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INNOV- 12 - 2004 FRI 12 ' 43 PIS FAX NOr Pr 01 <br /> _ C _ ient # : 34319 WAIco <br /> AJ2 Moo CERTIFICATE 4F LIABILITY INSURANCES 11/12/04 <br /> PRCOUCER -! THIS CERTIFICATE IS ISS' JED AS A MATTER OF INFORMATION <br /> BrC �AIn & Brown , znc . - Melbcurne ONLY AND CONFERS t+ .0 RIGHTS UPON THE CERTIFICATE <br /> 6 7 5 7 �1 . W i. c k ham nc Suite 214 HOLDER . THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br /> Melbourne , IFLJ 32940 -- 2024z <br /> INSURER: E AFFORDING COVERAGE <br /> 321 757 - 8686 _ - <br /> NSJREo l INSURER A.' Amers sure Mutual Ins . Co . <br /> The Watauga Company INSURER B: <br /> 4275 Capron. Ro <:Ld INSURER C : <br /> Titus'Ville , 1432 ;E80 - 6554 INSJRERD <br /> INSURER E: ` <br /> COVERAGES <br /> THE PG_ IC! ES OF INSURANCE LIS-�D B .LOVJ HAVE BEEN ISSUED TO THE kIVSURED NAMED ABOVE FOR THE POLICY PEFIOD INDICATED . NCTWITHSTANDING <br /> ANY REQUIREMENT, TEEM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY <br />BE ISSUED OR <br /> MAY PERTAIN , 71 Hr= INSURANCE AFFORDED BY THE POLICIES DESCRIBED LEREIN IS SLEJECT TO A'_L THE TERMS , EXCLUSIONS AND CON' <br />D TIONS OF SUCH <br /> POLICIES A' _AC,GREG fF LIN. II S SHOWN MAY HAVE BEEN R_DUCED BY PNO CLAIMS. <br /> I `Tp PDLIGY ExFECTIVE ' POLICY EXPYRATI N LIMITS <br /> TYPE CFINSUIIANCE POLICY NUM9ER DATE/(I� M1D_.D/YYl SATE MM/DDN <br /> �, OENERALLIABILI , Y C I) 20109210 GO / <br /> / 01 / 04 06 01f 01 ) EAC- OCCURRENCE 1 $ 5001 C00 <br /> COM MEf1C1+1L CFN " TA'_ LIABILE'El� FFFE )AMAGE (Any one lire) $ 'j C r 000 <br /> CLAIMS MAI%E X OCCUR NED :XP (Any one person $ I Cr , 000 <br /> X ' P 0 I) ed : 2 C7 O PERSONAL & ADV INJURY <br /> $ 5.q 0 , P 0 0 <br /> j ' <br /> GENERAL AGGREGATE 1 $ 1 , 000 , OOC <br /> GEN 'L A3Gt4ECA1'L' LIM I'1 Af�PLi [ S PEFI ', 1 PRODUCTS - COMPIOP AGG $ 1 , 0 0 0 , .000 <br /> FFO • _ <br /> ���� <br /> A AUTOMOI LIAR11TV CA2 010 919 0 0 0 0 0 0 C6 / C11 / 04i06 / 01 / 05 cOM 3INED SINGLE LIMIT $ 50C 000 <br /> (Ea axidenl) <br /> X ANY AU I.0 <br /> ALL. OVJNF D AUT OS BOO LY INJUFY S <br /> SCHFOIJ0L) AUIOS (Pzrp rsanJ <br /> X 11IREDAUI'0S BOO LY INJURY S <br /> (Per ICC dent) <br /> X NON•OWNL.D AU roS <br /> jPROPERTY DAMAGE $ <br /> j - (Per accident , <br /> AUT) CNLY • EA. ACCIDENT S <br /> GARAGE LIABILITY , <br /> ANYAUTOOTHER THAN EA ACC $ <br /> AUTDONLY. AGG S <br /> A Excess uABIUTv�T CU2 010 9 2 3 0 6 / G l / 0 4 0 6 / 0110 5 A HocCURRENGE $ 2 , 000 , OGO <br /> OCCUI'i CLAIEhS MADE AGGREGATE 0 0 0 <br /> $ <br /> DEDUCTIBLE I i $" <br /> X ' RETENTION _ 110000 S <br /> +- WC STATU- OTH- <br /> WORKERS COMPENSATION AND - TORY LIMIT'S _ ! ER I . <br /> EMPLOYERS' LJA8ILITY E L EACH ACCIDENT � $ <br /> I E L. DISEASE - EA E=MPLOYEE+ $ <br /> E. L. DISEASE . PO_ ZYLIMIT 1 $ <br /> F, oTHEfi�C" or;mercl. al I. CPP20109210 C6 /T01 / 04 05 / 01 / 05 <br /> DESGRiPTIO,N OF CPERATIONS/LOCATIONSYEHIC, ES/EXOL'USIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> Certificate holde :c ie named as additional insured with regard to liability <br /> coverage ATIMA re : Project : Bld # 6085 , West Wa^ basso Park Pavilions <br /> CERTIFICATE HOLDER X i ADDITIONAL INSURED ; INSURERLETTER: CANCELLATION <br /> SH OULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> z. ss _ oners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO <br /> Board C7 County Comm ' <br /> DAYSWRITTEN <br /> 840 25t1: Street NOTICE70TH £ CERTIFICATEHO .DERNAAIEDTOTHELEFT, B 'JTFAILURETODOSOSHALL <br /> Vero Beach , FAL 32960 - 3365 Jjil POSE NO OBLIGATION OR LIABILITY OV ANY KND UPON TH E IkSUPER,ITS AGENTS OR <br /> HEPRESENTATIVES. <br /> Attn : G , Sean McGuire , P . E. AUTHORIZED REPR SENTA VE <br /> ACORD 25-S (7197) 1 (D f: 2 4112547 MC4 © ACORD CORPORATION 198E <br />