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2010-148
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2010-148
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Last modified
2/18/2016 11:40:06 AM
Creation date
10/1/2015 2:18:43 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/15/2010
Control Number
2010-148
Agenda Item Number
8.E.
Entity Name
Andrew Thomas with A. Thomas Construction, Inc.
Subject
Gifford Community Center Repairs
Bid Number
2010045
Supplemental fields
SmeadsoftID
9710
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CERTIFIGATE OF LIABILITY INSURAvXE OP ID SH 1 <br /> DATE (MM/DD/YYY`0 <br /> 06 1, 7 / 10 <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 /> TA T: the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed . tf 9"MffRGATION IS WAIVED, subject to <br /> the terms and conditions of the policy , certain policies may require an endorsement A statement on this certificate does not confer rights <br /> to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAME: <br /> Post Insurance b Financial Inc 11aaIcc'� ac, No): <br /> Katherine E . Post —E-lofAlL1� <br /> 146 NW Central Park Plaza , 102 ADDRESS: <br /> Port St . Lucie FL 34986 CUSTOMER ID p: ATHOM- 1 <br /> Phone : 772 - 878 - 8184 Fax : 772 - 878 - 8292 INSURER(S) AFFORDINGCOVERAGE NAIC0 <br /> INSURED INSURERA : Fla Citrus , Business 6 Zndustr <br /> A Thomas Construction Inc INSURER B : <br /> PO Box 3285 <br /> Fort Pierce FL 34948 INSURER C : <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 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 ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INTSR — ADDE R TYPE OF INSURANCE INSR POLICY NUMBER (MWDDIYYYY) (MM/DD/1'YYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE b <br /> COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ <br /> CLAIMS-MADE OCCUR MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S <br /> 1-7 POLICY PRO- $ <br /> LOC <br /> JECT <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY (Per person) S <br /> ALL OWNED AUTOS BODILY INJURY (Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE $ <br /> HIRED AUTOS (Per accident) <br /> E <br /> NON-OWNED AUTOS <br /> S <br /> UMBRELLA LIAB HOCCUR EACH OCCURRENCE 5 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> 5 <br /> DEDUCTIBLE <br /> S <br /> RETENTION E <br /> A WORKERS COMPENSATION 10642180 04 � O1J10 04 / 01 / 11 X TORY LIMITS ER <br /> AND EMPLOYERS' LIABILITY Y I N <br /> E. L. EACH ACCIDENT $ 1000000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE❑ <br /> / A <br /> OFFICERIMEMBEREXCLUDED? <br /> (Mandatory in NH) E. L. DISEASE - EA EMPLOYE $ 1000000 <br /> If Yes, describe under E. L. DISEASE - POLICY LIMIT $ 1000000 <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHK:LES (Attach ACORD 101 , Additional Remarks Schedule, H more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> INDIA- 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Indian River County AUTHORIZED REPRESENTATIVE <br /> Purchasing Division <br /> 1800 27th St Katherine Post <br /> ,Vero Beach FL 32960 <br /> © 1988-2009 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 (2009/09 ) The ACORD name and logo are registered marks of ACORD <br />
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