Laserfiche WebLink
From . Tani Jacobson FaxlD : STUINS- FAX01 Page 2 of 2 Date 211612012 03 : 11 PM Page : 2 of 2 <br /> OP ID : TJ <br /> CERTIFICATE OF LIABILITY INSURANCE 02DATE 02/161116112 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( S) , AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER , AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy( les ) must be endorsed . If SUBROGATION IS WAIVED, subject <br /> to <br /> the terms and conditions of the policy, certain policies may require an endorsement . A statement on this certificate does not <br /> confer rights to the <br /> certificate holder in lieu of such endorsement (s). <br /> PRODUCERCONTACT <br /> 772m286=4334 <br /> Stuart Insurance , Inc. NAME ' <br /> 3070 S W Mapp 772 -286-9389 PHC rNo E : FAC No : <br /> Palm City , FL 34990 E -MAIL <br /> Rick Halcomb , CIC , ARM ADDRESS : <br /> PRO ICER <br /> CUSTOMER ID 1 : TIMOR- 1 <br /> INSURERS AFFORDING COVERAGE NAIC <br /> INSURED Timothy Rose INSURERA : Westfield Insurance 24112 <br /> Contracting , Inc . INSURER B : <br /> 1360 Old Dixie Hwy SW <br /> INSURER C <br /> Vero Beach , FL 32962 <br /> INSURER D <br /> INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER : REVISION NUMBER : <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE <br />POLICY PERIOD <br /> INDICATED , NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO <br /> ALL THE TERMS , <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES , LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . <br /> INSIR ALI SUBIR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE WVD POLICY NUMBER MMIDOrNYYI (MMIDDNYYYI LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 11000, 00 <br /> A X COMMERCIAL GENERAL LIABILITY X CMM6079889 06/06 /11 06 /06/12 DAMAGE TO RENT Eu� <br /> PREMISES Ea occurrence $ 100100 <br /> CLAIMSMADE 5XI OCCUR MED EXP ( Any one person ) $ 5900 <br /> X Contractual Liab PERSONAL & ADV INJURY $ 11000100 <br /> X Incl XCU GENERAL AGGREGATE $ 29000100 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2, 000, 00 <br /> 17 POLICY FX PJERCoi Ll <br /> LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $( Eaacciden1 , 000, 00 <br /> A X ANY AUTO CMM6079889 06/06/11 06/06/12 q _ _ <br /> BODILY INJURY ( Per person ) $ <br /> ALL OWNED AUTOS <br /> BODILY INJURY ( Per accident ) $ <br /> SCHEDULED AUTOS <br /> PROPERTY DAMAGE $ <br /> X HIRED AUTOS ( Per accident) <br /> X NON- OWNED AUTOS $ <br /> $ <br /> UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 31000, 00 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3, 000 , 00 <br /> A CMM6079889 06/06/11 06 /06/ 12 <br /> DEDUCTIBLE $ <br /> RETENTIONSTATI S <br /> WOPoT(ERS COMPENSATION WCRY LIMITS <br /> R <br /> 1 <br /> AND EMPLOYERS' LIABILITY YIN IMITEER <br /> ANY PROPRIETORIPARTNERIEXECUTIVEEl NIA E L EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandatory In NH) E L . DISEASE - EA EMPLOYEEI $ <br /> If as , describe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ <br /> A rontractors Equip CMM6079889 06/ 06 /11 06106/12 Rented 50100 <br /> Equipment $ 1000 de <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Ramart(a Schedule , if mon apace Is required) <br /> Grading of LandlSite Prep - State of Florida RE : 6th Ave SW Culvert <br /> Replacement, North of 23rd St sw Indian River County is additional insured <br /> or general liability <br /> CERTIFICATE HOLDER CANCELLATION <br /> IRCBC -1 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS . <br /> Indian River County <br /> Attn : Purchasing Division <br /> AUTHORIZED REPRESENTATIVE <br /> 27th Street <br /> Vero <br /> Vero Beach , FL 32960 <br /> O 1988-2009 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 ( 2009/09) The ACORD name and logo are registered marks of ACORD <br />