATION OA`EIMAI/00NYYI LIMITS GENERAL - L IABIU7Y i:('.Ill I?c:AL •�_t.:Ei' AL 1.:,bLl r' _: ':I A.IM rAh7E. I JC.CIIR EACH VC::LK`(FNC r:E no cover LIRE•WIiF. 1r_a mIEU IT['.rtI.�LS( ac.rrvur!�n::�1 •FIIO cover j?=n EXF(.1,/,Hx�lr,ywi) ,,,no cover :'Gl5ON/,L i ADV INJURY .ono cover ! cN:nAL AGGREGATE Y.no cover _ •_hN'L AUG RLiiA ":.:L1CY L E UMIT ki-i-tI ESTER . J n -o:' PROXCT S. CON1140,A(.;_ in0 cover no cover Alf --. _ _ —1 --' OIAOGILE LIABILITY 4FIY AUTO AL.OM)ED ALrfOS f I ,S':.'liLl1U 7 Alfl _ s H4ti:Lt AU! (IS NGN-C• A.NE D ALMS' a T'.f7� fi9Yk'.L �.�� °V /// I -- al'" COME:Nei_• S1NCLEUMi i (CJ-uuaclerN) E110 cover o DLY N.IUfC'r .. ersm) $n0 cover SOD LY NUBBY (Pe- Ic.ciden0 i n0 Cover PRO=FRTY )'+RIA GF (F's• aceienp `r10 cover GARAGE LIABILITY ANY .ore AIJ"DON-Y • FA ACCIOE,Nr : no cover 07Hti THAV EA aCr, ?no cover AUOON_Y ,1 ,O gr o cover EXCESSIUMSRELLA _ LIABILITY OCCUR CtAMsMADE UI-UUC11ELE RIFTENIInN 5 CACTI OCCUP.R icc ,Eno cover AGGREGATE Eno cover xno cover sno cover Ono cover WOAKERS COMPENSATION ND EMPLOYERS' LIABILITY ANY PHT_,I''RIETOR.I'AR. NERJMx»:LITIVE OFFICER/1.1EM5EE EXCLUDED? .{ if yes rJ.: Sr.1,�Yt Uncer :l,FC'I.AI. PROVISIONS 'row VA' ZIT KW- TORY'IIp9"S PR E._. E.4;.H.4•_.GUEPT tn0 Lover ...DstAs�-EAFrv'LVYtE Tnocover E:... U SEASE-1'`'•LICY UN! E n0 cover A B °THE ProfL4ab Employee Theft 1076991 CCP005981901 09/05/04 9/5/04 09/05/05 9/5/05 $1,000,000 $50,000 )ESCRIP DON OF OPERATIONS 1 LOCATIONS 1 VEHICLES! EXCLUSIONS ADDED UY ENDORSEMENT 1 SPECIAL PROVISIONS ftf4S CERTIFICATE VIODS AND SUPERCEEDS ALL PRIOR CERTIFICATES 1,000 deductible applies to loss due to employee theft. '15,000 deductible applies to loss due to professional liability 'Except 10 Days notice )f cancellation for non-payment. ;ERTIFICATE HOLDER CANCELLATION City of Miami Risk Management 444 SW 2nd Ave. - gill floor Miami, FL 33130 SHOULD ANY OF THE LtaoYE UESCRIBEO POLICIES GE CANCELLED BEFORE THE EXPIRA TIC DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL _3 1 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SWELL IMPOSE NO OBLIGATION OR LIABILTY OF ANY KIND UPON THE INSI:P.EK, ITS A:iEN'FS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE • 1CORD 25 (2001/58) 1 oi2 #tS294276/M294263 NO1J-1=0-E0E14 1=13: 32PM FAX :R i •af-I sFs>; KARER e ACORD CORPORATION 11 ID: Pi1C-;E: EEC^ R 92% Client#: 106064 PARAGBEN ACORD,.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DO/YYYY) 12/01/04 PRODUCER USI Insurance of Florida Commercial Lines 8100 SW 10th Street, Suite 2000 Plantation, FL 33324-3218 INSURED Paragon Dental Services, Inc. 8751 W Broward Blvd, #300 Plantation, FL 33324 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. Transportation Casualty Insurance Co INSURER B: 24619 INSURER C: INSURER 0; INSURER E: COVERAGES COVERAGES AS OF 12/01/04 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADO'L NSRC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMM/0D/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S POLICY n PRO- JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ A ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) S VED Q PROPERTY DAMAGE �a°i� v«ly 121 (Per accident) S GARAGE LIABILITY OM AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S J AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1 OCCUR , CLAIMS MADE AGGREGATE S $ 1 DEDUCTIBLE S RETENTION $ S A WORKERS COMPENSATION AND WC07059143 11/30/04 11/30/05 )( STATU• TORORY LIMITS OTH- FR EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1 OO,000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE • EA EMPLOYEE $500,000 If yes, describe under SPECIAL PROVISIONS below - E.L. DISEASE - POLICY LIMIT _S 1 00,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS "Except 10 days notice of cancellation for non-payment. CERTIFICATE HOLDER CANCELLATION City of Miami Attn: Frank Gomez 444 S.W. 2nd Ave Risk Management - 9th Floor Miami, FL 33130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL in'r DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #301389 KARER © ACORD CORPORATION 1988