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COI Expires 06/26/2013 �...40 GMSELBY -01 LRANDOLPH ACC :7R0* CERTIFICATE OF LIABILITY INSURANCE DATE (MM/D °^^' m) I 4/29/2013 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ' 'CONTACT NAME: Collinsworth, Alter, Fowler 8, French, LLC PHONE FAX 8000 Governors Square Blvd e n Lo. Ext): (305) 822 - 7800 (ac, No►: (305) 362 -2443 Suite 301 ADDRESS: _ Miami Lakes, FL 33016 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Phoenix Insurance Co 25623 INSURED -_ -- - - - - -- INSURER B : First Mercury Ins. Company _ 10657 G.M. Selby, Inc. INSURER C : 6999 N Waterway Drive INSURER D : Miami, FL 33155 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 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. POLICY EFF INSR _ -- -- - -- LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER {MM/DD/YYYY) LIMITS (MMIDDIYYYY LIMIT GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X - COMMERCIAL GENERAL LIABILITY X X6600C392014PHX12 6/26/2012 6/26/2013 PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) I $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE I $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG ' $ 2,000,000 PRO - POLICY X LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ _.- ANY AUTO a ' i • -1 • • �y I AGE BODILY INJURY (Per person) $ AUTOS AUTOSULED N A j - la ; BODILY INJURY (Per accident) $ ~ AUTOS • 1 ' d`� PROPERTY DAMAGE HIRED AUTOS $ I TOS (Per accident) $ UMBRELLA LIAB I CLAIMS -MADE' EACH OCCURRENCE I $ 1 . OCCUR 1 EXCESS LIAB AGGREGATE $ A f E RETENTION $ $ WORKERS COMPENSATION - - WC STATU- OTH- ; AND EMPLOYERS LIABILITY Y I N _ TORY LIMITS ER ' I ANY PROPRIETOR/PARTNER/EXECUTIVE z ' OFFICER/MEMBER EXCLUDED? J N / A E.L. EACH ACCIDENT - $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under -- - - DESCRIPTION OF OPERATIONS below . _ _ E.L. DISEASE - POLICY LIMIT ' $ _ 1 B 1 Prof Liab Claim Made FMFE101816 4/27/2013 4/27/2014 Each Claim /Aggregate 500,000 B ''Retro Date 4/27/1992 FMFE101816 4/27/2013 4/27/2014 ,@ Claim Retention 10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) (Certificate Holder shall be named Additional Insured if required by written contract. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of Comissioners Attn: Engineering Dept ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Key West, FL 33040 AUTHORIZED REPRESENTATIVE Cam' © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD