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,aco CERTIFICATE OF LIABILITY INSURANCE FDATE (MM/DDtYYYY) 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 endorsemen s). CONTACT PRODUCER NAME: Rebekah Wolf -_- . - - ---- --- --------__ Waldorff Insurance & Bonding PHONE FAX ac No Ext : 352 - 74 - 777 AIc No : 50 - 581 - 4930 5023 NW 8th Ave , Ste B E-MAIL Gainesville FL 32605 ADDRESS:T tionist@waldorffinsurancesc m INSURER(S) AFFORDING COVERAGE NAIC p INSURER A :Westf ield insurancem 4112 INSURED GOOD - 01 INSURER B :Bridaefield Employers Ins , CQ-.-- -- Goodson 4 . —Goodson Paving , Inc . INSURER C : mmerce & Industry InS , Co , 630 Cidco Road INSURER D : Cocoa FL 32926 - INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER : 143080704 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MWDD MMIDDM(YY A GENERAL LIABILITY Y 5626493 7 / 1 / 2011 / 1 / 2012 EACH OCCURRENCE $ 10000 , 000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1000000 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERALAGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER : PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 POLICY F PRO LOC $ A AUTOMOBILE LIABILITY CMM5626493 / 1 / 2011 / 1 / 2012 Ea accident $11000 , 000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY ( Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per accident X HIRED AUTOS X AUTOS A X UMBRELLA LIAB X , OCCUR Y CMM5626493 / 1 / 2011 / 1 / 2012 EACH OCCURRENCE $ 1 , 0000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 , 0000000 DED X RETENTION $ 0 $ g WORKERS COMPENSATION 830 - 28143 1 / 1 / 2011 / 1 / 2012 X TWCTH- IMT O R AND EMPLOYERS' LIABILITY _Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE. L. EACH ACCIDENT $ 500 , 000 OFFICER/MEMBER EXCLUDED? N / A - ( Mandatory in NH) ❑ E. L. DISEASE - EA EMPLOYE $ 500 , 000 Ifes, describe under - - - DESCRIPTION OF OPERATIONS below E . DISEASE - POLICY LIMIT $500 , 000 A Leased / Rented Equipment ZI 5626493 / 1 / 2011 1 / 1 / 2012 Equip Limit $ 500 , 000 C Pollution Liability FPL007510571 / 20 / 2011 S / 20 / 2012 Poll Ea Occur $ 1 , 000 , 000 Poll Aggregate $ 2 , 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required) Certificate Holder is listed as additional insured per terms of written contract . INDIAN RIVER COUNTY 1801 27TH STREET VERO BEACH , FL 32960 - 3388 Cancellation provision : 30 days notice of cancellation except for 10 days notice for non payment of premium . 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, 1801 27TH STREET VERO BEACH FL 32960 - 3388 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION . All rights reserved . ACORD 25 ( 2010/05) The ACORD name and logo are registered marks of ACORD