HomeMy WebLinkAboutInsuranceACORND_ CERTIFIC/ _ OF LIABILITY INSURA. :E
Pa000CER
Insource, Inc.
9500 South Dadaland Blvd. ,#200
P.O. Box 561567
Miami FL 33256-1567
Pnona:305-670-6111 Fax:305-670-9699
INSURED
DATE ,(1416/00erYT�'
12/17 02
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.
OP 1D SG
MANZ-1
INSURERS AFFORDING COVERAGE
NAIL
My Plater-Lyberk i Co., Inc
a DPZ & Co. & Decumanus,
laOW 25 e 33135nue
INSURER A. Assurance Caapany of Americas
rNSURER a Twin City Fire Insurance Co.
INSURER C.
19305
29459
INSURER 0
INSURER E
COVERAGES
THE PLIICIES OF INSURANCE LISTED BELOW HAVE BEEN r5SUED TO THE INSURED NAMED ABOVE %OR THE POLICY PERIOD INOICATEO NOTWITHSTANDING
ANY REQUIREMENT TERM OR CONDITION OF ANY C0N7RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
NAY PERTAIN THE INSURANCE AFFORDED BY THE P0.1CIE5 DESCR(SED HEREIN 15 SUBJECT 70 ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 31. PAID CLANS.
LTV M/eR17 TYPE Of INSURANCE
POLICY NUMBER
POUC,EFFECTIVEsYOG
(aYn�
EXPIRATION
OATE(af$DO/Y1
UMTfS
A
X
GENERAL
UABIUTY
COMMERCIAL OENERAL LIABLITY
PA824213853
12/18/02
12/18/03
EACH OCCURRENCE
s 20D0000
X
LIAMACalENItis
PR9MIISE5(Ea ccarence1
s2000000
IC_AIMS MADE 7 OCCUR
ME..) EXP (Any one xrson)
$10000
PERSONA. £ OVIKJURY
�S 2000000
GENERAL AGGREGATE
54000000
GENt
7
AGGREGATE LfM(TAPPLIES PER
PROOUCTS • COMP/OP AGG
54000000
POUC, PRC>•
n JECT n LGC
AUTO
MOBILE UA8IUTY
ANY AUTO
ALL OWNED AUTOS
SCHEDLXED ALTOS
HIRED AUTOS
NON -OWNED ALTOS
PA924213853
12/18/02
12/18/03
CC.lBINED 5INCA ELI IT s 1000000
(Esec,oer:)
x
80C/LY IN.J uR':
IPer oersad
X (
BODILY INJURY
+P e: suee lc)
X I
PR OI.ERTY DAMAGE
;Per acad... NI
GARAGE
UABILT,
ANY AUTO
AUTO ONLY • EA ACC:DENT , S
OTHER THAN EA ACC 5
I�
AUTO ONLY AGO I S
A.
IX
EXCESS/UMBRELLA UABIUTY
PA824213853
12/18/02
12/18/03
EACH OCCURRa4CE S 4000000
occ.:R 1 c.A(.WSMADE
AGGREGATE s 4000000
OEDUCT(8LE
RETENTION S 0
s
II1
S
X I
i s
B
%YORKERS OOMPENSATDN ANO
EMPLOYERS' UABIuTY
ANY ?R OPRIET OR.P ARTNER ECJTM1E
0.FICERNia,ABER EXOWDE•C'
/tP EcIo?L PROVISIescnuntiONe/ SW.Iwr
S
211®.D177465
10/01/02
WC STA fU- CTH-,
X TORY OATS ER ,
10/01/03
EL EAC)-ACC'OENT ! s 1000000
E.L. DISEASE - EA EMPLOYEE s 1000000
El. DISEASE- POLICYLAST iS1000000
OTHER
RATIONS 1 LOCATIONS I VEHICLES/ EXCLUSIONS AOOEO BY ENOORSHAENT I SPECIAL PROV134OH3
Certificate holder is included as additional insured with respects to
general liability reference Projects 2002 through 2004. +30 days notice on
workers ooaRp.
CERTIFICATE HOLDER
CANCELLATION
QTDQA
City of Ki.s si Bldg Loainq
Dept.
444 SW 2nd Avenue
Miami, FL 33130
SHOULD ANT Of The ArC(Vt OOdreeD POUoe* ee CAACEL Lzo arm TN! EXPORATKR
DATE THEREIOr, THE ISSUING INSURER WILL ENDEAVOR TO MALL. 10 * OATS WRITTEN
NOTICE TO TSE CERTIFlCATE HOLDER NAMED TO THE LET. BUT PAJLURE TO 00 S0 SHALL
IMPOSE NO OAUGATION OR LIABILITY Or ANY NNO UPON THE INSURER. ITS AGENTS OR
R EPREIENTTAATT1VPJ. /-�
ALI7 1pp�E ►RfS E NTO7/
ACORO 25 (2001/011)
0 ACORD CORPORATION 19S
4.
