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ACO� ® CERT F CATE {, app. L ABOp ITY � NS ,q {� � Co. DATE (MMIDDIYYYY) va fel 1k� 81 @ Y !9 � &'� U �I +hoE 5 / 11 ! 2011 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: Ann Watters Brown & Brown of Brevard PHONE ( 321 ) 757 - 8686 FAx (A1C No Ext)- , {AIC. No): ( 321 ) 757 - 8687 7341 Office Park Place E-MAIL ADL)RESS: awatters@bbbrevard . com Suite 202A PRODUCER () 0001815 Melbourne FL 32940 CU INSURED INSURERS AFFORDING COVERAGE NAIC # INSURER A :ST Paul Fire & Marine 4767 INSURER a :The Phoenix Insurance Co , 5 623 Data Flow Systems , Inc . INSURERC :Phoenix Insurance Com an 025623 605 N . John Rodes Blvd . INSURER0 ,14orth River Insurance Com an Melbourne FL 32934 INSURER E — INSURER F : COVERAGES CERTIFICATE NUPIBER .-CZ111309002 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 . INSR ODL U LTR TYPE OF INSURANCE iN R D POLICY NUMBER POLICY EFF POLICY EXP '- 1 MMIDDIYYYY MMIDDIYYYY LIMITS 1 GENERAL LIABILITY ' I EACH OCCURRENCE S 11000 , 000 F7X COMMERCIAL GENERAL LIABILITY f AMA E TO REN ESI D �� I PREMISES Ea occurrence I S 250 , 000 A CLAIMS-MADE I x I OCCUR E05801078 x /1 /2011 !1 / 1 /2012 MED EXP (Any one person) S 10 , 000 PERSONAL 8 ADV INJURY I S 1 , 000 , 000 GENERAL AGGREGATE � S 2 , 000 , 000 I GEN'L AGGREGATE LIMIT APPLIES PER: , --� —� PRODUCTS - COMPIOP AGG I $ 2 , 000 , OOO XCf 1 POLICY 5 ( PRO I I LOC S AUTOMOBILE LIABILITY ( ( f COMBINED SINGLE LIMIT i X ( ANY AUTO j j i (Ea accident) ( S 1 , OQO , 000 I 1428X849 / 1 /2012 BODILY INJURY (Per person) S B ALL OWNED AUTOS 1 / 1 /2011 SCHEDULED AUTOS I ' BODILY INJURY (Per accident) S PROPERTY DAMAGE i HIRED AUTOS ' (Per accident) $ NON OWNED AUTOS-- � uninsttmtd mr!'nrist sI-single s 500 , 000 I PIP-Basic S 10 , 000 X UMBRELLA LIAB HOCCUR i EACH OCCURRENCE 5 31000 , 000 EXCESS LIABCLAIMS.MADE ` III AGGREGATE S 3 , 000 , 000 DEDUCTIBLE i A XX7 RETENTION S 0 frEO5801078 1 / 1 /2011 1 / 1 /2012 C S I WORKERS COMPENSATION IWC STATU- O'- WCEMPLOYERS' LIABILITY Y / N ORY L1N1 �_ ANY PROPRIETORIPARTNERIEXECUTIVE j OFFICER/MEMBER EXCLUDED? F N ! A 1 E. L. EACH ACCIDENT 5 1 , OOO OOO I ( Mandatory In NH) IUB I1 /1 /2011 11 / 1 /2012 E. L. DISEASE - EA EMPLOYE $ 1 000 000 If Yes, describe under I ,_ DESCRIPTION OF OPERATIONS below I 1 I E. L DISEASE - POLICY LIMIT S 1 000 000 ; Errors & Omissions 1 1924 -206604 - 6 10/01 /2010 0/01/2011 D I I 0/01/20111 Limit $ 1 , 000 , 000 I Decutible $ 10 ( 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Indian River County ACCORDANCE WITH THE POLICY PROVISIONS. 1800 27th Street Vero Beach , FL 32960 AUTHORIZED REPRESENTATIVE Paul Corbley/ANN ACORD 00 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved . INS025 (2oosos) The ACORD name and logo are registered marks of ACORD