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AMCON - 1 OP ID : JR ,4`coRn CERTIFICATE OF LIABILITY INSURANCE DAT0712411D NWY) 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( les ) 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 321 -397-3870 NAME: Insurance By Ken Brown, Inc. 321 -397-3888 HONK, E,�); FAX No PO Box 948117 -- - Maitland , FL 32794-8117 E-MAIL David R. Griffiths ADDRESS: INSURER(S) AFFORDING COVERAGE "CA INSURER A : Amerisure Ins Company 19488 INSURED AM Construction Group, Inc . INSURERB : Amerisun_e Mutual Ins. Co23396 12689164th Court N -- Jupiter, FL 33478 INSURER C : INSURER D : 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. INR TYPE OF INSURANCE POLICY NUMBEIt SUBIT POIDDY EF (MMtDDffyyyl LILY EXP LIMITS LTR TYPE LIABILITY I EACH OCCURRENCE $ 1 ,000AO ADD 01 A COMMERCIAL GENERAL LIABILITY X 34413 06/24/12 06/24113 PREMISESErre $ 100900 CLAIMS-MADE I X OCCUR MED EXP (Any one person) $ 5,00 X CGL Ext endt PERSONAL & ADV INJURY $ 11000100 GENERAL AGGREGATE $ 21000,00 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGG $ 2 ,000100 17 POLICY X� PRO- F1 LOC Il $ AUTOMOBILE LIABILITY EaMBINED accident SINGLLI 1100010 00 A X ANY AUTO 34414 06124112 06/24/13 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS I X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident 'HI UMBRELLA UAB X OCCUR [ AACH OCCURRENCE $ 29000 ,00 B I X EXCESS LIAB CLAIMS-MADE 34415 06/24/12 06124J13 EGATE $ 2x00090 FFF---------111 DEC) X RETENTION $ 0 S WORKERS COMPENSATION T RY LSM T R AND EMPLOYERS' LIABILITY Y / N I ANY PROPRIETOR/PARTNER/EXECUTIVE N / A EL. EACH ACCIDENT _ $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL. DISEASE - EA EMPLOYE $ Ifyes, describe under I DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ i I i i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, If more space Is r"ulred) Indian River County BOCC is listed as additional insured as respects to General Liability per CG7048 03 / 04 per written contract . CERTIFICATE HOLDER CANCELLATION INDIANR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Indian River County BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS, 1801 27th Street Vero Beach , FL 32960 AUTHORIZED REPRESENTATIVE moo. 4de;R . © 1988-2010 ACORD CORPORATION . All rights reserved . ACORD 25 ( 2010/05) The ACORD name and logo are registered marks of ACORD