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{ ¢ I �C as 3 I 7 - I KI I1 1 � > .S < III . , OP ID : D3 CERTIFICATE OF LIABILITY INSURANCE DAT04/18D/Y1VY) arl sr12 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), PRODUCERCONTACT 954-776. 2222 NAME : Brown 8, Brown of Florida, Inc . 954-776 -4446 PHONE FA/C, No 1201 W Cypress Creek Rd # 130 IAfC• Nq€ nt__ _ __ _ _ __ __ __ _ . ....__ . ._ ____ ..1 ) P . O. Box 5727 E-MAIL Ft. Lauderdale, FL 33310 -6727 Aooggss __ _- - ee - - _ PRODUCER GUETT-3 Gerald J . Arch , CPCU , CIC c sroraEglo M_ W SURERtS) AFFORDING COVERAGE NAIC N — __.._. _. _. . . ._ INSURED Guettler Brothers Construction INSURER A : Amerisure Mutual Ins . Co . 23396 LLC _ � �--- - W SURER 8 : Benjamin G Guettler INSURER c : PO Box 12271 _ _ _ - - INSURER D I Fort Pierce , FL 34979 -2271 - -- - ---- - - I - --- - 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 . IN SR _._ _... . _ 0000-0000 --_ . -. __. AD(SLi3UBR 0000 _ _...._. _..0000_.___T..-POLICY EFF POLICY E%P LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDD(YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE J $ 1 ,000 , 00 _ - DAMAGE TO t: f0000— 0000 A X COMMERCIAL GENERAL LIABILITY GL2054501 06/02/11 06/30/12 PREMISES (Ea occurrence) tS 300 ,00 CLAIMS-MADE LiOCCUR MED EXP (Any one Person) f S 10100 PERSONALd ADV INJURY ! S I 1 ,000 , 00 & ADV N . . GENERAL AGGREGATE $ 2,000, 00 _. ---- — * — 0000 — -- GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG_ $ 21000100C POLICY i X PRO• LOC S AUTOMOBILE LIABILITY 4 COMBINED SINGLE LIMIT ( Eaacaeent ) S 1 , 000, 00 ANY AUTO - -- _._. .--- - ' -- BODILY INJURY ( Per person) S i . . .... ..._. _.__ . __ __ _ ALL OWNED AUTOS _ BODILY INJURY (Per accident) , S SCHEDULED AUTOS I PROPERTY DAMAGE A X y HIREDAUTOS I CA2054502 06/02/11 06/30/12 (Per accident) S A X NON-OWNEOAUTOS i CA2054502 06/02/11 06/30/12 S i S X UMBRELLA LIAB X OCCUR I � ' EACH OCCURRENCE S 5 000 , 00 EXCESS LIAB CL:JMS-MADE � AGGREGATE $ 51000j000 A 0000 _ : .. _ _ _.— __ _ _ CL12064503 06/02/11 06/30/12 -. T_ DEDUCTIBLE 5 X RETENTION $ 0 WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS' LIABILITY YIN ! - TORY_ LIMITS :._ Ei_:0000. ___ _ _ . . .. ANY PROPRIETOR/PARTNER/EXECUTIVE i E L. EACH ACCIDENT S OFFK;ERrMEMBER EXCLUDED � N / A ( Mandatory In NH ) i E L DISEASE - EA EMPLOYEE S I1 • es descrioe under _- DESCRIPTION OF OPERATIONS telo E L. DISEASE - PCLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required ) RE : IRC Bid# 2012032- 66th Avenue Roadway Improvements Phase 2 (4th Street to 16th Street) . Certificate holder Indian River County Is listed additional insured with respects to general liability if required by written contract. CERTIFICATE HOLDER CANCELLATION INDIAN / SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Indian River County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS , 1800 27th Street Vero Beach , FL 32960 AUTHORIZED REPRESENTATIVE © 1988 -2009 ACORD CORPORATION . All rights reserved . ACORD 25 ( 2009/09) The ACORD name and logo are registered marks of ACORD 14 J led, It: f� - le