1 _ ... _ '.
..::,: U 03/07/03
rRC ucim
Collinsworth, Aher, Nielson,
Fowler & bowling,lnc,(WMC/OIA)
Tin CT.R1V1CATE 13 2s MD AS . ITER Or 12,713 MA-110N ONLY AM)
ols NO MGa s taor+ TrM CSRITPICATE EOL DEL 1 Is CI3DDICATE
DCE! NOT AKIXD. ETIEND OQ ALTTE TINS COvEE.AGE AnOoDED DY Tux
?Out= snow
.
5979 NW 151 Street, Suits 105
COMPANIES AFFORDING COVERAGE
Miami Lakes, FL 33014
COMPANY
um* A Lexington Insurance Company
COpar_semi* la
Owny Plater-Zyberk &Co.
OMEPANY
LITTER C
Attn: Tony Lopez
1023 S.W. 25th Ave.
COKrANY
LYTTEt D
Miami FL 33135�
COka
-mai E TO CERTIFY THAT THY mums at SPISUKADICL LIS.TEE 1*LOW HAVE IIIID4 LSSUED TO 1TLE DBNSLD :TAMED MOVE TOR TaE TOUCY PEEIOO
D'mEtwlTEa. NOTNTTarrANLDDIG ANY asQLmm1®rr, Mato* COI D DON OF ANY CON TRACT OR maxi DOCZ1►t WITS RESPECT Tb Willa! Tra
�t CATE
MAT SE LESUCD OR MAY PERTAIN, TRS Db'CDAeO A son= tY THE POL ICZL3 DESCRLiED =LLEW IS SUBJEXT TO ALL TEE TERMS,
$XCL71s oas
AND CONDm0rs Of sum POt2CtiL. MEM MUMrN MAY aim IETN REDVCW l7 PAID CLAIMS.
CO
1 TR
E TrrIt Or 1r6TRANCL
POLICY mip4BEIL
[Vl.]CY En.
DATE 004.foR ry)
POLICY E7'D•.
DAZE COd/DD/YY)
S II �T3
L LEAifJLy
GeramAL AGGREGATE
;.-
C01 1. Clo ERAL LLUIDSIY
IRODCDHPf0t AGO.
f1
, CLAIMS MADE UOCC.
rEas. l ADV. 9 aURY
• p
VAN(ES'S R CON'SEACT•Sracer
iACa OCCVERIT =
i
ME DAMAGZlOn lie/
i 4
_ Mita ECP (Our Pan
IFTOMODIII I.LAIRSTY
t
ANY AUTO
co.1mC6a StYGIS
LAM•
•
Ail. OWNED ALTOS
SCIPEDULED AUTOS
IODILY DLTL'RY
(Per pvsre)
ice
1
ILDLPD AL`TO6
Non -Ow D AUTOS
-
BOOM/ LYJi,RY
(ltr Amid.t)
1
GARAGE LL :MITT
PEOPTirr DAHACE
_
RECL S LiAIOiTY
EACa OCC1RRivCE
•
INE E2LA PORM
!RAN
AGGl2twTE
rOTBER
G1m'RELTA PORN
J.
wca ots COMTFMAITOil
i
1sTArt,TORY LDUTs
s _ ;
RACH ACCD)ENT
Alfa
• 4 xhat.Ontri CLiiLITY
DISGSLTOLKY Lutz
►._�
orsEA E•EACA CMP.
A
f rofessionai
inability
SJairns-made form
0319774`
9/12/02
9/12/03
$ 1,000,000 ea claim
$2.000,000 agg
04101/80 Retrodate
• cE.scRwrION Or oPELarrONS'LoCA71oPliNIIDCI_TSISPEC &L IMO
I
.. ._ .., _g. I .. ,. F.. .. �.. - - Y.
•
.t
SMOULD ANY or TES AIMTII DCfC7UE= POLICIES BE CANCELLED WOGS TICL
t1Q41IA7TON DATE TIIEACOP. THY ISSCINC COMPANY WILL L`m€AYOR TO
MAIL '3{) DAYS WRITTEN NOTICE TO TEE CIRTDLCATE HOLDER !WEED TO MS
City of Miami
Planning & Zoning Qapt.
444 SW 2nd Avenue - 3rd F1
LXPT, RUT FAILURE TO MALL SLCa NOTTCII MALL DLPOSI NO OBLIGATION oe
uAEL err OP ANY MN) UPON TEC COMPANY, ITS AGENTS 09. 7¢PREsEw/ATlvis
Miami, FL 33130
a
AUTHORIZED
f // i ,# ,/ % , "/
.
... , .. s y a -:ail
TOTAL P.02